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Perioperative FLOT chemotherapy for locally advanced esophageal adenocarcinoma: from ESOPEC to daily practice-a
Andreas Bouckaert1,2, Filip Van Herpe3, Johnny Moons1,2
1Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
Background:
Two neoadjuvant treatment strategies exist for esophageal and gastro-esophageal junction (GEJ) adenocarcinoma: Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) chemoradiotherapy or peri-operative FLOT chemotherapy (5-fluorouracil, leucovorin, oxaliplatin, docetaxel). ESOPEC showed improved overall survival (OS) after FLOT. This study aimed to reassess OS after perioperative FLOT and surgery in real-life.
Methods:
This single center retrospective cohort study included all patients with locally advanced esophageal or GEJ adenocarcinoma (cT1/2N+ or cT3/4N0/+) treated with intended perioperative FLOT and surgery between 2017 and 2023. Primary endpoint was OS.
Results:
One-hundred forty-four patients were included with mostly high T-stages [cT3 (n=120, 83.3%), cT4 (n=14, 9.7%)] and node-positive tumors [cN1 (n=37, 25.7%), cN2 (n=60, 41.7%), cN3 (n=19, 13.2%)]. Nineteen patients (13.2%) didn't proceed to surgery (PRE), and 19 patients (15.2%) did not receive any postoperative FLOT (PRE-SURG). Finally, 96 (76.8%) started postoperative FLOT (PRE-SURG-POST). Median OS was 53.3 months and after stratification 12.9 months [95% confidence interval (CI): 11.1-14.7] for PRE and 13.0 months (95% CI: 5.6-20.5) for PRE-SURG. Median OS for PRE-SURG-POST was not reached but significantly higher (P<0.001). Median event-free survival (EFS) was 29.6 months for PRE-SURG-POST, compared with 12.4 months (95% CI: 8.8-15.9) for PRE-SURG (P=0.06) and 7.7 months (95% CI: 1.0-14.4) for PRE (P<0.0001).
Conclusions:
Our results, with predominantly advanced and node positive tumors, corroborate the OS and EFS of perioperative FLOT with surgery observed in the FLOT-4 and ESOPEC-trial. Completion of treatment was associated with improved OS and EFS. This emphasizes the importance of patient selection, high-quality surgery and supportive care to maximize treatment continuation and increasing survival.
