National Cancer Database analysis of outcomes with neoadjuvant chemotherapy versus chemoradiation for esophageal adenocarcinoma

Analysis of the National Cancer Database examined outcomes of neoadjuvant chemotherapy (NCT) compared with neoadjuvant chemoradiation (NCRT) for esophageal adenocarcinoma (EAC). After propensity score matching, there were 1007 patients in each group. There was improved lymphadenectomy and higher use of adjuvant therapy in the NCT group, and improved R0 resection and pathological response in the NCRT group. Median and 5-year OS werd 42.7 months and 42% in the NCT group compared with 34.2 months and 35% in the NCRT group (p=0.001). Among pathologic complete responders, median and 5-year OS were 101 months and 64% in the NCT group versus 71.2 months and 53% in the NCRT group (p=0.04). The authors conclude that NCT compared with NCRT for EAC resulted in longer OS; however, regimen heterogeneity precludes definitive therapeutic recommendations.