Perioperative Complications after Neoadjuvant Chemoradiation for Locally-Advanced Esophageal Cancer: A Comparison of Platinum/5-FU and Carboplatin/Paclitaxel.

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Presentation transcript:

Perioperative Complications after Neoadjuvant Chemoradiation for Locally-Advanced Esophageal Cancer: A Comparison of Platinum/5-FU and Carboplatin/Paclitaxel Abigail T. Berman1; Andrew R. Barsky2; Rosemarie Mick3; James M. Metz1; Edgar Ben-Josef1; Ursina Teitelbaum4; Noel Williams5; John C. Kucharczuk5; David J. Margolis3; John P. Plastaras1 1Department of Radiation Oncology 2Perelman School of Medicine 3Clinical Center for Biostatistics and Epidemiology 5Division of Hematology/Oncology, Department of Medicine 5Division of Thoracic Surgery, Department of Surgery Perelman School of Medicine; University of Pennsylvania, Philadelphia, PA, USA

The optimal chemotherapy regimen is not clearly defined. Introduction Standard treatment paradigm for locally-advanced esophageal cancer (LAEC)” trimodality therapy, with neoadjuvant chemoradiation (nCRT) followed by surgery The optimal chemotherapy regimen is not clearly defined. CALGB 9781: nCRT with cis-platinum and 5-FU (PF) improved the 5-year OS by 23% over surgery alone The recent CROSS trial showed a median overall survival (OS) benefit of 49.4 vs 20 mos for nCRT with carboplatin-paclitaxel (PT) versus surgery alone Postoperative morbidity and mortality is highly clinically- significant, with rates of 50-60% and 0-15%, respectively In the absence of randomized data of PF versus PT, we sought out to investigate if there are any significant differences in the perioperative morbidity of PF vs PT for nCRT prior to esophagectomy.

Methods Retrospective cohort design with subjects as LAEC patients diagnosed between July 2008 and October 2013 Perioperative complications were defined as: pulmonary (pneumonia, ARDS, pulmonary effusion, respiratory insufficiency) cardiac (atrial fibrillation or arrhythmia, myocardial infarction, heart failure) GI (anastamotic leak, ileus, fistula, J- tube complications) hospital readmission to reflect composite toxicity Significant secular trend for PT vs PF use across years from 2008-2013

Results Median follow-up was 24 months. PT PF n=48 n=52 Age (y) Median 65 Range 46-78 16-78 Gender Male 41 (85) 45 (87) Female 7 (15) 7 (13) Race Caucasian 46 (96) 47 (90) Black 2 (4) 3 (6) Asian Initial ECOG PS 0-1 47 (98) 50 (96) 2 1 (2) Smoking History Never 9 (19) 18 (35) Former 36 (75) 30 (57) Current 4 (8) Clinical Stage II 23 (48) 19 (37) III 27 (52) IV 6 (12) Histologic Type Adenocarcinoma 45 (94) 48 (92) Squamous cell carcinoma Location Middle Distal/GE junction Type of Surgery Transhiatal Esopahgectomy 24 (50) 38 (73) Ivor-Lewis Procedure 14 (27) Median RT Dose 50.4 (50.4-54) (45.4-59.4) End RT to Surgery (d) 52 45 (29-390) (29-101) Median follow-up was 24 months. No significant differences between groups in baseline characteristics pCR rate: 24% PF vs. 25% PT, p=0.91

Results % for PF % for PT PF vs. PT Odds Ratio (OR) % for PF % for PT PF vs. PT Odds Ratio (OR) Confidence Interval Readmission 42 22 2.42 1.01-5.79 Pulmonary Complications 29 37 0.72 0.31-1.66 Cardiac Complications 34 33 1.06 0.46-2.4G5 GI Complications 52 46 1.28 0.58-2.83

Conclusion and Discussion