Chemotherapy vs Observation in Postoperative Gastroesophageal Cancer

10/02/17

A recent study compared the effects of adjuvant chemotherapy and observation after preoperative chemoradiation and resection in gastroesophageal cancer, published in JAMA Oncology (online September 21, 2017; doi:10.1001/jamaoncol.2017.2805).

Distant recurrence is common in patients with gastroesophageal adenocarcinoma following preoperative chemoradiotherapy. Adjuvant chemotherapy may improve survival in patients with recurrence, but the effects of this therapy are not well researched.

Ali A Mokdad, MD, MS, division of surgical oncology, department of surgery, University of Texas Southwestern Medical Center (Dallas, TX), and colleagues conducted a study to compared adjuvant chemotherapy with postoperative observation following preoperative chemoradiation and surgery in patients with gastroesophageal adenocarcinoma. Researchers used a propensity score-matched analysis with data from 10,086 patients in the National Cancer Data Base diagnosed with gastroesophageal cancer from 2006-2013. All patients were treated with preoperative chemoradiation and curative-intent resection, and patients receiving adjuvant chemotherapy (n = 732) were matched to patients undergoing postoperative observation (n = 3660).

The primary outcome was overall survival (OS).

Results of the analysis showed that adjuvant chemotherapy was associated with improved OS compared with postoperative observation (median survival, 40 months; 95% CI, 36-46 months vs 34 months; 95% CI, 32-35 months; respectively). After 1, 3, and 5 years, OS was significantly higher in the adjuvant chemotherapy group (94%, 54%, and 38%) than in the observation group (88%, 47%, and 34%).

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Additionally, researchers reported that adjuvant chemotherapy was associated with an improved survival benefit compared with postoperative observation in multiple patient subgroups.

Researchers concluded that adjuvant chemotherapy is an effective treatment option for patients with gastroesophageal adenocarcinoma preoperatively treated with chemoradiation and resection. “Our findings have important implications for the postoperative treatment of this patient group for which few data are available,” they wrote.—Zachary Bessette