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Open AccessArticle

Pattern of Recurrence and Patient Survival after Perioperative Chemotherapy with 5-FU, Leucovorin, Oxaliplatin and Docetaxel (FLOT) for Locally Advanced Esophagogastric Adenocarcinoma in Patients Treated Outside Clinical Trials

1
Department of Surgery, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampiring 40, 44625 Herne, Germany
2
Center for Surgery, Department of General and Visceral Surgery, Medical Center-University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
3
Institute for SurgicalPathology, Medical Center-University of Freiburg, Breisacher Str 115A, 79106 Freiburg, Germany
4
Tumorbank Comprehensive Cancer Center Freiburg, Medical Center-University of Freiburg, 79106 Freiburg, Germany
5
Department of Medical Oncology, Medical Center and Faculty of Medicine—University of Freiburg, Hugstetter Straße 55, 79098 Freiburg, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(8), 2654; https://doi.org/10.3390/jcm9082654
Received: 30 June 2020 / Revised: 12 August 2020 / Accepted: 14 August 2020 / Published: 16 August 2020
Background: The 5-FU, Leucovorin, Oxaliplatin and Docetaxel (FLOT) protocol provides superior oncologic results compared to other perioperative chemotherapeutic protocols for the treatment of non-metastatic esophagogastric cancer (EGAC). Survival and the pattern of recurrence of EGAC after FLOT and curative tumor resection are analyzed in a collective of patients treated outside clinical trials. Methods: Two-hundred-seventy-seven patients with EGAC (cT3-4 and/or cN+) were treated with perioperative FLOT-chemotherapy plus curative surgery between 2009 and 2018. Data were analyzed retrospectively from a prospective database. Results: Two-hundred-twenty-eight patients were included in the analysis. Postoperative in-hospital mortality was 2%. The median survival was 61–months, and median recurrence-free survival was 42 months. Multivariate analysis identified postoperative nodal status and T-stage as independent predictors of improved overall and recurrence-free survival. Administration of adjuvant chemotherapy failed to be significant for overall survival but was an independent predictor of recurrence-free survival. Recurrence occurred after a median of 9 months (range 1–46 months). Eighty-nine percent of recurrence occurred during the first 24 months. The rate of local recurrence was low. After surgery for gastric cancer, the major recurrence site was peritoneal carcinomatosis (56%), while esophageal cancer recurred mostly as metastasis to distant organs (78%). The specific site of recurrence had no impact on overall survival time. Conclusion: Real-life application of FLOT shows oncologic results comparable to clinical trials. Recurrence after FLOT and surgery for EGAC occurs predominantly early within the first two years after surgery and in the form of distant organ metastasis for esophageal tumors or peritoneal carcinomatosis for gastric tumors. View Full-Text
Keywords: esophageal cancer; gastric cancer; adenocarcinoma; perioperative chemotherapy; adjuvant chemotherapy; histopathological regression esophageal cancer; gastric cancer; adenocarcinoma; perioperative chemotherapy; adjuvant chemotherapy; histopathological regression
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Glatz, T.; Verst, R.; Kuvendjiska, J.; Bronsert, P.; Becker, H.; Hoeppner, J.; Kulemann, B. Pattern of Recurrence and Patient Survival after Perioperative Chemotherapy with 5-FU, Leucovorin, Oxaliplatin and Docetaxel (FLOT) for Locally Advanced Esophagogastric Adenocarcinoma in Patients Treated Outside Clinical Trials. J. Clin. Med. 2020, 9, 2654.

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