Adenocarcinoma of the oesophagus: neoadjuvant chemoradiation and
· Holger Göbel
· Bernhard Leibl
· Thomas Aigner
· Gerhard G. Grabenbauer
Received: 26 February 2018 / Accepted: 15 May 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose To retrospectively evaluate long-term treatment results following neoadjuvant chemoradiation (CRT) and radical
surgery in patients with advanced adenocarcinoma (AC) of the oesophagus.
Patients and methods Between 2005 and 2015, a total of 102 consecutive patients with a median age of 64 years (range,
44–86 years) and AC of the oesophagus were evaluated of whom 84 received a full CRT. A group of 51 patients was treated
with neoadjuvant intent followed by radical surgery. A total dose of 50.4 Gy with mostly weekly paclitaxel/ﬂuorouracil
chemotherapy was administered. Six to eight weeks following CRT, a transthoracic subtotal oesophageal and proximal
gastric resection was performed. Survival curves for overall survival and no evidence of disease (NED) survival (primary
endpoints) were calculated according to Kaplan–Meier, and possible prognostic factors were evaluated by the log-rank test
as well as by a Cox regression analysis.
Results Median follow-up time of the surviving patients was 48 months (range, 14–134 months). Overall and NED survival
rates for patients of the study group (n = 51) were 40 and 32%, respectively, at 5 years. Age (p= 0.04), ypT category (p=0.1)
and the development of distant metastases (p= 0.05) were identiﬁed as (marginally) independent prognostic variables with
impact on survival. Median survival time for patients of the study group (n = 51) was 45± 18 months (95%CI 9–81 months).
Clear resection margins were achieved in 46/51 patients (92%). Regression rates with complete regression rare residual
cancer and increased number of residual cells, but predominantly ﬁbrosis were 33, 41, and 10%, respectively. Patterns of
failure revealed local with distant recurrence in 2/51 (4%), regional recurrence alone in 2/51 (4%), and distant metastases
in 27/51 (53%) patients.
Conclusion Neoadjuvant CRT in patients with AC of the oesophagus followed by thoracoabdominal surgery is a locally
very effective concept. A signiﬁcant tumour regression in almost 75% of the patients may stimulate prospective trials on
the omission of radical surgery for some elderly patients. Due to a high rate of distant metastases further investigations in
terms of effective systemic therapy may be warranted.
Keywords Adenocarcinoma · Oesophagus · Gastroesophageal junction · Chemoradiation
The present work was performed by S. Vitz in partial fulﬁllment
of the requirements for obtaining the degree Dr. med. at the
Friedrich-Alexander-University of Erlangen-Nürnberg (FAU).
Gerhard G. Grabenbauer, M.D.
Extended author information available on the last page of the