title: The role of adjuvant platinum-based chemotherapy in esophagogastric cancer patients who received neoadjuvant chemotherapy prior to definitive surgery.
abstract: OBJECTIVE
  For patients with operable esophagogastric cancer, peri-operative chemotherapy confers a significant overall survival benefit compared to surgery alone, however only 30-40% of patients demonstrate histopathological response. It is unclear whether those with no neoadjuvant chemotherapy response should go onto receive adjuvant chemotherapy, as no further benefit may be conferred.
  
  
  METHODS
  Esophagogastric cancers were prospectively captured with associated histopathological tumor regression grades following neoadjuvant chemotherapy. This cohort was then interrogated for clinico-pathological and survival outcomes.
  
  
  RESULTS
  Following neoadjuvant chemotherapy and surgery, patients with chemotherapy responsive cancers, who were administered adjuvant chemotherapy gained a significant overall survival benefit. Multivariate Cox analysis, demonstrated a final adjusted hazard ratio for adjuvant therapy of 0.509; (95%CI 0.28-0.93); P = 0.028. In contrast, patients with non-responsive tumors, who underwent adjuvant chemotherapy, did not show any survival benefit. Chemotherapy toxicity was prevalent and contributed to only half of patients receiving adjuvant chemotherapy.
  
  
  CONCLUSIONS
  These results suggest the benefit of the adjuvant portion of chemotherapy is limited to those who demonstrate a histopathological response to neoadjuvant chemotherapy. The administration of the adjuvant portion of chemotherapy to patients without a response to neoadjuvant chemotherapy may not provide any survival benefit, while potentially causing increased morbidity.
authors.affiliation: Department of Upper GI Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.|Cancer Biology Unit, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
authors.forename: John H
authors.identifier: http://orcid.org/0000-0003-0383-3676
authors.initials: JH
authors.lastname: Saunders
authors.affiliation: Department of Upper GI Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Bowman
authors.affiliation: Department of Upper GI Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
authors.forename: Alex M
authors.initials: AM
authors.lastname: Reece-Smith
authors.affiliation: Cancer Biology Unit, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Vincent
authors.initials: V
authors.lastname: Pang
authors.affiliation: Cancer Biology Unit, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Dorrington
authors.affiliation: Department of Upper GI Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
authors.forename: Errum
authors.initials: E
authors.lastname: Mumtaz
authors.affiliation: Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
authors.forename: Irshad
authors.initials: I
authors.lastname: Soomro
authors.affiliation: Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
authors.forename: Philip
authors.initials: P
authors.lastname: Kaye
authors.affiliation: Academic Unit of Oncology, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Madhusudan
authors.affiliation: Department of Upper GI Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.|Cancer Biology Unit, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Simon L
authors.initials: SL
authors.lastname: Parsons
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D000069287:Capecitabine / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D015251:Epirubicin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D015251:Epirubicin; D000069287:Capecitabine; D002945:Cisplatin; D005472:Fluorouracil
keywords: chemo-resistance; chemotherapy; drug toxicity; esophagogastric cancer; tumor regression