Preoperative chemotherapy versus chemoradiotherapy in locally advanced adenocarcinomas of the oesophagogastric junction (POET): Long-term results of a controlled randomised trial. (August 2017)

• Record Type: Journal Article
• Authors: Stahl, Michael; Walz, Martin K.; Riera-Knorrenschild, Jorge; Stuschke, Martin; Sandermann, Andreas; Bitzer, Michael; Wilke, Hansjochen; Budach, Wilfried
• Is Part Of: European journal of cancer. Volume 81(2017)
• Page Start: 183
• Page End: 190
• Publication Date: 2017-08
• Subjects: Preoperative chemotherapy -- Preoperative chemoradiotherapy -- Oesophagogastric adenocarcinoma -- Phase III trial; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2017.04.027
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: Results of the PreOperative therapy in Esophagogastric adenocarcinoma Trial (POET) showed some benefits when including radiotherapy into the preoperative treatment. This article is reporting long-term results of this phase III study. Patients and methods: Patients with locally advanced adenocarcinomas of the oesophagogastric junction (Siewert types I–III) were eligible. Randomisation was done to chemotherapy (group A) or induction chemotherapy and chemoradiotherapy (CRT; group B) followed by surgery. Results: The primary end-point of the study was overall survival at 3 years. The study was closed early after 119 patients having been randomised and were eligible. Local progression-free survival after tumour resection was significantly improved by CRT (hazard ratio [HR] 0.37; 0.16–0.85, p = value 0.01) and 20 versus 12 patients were free of local tumour progression at 5 years (p = 0.03). Although the rate of postoperative in-hospital mortality was somewhat higher with CRT (10.2% versus 3.8%, p = 0.26), more patients were alive at 3 and 5 years after CRT (46.7% and 39.5%) compared with chemotherapy (26.1% and 24.4%). Thus, overall survival showed a trend in favour of preoperative CRT (HR 0.65, 95% confidence interval [CI] 0.42–1.01, p = 0.055). Conclusion: Although the primary end-point overall survival of the study was not met, our long-term follow-up data suggest a benefit in local progression-free survival when radiotherapy was added to preoperative chemotherapy in patients with locally advanced adenocarcinoma of the oesophagogastric junction. Highlights: POET is the first phase III study to compare preoperative CT to CRT in locally advanced oesophagogastric adenocarcinoma. 3 year survival was improved by combined chemoradiotherapy, although this was not statistically significant (p = 0.055). Freedom of local tumour progression was significantly increased with CRT compared to CT (HR 0.37; 0.16–0.85, p = 0.01).