ArticleJournal of thoracic disease2026
Perioperative FLOT chemotherapy for locally advanced esophageal adenocarcinoma: from ESOPEC to daily practice-a retrospective cohort study.
Article in Journal of thoracic disease, 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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Abstract
Background: Two neoadjuvant treatment strategies exist for esophageal and gastro-esophageal junction (GEJ) adenocarcinoma: Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) chemoradiotherapy or peri-operative FLOT chemotherapy (5-fluorouracil, leucovorin, oxaliplatin, docetaxel). ESOPEC showed improved overall survival (OS) after FLOT. This study aimed to reassess OS after perioperative FLOT and surgery in real-life. Methods: This single center retrospective cohort study included all patients with locally advanced esophageal or GEJ adenocarcinoma (cT1/2N+ or cT3/4N0/+) treated with intended perioperative FLOT and surgery between 2017 and 2023. Primary endpoint was OS. Results: One-hundred forty-four patients were included with mostly high T-stages [cT3 (n=120, 83.3%), cT4 (n=14, 9.7%)] and node-positive tumors [cN1 (n=37, 25.7%), cN2 (n=60, 41.7%), cN3 (n=19, 13.2%)]. Nineteen patients (13.2%) didn't proceed to surgery (PRE), and 19 patients (15.2%) did not receive any postoperative FLOT (PRE-SURG). Finally, 96 (76.8%) started postoperative FLOT (PRE-SURG-POST). Median OS was 53.3 months and after stratification 12.9 months [95% confidence interval (CI): 11.1-14.7] for PRE and 13.0 months (95% CI: 5.6-20.5) for PRE-SURG. Median OS for PRE-SURG-POST was not reached but significantly higher (P<0.001). Median event-free survival (EFS) was 29.6 months for PRE-SURG-POST, compared with 12.4 months (95% CI: 8.8-15.9) for PRE-SURG (P=0.06) and 7.7 months (95% CI: 1.0-14.4) for PRE (P<0.0001). Conclusions: Our results, with predominantly advanced and node positive tumors, corroborate the OS and EFS of perioperative FLOT with surgery observed in the FLOT-4 and ESOPEC-trial. Completion of treatment was associated with improved OS and EFS. This emphasizes the importance of patient selection, high-quality surgery and supportive care to maximize treatment continuation and increasing survival.
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