• Thomas Steffen, Daniel Dietrich, Annelies Schnider, Christoph Kettelhack, Olivier Huber, Walter R Marti, Markus Furrer, Beat Gloor, Marc Schiesser, Sandra Thierstein, Peter Brauchli, Thomas Ruhstaller, and Swiss Group for Clinical Cancer Research (SAKK).
• Department of General, Visceral, Endocrine and Transplant Surgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
• Ann. Surg. 2019 Jan 1; 269 (1): 83-87.

ObjectiveThe long-term follow up data of 2 prospective phase II trials is reported (NCT00072033, NCT00445861), which investigated neoadjuvant chemoradiation followed by surgery in patients with esophageal carcinoma. Postoperative complications as well as prognostic factors and patterns of relapse during long-term observation are shown.Summary Of Background DataLong-term follow-up is often missing in the complex setting of multimodal treatments of esophageal carcinoma; this leads to rather undifferentiated follow-up guidelines for this tumor entity.MethodsIn the first trial, patients received induction chemotherapy followed by chemoradiation and surgery. In the second trial, cetuximab was added to the same neoadjuvant treatment concomitant with induction chemotherapy and chemoradiation.ResultsEighty-two patients underwent surgery; the median follow-up time was 6.8 and 6.4 years, respectively. Fifty-five percent were diagnosed with adenocarcinoma, 80% clinically node-positive, 68% received transthoracic esophagectomy, and 32% transhiatal or transmediastinal resection. Five patients died postoperatively in-hospital due to complications (6%). The median overall survival was 4.3 years, and the median event-free survival was 2.7 years. Patients with adenocarcinoma rarely relapsed after a 3-year event-free survival. Whereas patients with residual tumor cells after neoadjuvant therapy primarily experienced relapse within the first 2 postoperative years, this in contrast to several patients with complete remission who also experienced late relapses 4 years after surgery.ConclusionAfter curative surgery in a multimodal setting, the histological type and the response to neoadjuvant therapy predicted the time frame of relapse; this knowledge may influence further follow-up guidelines for esophageal carcinoma.

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