title: Influence of Different Neoadjuvant Chemotherapy Regimens on Response, Prognosis, and Complication Rate in Patients with Esophagogastric Adenocarcinoma.
abstract: BACKGROUND
  Perioperative chemotherapy improves survival in patients with advanced esophagogastric cancer, but the optimal treatment regimen remains unclear. More intensive chemotherapy may improve outcome, but also increase toxicity and complications.
  
  
  METHODS
  A total of 843 patients were included in this retrospective study and stratified in 4 groups: doublet therapy with cisplatin or oxaliplatin and 5-fluorouracil (groups A/B) or triplet therapy with additional epirubicin or taxane (groups C/D). The influence of the different neoadjuvant chemotherapy regimens on response, prognosis, and complications was assessed.
  
  
  RESULTS
  Clinical and pathological response were associated with longer overall survival (OS; p < 0.001). No significant differences regarding response or OS were found, but there was a trend toward better outcome in group D (taxane-containing triplet). In the subgroup of 669 patients with adenocarcinomas of the esophagogastric junction (AEG), patients who had received taxane-containing regimens had a significantly longer OS (p = 0.037), but taxane use was not an independent factor in multivariate analysis. Triple therapy with taxanes did not result in a higher complication rate or postoperative mortality.
  
  
  CONCLUSIONS
  Although no superior neoadjuvant chemotherapy regimen was identified for patients with esophagogastric adenocarcinoma, taxane-containing regimens should be further investigated in randomized trials, especially in patients with AEG tumors.
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Springfeld
authors.affiliation: Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Wiecha
authors.affiliation: Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Romy
authors.initials: R
authors.lastname: Kunzmann
authors.affiliation: Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Heger
authors.affiliation: Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Wilko
authors.initials: W
authors.lastname: Weichert
authors.affiliation: Institute for Pathology, University of Bern, Bern, Switzerland.
authors.forename: Rupert
authors.initials: R
authors.lastname: Langer
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Stange
authors.affiliation: Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Blank
authors.affiliation: Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Leila
authors.initials: L
authors.lastname: Sisic
authors.affiliation: Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmidt
authors.affiliation: University Cancer Center Leipzig, Leipzig, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Lordick
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Jäger
authors.affiliation: Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Grenacher
authors.affiliation: Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Tom
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.affiliation: Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany. katja.ott@ro-med.de.|Klinik für Allgemein-, Gefäß-, und Thoraxchirurgie, RoMed Klinikum Rosenheim, Rosenheim, Germany. katja.ott@ro-med.de.
authors.forename: Katja
authors.initials: K
authors.lastname: Ott
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D015251:Epirubicin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D009944:Organoplatinum Compounds; D043823:Taxoids; D000077150:Oxaliplatin; D015251:Epirubicin; D002945:Cisplatin; D005472:Fluorouracil