title: Perioperative chemotherapy versus neoadjuvant chemoradiotherapy for esophageal or GEJ adenocarcinoma: A propensity score-matched analysis comparing toxicity, pathologic outcome, and survival.
abstract: OBJECTIVE
  To evaluate toxicity, pathologic outcome, and survival after perioperative chemotherapy (pCT) compared to neoadjuvant chemoradiotherapy (nCRT) followed by surgery for patients with resectable esophageal or gastroesophageal junction (GEJ) adenocarcinoma.
  
  
  METHODS
  Consecutive patients with resectable esophageal or GEJ adenocarcinoma who underwent pCT (epirubicin, cisplatin, and capecitabine) or nCRT (paclitaxel, carboplatin, and 41.4 Gy) followed by surgery in a tertiary referral center in the Netherlands were compared. Propensity score matching was applied to create comparable groups.
  
  
  RESULTS
  Of 193 eligible patients, 21 were discarded after propensity score matching; 86 and 86 patients who underwent pCT and nCRT, respectively, remained. Grade ≥3 thromboembolic events occurred only in the pCT group (19% vs. 0%, P < 0.001), whereas grade ≥3 leukopenia occurred more frequently in the nCRT group (14% vs. 4%, P = 0.015). No significant differences regarding postoperative morbidity and mortality were found. Pathologic complete response was more frequently observed with nCRT (18% vs. 11%, P < 0.001), without significantly improving radicality rates (95% vs. 89%, P = 0.149). Both strategies resulted in comparable 3-year progression-free survival (pCT vs. nCRT: 46% vs. 55%, P = 0.344) and overall survival rates (49% vs. 50%, P = 0.934). At 3-year follow-up, fewer locoregional disease progression occurred in the nCRT group (19% vs. 37%, P = 0.024).
  
  
  CONCLUSIONS
  Compared to perioperative chemotherapy, neoadjuvant chemoradiotherapy achieves higher pathologic response rates and a lower risk of locoregional disease progression, without improving survival.
authors.affiliation: Department of Surgery, University Medical Center, Utrecht, The Netherlands.|Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Lucas
authors.identifier: http://orcid.org/0000-0001-5824-8736
authors.initials: L
authors.lastname: Goense
authors.affiliation: Department of Surgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: van der Sluis
authors.affiliation: Department of Surgery, University Medical Center, Utrecht, The Netherlands.|Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Peter S N
authors.initials: PSN
authors.lastname: van Rossum
authors.affiliation: Department of Surgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: Sylvia
authors.initials: S
authors.lastname: van der Horst
authors.affiliation: Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Meijer
authors.affiliation: Department of Medical Oncology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Nadia
authors.initials: N
authors.lastname: Haj Mohammad
authors.affiliation: Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: van Vulpen
authors.affiliation: Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Stella
authors.initials: S
authors.lastname: Mook
authors.affiliation: Department of Surgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: Jelle P
authors.initials: JP
authors.lastname: Ruurda
authors.affiliation: Department of Surgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: van Hillegersberg
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D000069287:Capecitabine / Q000008:administration & dosage; D016190:Carboplatin / Q000008:administration & dosage; D059248:Chemoradiotherapy / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage; D003967:Diarrhea / Q000209:etiology; D018450:Disease Progression; D015251:Epirubicin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000628:therapy*; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007970:Leukopenia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009426:Netherlands / Q000453:epidemiology; D017239:Paclitaxel / Q000008:administration & dosage; D057216:Propensity Score; D013923:Thromboembolism / Q000209:etiology
chemical_list: D015251:Epirubicin; D000069287:Capecitabine; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin
keywords: capecitabin; carboplatin; chemoradiotherapy; chemotherapy; cisplatin; epirubicin; esophageal adenocarcinoma; esophagectomy; gastroesophageal junction adenocarcinoma; paclitaxel; radiotherapy