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The following is a summary of “Perioperative Chemotherapy or Preoperative Chemoradiotherapy in Esophageal Cancer,” published in the January 2025 issue of Critical Care by Hoeppner et al. 

Researchers conducted a retrospective study to determine whether perioperative chemotherapy offered better outcomes than preoperative chemoradiotherapy for resectable locally advanced esophageal adenocarcinoma.  

They assessed individuals with resectable esophageal adenocarcinoma in a 1:1 ratio to receive perioperative chemotherapy with FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) plus surgery or preoperative chemoradiotherapy (41.4 Gy radiotherapy with carboplatin and paclitaxel) plus surgery. Eligibility included primary tumors with clinical stages cT1 cN+, cT2–4a cN+, or cT2–4a cN0 (where T indicates tumor size/extent and N reflects lymph node involvement) N indicates the presence (N+) or absence (N0) of cancer spread to the lymph nodes, with no metastatic disease. The primary endpoint was overall survival.  

The results showed that 221 individuals were assigned to the FLOT group and 217 to the preoperative-chemoradiotherapy group. With a median follow-up of 55 months, the 3-year overall survival was 57.4% (95% CI, 50.1 to 64.0) in the FLOT group and 50.7% (95% CI, 43.5 to 57.5) in the preoperative-chemoradiotherapy group (hazard ratio for death, 0.70; 95% CI, 0.53 to 0.92; P=0.01). The 3-year progression-free survival was 51.6% (95% CI, 44.3 to 58.4) in the FLOT group and 35.0% (95% CI, 28.4 to 41.7) in the preoperative-chemoradiotherapy group (hazard ratio for disease progression or death, 0.66; 95% CI, 0.51 to 0.85). Among those who received treatment, grade 3 or higher adverse events occurred in 120 of 207 (58.0%) individuals in the FLOT group and 98 of 196 (50.0%) in the preoperative-chemoradiotherapy group. Serious adverse events were noted in 98 of 207 (47.3%) in the FLOT group and 82 of 196 (41.8%) in the preoperative-chemoradiotherapy group. Mortality within 90 days post-surgery was 3.1% in the FLOT group and 5.6% in the preoperative-chemoradiotherapy group.  

Investigators concluded the perioperative chemotherapy with FLOT regimen demonstrated superior survival outcomes compared to preoperative chemoradiotherapy in patients with resectable esophageal adenocarcinoma. 

Source: nejm.org/doi/full/10.1056/NEJMoa2409408