Induction chemotherapy in Barrett cancer: influence on surgical risk and outcome.
OBJECTIVE
To study the impact of induction chemotherapy on surgical risk and outcome in locally advanced Barrett cancer.


BACKGROUND
Induction chemotherapy has become an accepted choice for the treatment of locally advanced adenocarcinoma of the esophagus and the esophagogastric junction. It has been shown that early assessment of metabolic response using positron emission tomography predicts response to chemotherapy. Metabolic response has also been revealed to be an independent prognostic factor.


METHODS
Surgical risk and outcome in metabolic responders were compared with those in nonresponders. The study design predefined a 12-week multicourse preoperative chemotherapy regimen in metabolic responders. In contrast, chemotherapy was stopped after a 2-week induction period in metabolic nonresponders. All patients were scheduled for surgical resection.


RESULTS
Of 110 evaluable patients, 50 metabolic responders and 54 nonresponders underwent resection. Postoperative complications occurred in 34%. Two patients (1.8%) died. There were no significant differences between responders and nonresponders in terms of postoperative morbidity and mortality. Major histologic remissions were seen in 58% of metabolic responders. Metabolic responders had an increased chance of having an R0 resection (96% vs. 74%; P=0.002) and a decreased risk of developing hematogenous or distant lymphatic recurrence (32% vs. 54%, P=0.019). This translated into better recurrence-free and overall survival.


CONCLUSIONS
Induction chemotherapy and early metabolic response assessment is a new concept in the treatment of locally advanced Barrett cancer. Metabolic responders undergoing multicourse preoperative chemotherapy have a good prognosis. The best treatment strategy for nonresponders remains to be defined.
Siewert
Joerg R
JR
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Lordick
Florian
F
Ott
Katja
K
Stein
Hubert J
HJ
Weber
Wolfgang A
WA
Becker
Karen
K
Peschel
Christian
C
Fink
Ulrich
U
Schwaiger
Markus
M
D000230:Adenocarcinoma / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D049268:Positron-Emission Tomography; D011183:Postoperative Complications; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012074:Remission Induction; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18