ArticleJTCVS open2026
A contemporary nationwide analysis of neoadjuvant regimens for esophageal adenocarcinoma.
Article in JTCVS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Background: In the United States, neoadjuvant chemoradiotherapy with CROSS (41.6 Gy, carboplatin/paclitaxel) has been the standard for patients with operable locally advanced esophageal adenocarcinoma (EAC). Recently, the ESOPEC multicenter phase III trial reported superior overall survival (OS) with perioperative FLOT (5-FU/leucovorin/oxaliplatin/docetaxel) compared to CROSS. We aimed to examine trends in neoadjuvant treatment strategies and compare outcomes in a contemporary real-world cohort. Methods: Patients with clinical stage II-IVA (T2-4aN0-3M0 by the American Joint Committee on Cancer 8th Edition staging classification) EAC who underwent neoadjuvant chemoradiation (nCRT; ≥41.4 Gy) or neoadjuvant chemotherapy (nCT) followed by esophagectomy were identified in the National Cancer Database (2015-2022). Postoperative outcomes and overall survival (Kaplan-Meier) were compared in propensity-matched cohorts. Results: A total of 9845 patients were identified, of whom 8955 (91.0%) received nCRT and 890 (9.0%) received nCT before esophagectomy. The median patient age was 65 years (interquartile range [IQR], 58-71 years), and 88.1% (n = 8674) of the patients were male. Over time, there was trend toward increasing use of nCT, from 6.7% of patients in 2015 to 9.6% in 2022 ( Conclusions: In a contemporary cohort of patients with locally advanced EAC, nCRT remained the predominant approach. However, consistent with ESOPEC, nCT alone was associated with improved OS.
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