Leu Martin, Mahler Hannes, Reinecke Johanna, König Ute Margarethe, Dröge Leif Hendrik, Guhlich Manuel, Steuber Benjamin, Grade Marian, Ghadimi Michael, Ellenrieder Volker, Rieken Stefan, König Alexander Otto
Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, 37075 Gottingen, Germany.
Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, 37075 Gottingen, Germany.
Cancers (Basel). 2025 Aug 6;17(15):2587. doi: 10.3390/cancers17152587.
BACKGROUND/OBJECTIVES: Neoadjuvant radiochemotherapy and perioperative chemotherapy are both well-established treatment strategies for locally advanced adenocarcinoma of the esophagus (EAC) and the esophagogastric junction (AEGJ). However, recent knowledge controversially discusses whether neoadjuvant radiotherapy or perioperative chemotherapy represents superior therapeutic options to prolong survival or cause less toxicity.
We retrospectively analyzed 76 patients with locally advanced EAC or AEGJ treated at our tertiary cancer center between January 2015 and March 2023. Patients received either perioperative FLOT chemotherapy (n = 36) or neoadjuvant radiochemotherapy following the CROSS protocol (n = 40), followed by surgical resection and standardized follow-up. We compared survival outcomes, toxicity profiles, treatment compliance, and surgical results between the two groups.
There were no statistically significant differences between FLOT and CROSS treatments in five-year loco-regional controls (LRC: 61.5% vs. 68.6%; = 0.81), progression-free survival (PFS: 33.9% vs. 42.8%; = 0.82), overall survival (OS: 60.2% vs. 63.4%; = 0.91), or distant controls (DC: 42.1% vs. 56.5%; = 0.39). High-grade hematologic toxicities did not significantly differ between groups ( > 0.05). Treatment compliance was lower in the FLOT group, with 50% (18/36) not completing all the planned chemotherapy cycles, compared to 17.5% (7/40) in the CROSS group. All the patients in the CROSS group received the full radiotherapy dose. Surgical outcomes and post-surgical tumor status were comparable between the groups.
Although perioperative chemotherapy with FLOT has recently become a standard of care for locally advanced EAC and AEGJ, neoadjuvant radiochemotherapy per the CROSS protocol remains a well-tolerated alternative. In appropriately selected patients, both approaches yield comparable oncological outcomes.
背景/目的：新辅助放化疗和围手术期化疗都是局部晚期食管癌（EAC）和食管胃交界腺癌（AEGJ）既定的治疗策略。然而，最近的研究对新辅助放疗或围手术期化疗是否是延长生存期或降低毒性的更优治疗选择存在争议。
我们回顾性分析了2015年1月至2023年3月在我们三级癌症中心接受治疗的76例局部晚期EAC或AEGJ患者。患者接受围手术期FLOT化疗（n = 36）或遵循CROSS方案的新辅助放化疗（n = 40），随后进行手术切除和标准化随访。我们比较了两组之间的生存结果、毒性特征、治疗依从性和手术结果。
FLOT组和CROSS组在五年局部区域控制率（LRC：61.5%对68.6%；P = 0.81）、无进展生存期（PFS：33.9%对42.8%；P = 0.82）、总生存期（OS：60.2%对63.4%；P = 0.91）或远处控制率（DC：42.1%对56.5%；P = 0.39）方面无统计学显著差异。两组之间高级别血液学毒性无显著差异（P>0.05）。FLOT组的治疗依从性较低，50%（18/36）未完成所有计划的化疗周期，而CROSS组为17.5%（7/40）。CROSS组的所有患者均接受了全量放疗。两组之间的手术结果和术后肿瘤状态相当。
尽管围手术期FLOT化疗最近已成为局部晚期EAC和AEGJ的标准治疗方法，但遵循CROSS方案的新辅助放化疗仍是耐受性良好的替代方案。在适当选择的患者中，两种方法产生的肿瘤学结果相当。
