American Surgical Association
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Induction Chemotherapy In Barrett Cancer - Influence On Surgical Risk, Outcome and Survival
Joerg R Siewert1, Florian Lordick*1, Katja Ott*1, Hubert J Stein2, Wolfgang A Weber*3, Karen Becker1, Christian Peschel*1, Ulrich Fink*1, Markus Schwaiger*1
1Technical University of Munich, Munich, Germany2Paracelsus Medical University, Salzburg, Austria3University of California, Los Angeles, CA

OBJECTIVE(S): Induction chemotherapy (ICTX) is evidence based nowadays. In a prospective trial we analyzed the surgical risk, outcome, and survival in patients with Barrett cancer.
METHODS: Patients had locally advanced adenocarcinoma of the esophagogastric junction (AEG I/II) classified T3 N0/+ M0 by endoscopic ultrasound, CT and 18FDG-PET. Patients with early metabolic response to ICTx assessed by FDG-PET continued on CTx for 12 weeks before surgery. Non-responding patients stopped CTx after 2 weeks and proceeded to surgery.
RESULTS: Between 05/2002 and 08/2005 111 patients were enrolled. The response rate to ICTx was 49%. Baseline characteristics were well balanced between responders and non-responders. 104 patients underwent resection (subtotal esophagectomy 70%, extended gastrectomy 30%). Postoperative complications occurred in 34% and the hospital mortality rate was 1.8% with no statistical difference between ICTX-responders and non-responders. There were more R0 resections (96% vs. 74%; p=0.002) in responders vs. non-responders. Lymph node involvement was seen in 20% vs. 62% (p<0.001). Both median relapse-free survival (29.7 vs. 14.1 months; p<0.002) and overall survival (median not reached vs. 25.8 months; p<0.015) were in favor of responders. Response to neoadjuvant chemotherapy led to a reduction in both local and systemic recurrences.
CONCLUSIONS: ICTX can differentiate between biologically less and more favorable tumors and can improve the prognosis for so-called responders. The surgical risk is not negatively influenced by ICTX. The more radical resectability and the favorable lymph node staging seen in responders most likely explain the better survival.

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