Perioperative Chemotherapy with 5-FU, Leucovorin, Oxaliplatin, and Docetaxel (FLOT) for Esophagogastric Adenocarcinoma: Ten Years Real-life Experience from a Surgical Perspective

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2023 Feb 10

PMID 36763220

Authors

Leila Sisic

Nerma Crnovrsanin

Henrik Nienhueser

Jin-On Jung

Sabine Schiefer

Georg Martin Haag

Thomas Bruckner

Martin Schneider

Beat P Muller-Stich

Markus W Buchler

Thomas Schmidt

Affiliations

Soon will be listed here.

Abstract

Purpose: According to the results of FLOT4 trial, perioperative FLOT chemotherapy improved overall survival (OS) in locally advanced, resectable esophagogastric adenocarcinoma (EGA) compared to perioperative ECF/ECX. We report real-life data 10 years after introduction of perioperative FLOT at our institution.

Methods: Survival of 356 consecutive EGA patients (cT3/4 and/or cN + and/or cM1) who underwent curative surgical resection was retrospectively analysed from a prospective database. A total of 263 patients received preoperative chemotherapy according to FLOT protocol and 93 patients received an epirubicin/platinum/5FU-based regimen (EPF). Propensity score matching (PSM) according to pretretment characteristics was performed to compensate for heterogeneity between groups.

Results: Median OS did not differ between groups (FLOT/EPF 52.1/46.4 months, p = 0.577). After PSM, survival was non-significantly improved after FLOT compared to EPF (median OS not reached/46.4 months, p = 0.156). Perioperative morbidity and mortality did not differ between groups. Histopathologic response rate was 35% after FLOT and 26% after EPF (p = 0.169). R0 resection could be achieved more frequently after FLOT than after EPF (93%/79%, p = 0.023).

Conclusion: Overall survival after perioperative FLOT followed by surgery is comparable to clinical trials. However, collective real-life application of FLOT failed to provide a significant survival benefit compared to EPF. In clinical reality, patient selection is triggered by age, comorbidity, tumor localization, and clinical tumor stage. Yet matched analyses support FLOT4 trial findings.

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