title: Induction chemotherapy followed by surgery for advanced oesophageal cancer.
abstract: BACKGROUND
  Patients with locoregionally advanced oesophageal tumours or disputable distant metastases are referred for induction chemotherapy with the aim to downstage the tumour before an oesophagectomy is considered.
  
  
  METHODS
  Patients who underwent induction chemotherapy between January 2005 and December 2012 were identified from an institutional database. Treatment plan was discussed in the multidisciplinary team. Response to chemotherapy was assessed by CT. Survival was calculated using the Kaplan Meier method. Uni- and multivariable analyses were performed to identify prognostic factors for survival.
  
  
  RESULTS
  In total 124 patients received induction chemotherapy mainly for locoregionally advanced disease (n = 80). Surgery was withheld in 35 patients because of progressive disease (n = 16) and persistent unresectability (n = 19). The median overall survival of this group was 13 months (IQR: 8-19). The remaining 89 patients underwent surgery of which 13 still had unresectable tumour or distant metastases. Of the 76 patients that underwent an oesophagectomy, 50 patients had tumour free resection margins (66%) with an estimated 5-year survival of 37%. A positive resection margin (HR 4.148, 95% CI 2.298-7.488, p < 0.0001) was associated with a worse survival in univariable analysis, but only pathological lymph node status with increasing hazard ratio's (6.283-10.283, p = 0.001) remained significant after multivariable analysis.
  
  
  CONCLUSIONS
  Induction chemotherapy downstages the tumour and facilitates a radical oesophagectomy in patients with advanced oesophageal cancer. Pathological lymph node status is an independent prognostic factor for overall survival.
authors.affiliation: Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. Electronic address: e.toxopeus@erasmusmc.nl.
authors.forename: E L A
authors.initials: EL
authors.lastname: Toxopeus
authors.affiliation: Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Talman
authors.affiliation: Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: van der Gaast
authors.affiliation: Department of Gastroenterology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: V M C W
authors.initials: VM
authors.lastname: Spaander
authors.affiliation: Department of Radiation Oncology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: van Rij
authors.affiliation: Department of Radiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: N C
authors.initials: NC
authors.lastname: Krak
authors.affiliation: Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Biermann
authors.affiliation: Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: H W
authors.initials: HW
authors.lastname: Tilanus
authors.affiliation: Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: R H J
authors.initials: RH
authors.lastname: Mathijssen
authors.affiliation: Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: J J B
authors.initials: JJ
authors.lastname: van Lanschot
authors.affiliation: Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: B P L
authors.initials: BP
authors.lastname: Wijnhoven
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D018365:Neoplasm, Residual; D012074:Remission Induction; D012189:Retrospective Studies; D047368:Tumor Burden
keywords: Advanced oesophageal cancer; Induction chemotherapy; Prognosis; Surgery