P-072Pattern of recurrence and efficacy of salvage therapy after relapse in locally advanced esophageal carcinoma treated with preoperative chemoradiotherapy plus surgery

Introduction: Patients (pts) with locally advanced esophageal carcinoma (LAEC) benefit from preoperative chemo-radiotherapy (NA CRT) followed by surgery. However, half of them will relapse within the first 2 years, having limited treatment options. Moreover, adenocarcinoma (ADC) and squamous cell carcinoma (SCC) are thought to represent two different diseases which might differ in terms of recurrence. Our aim is to analyze the characteristics and outcome of pts who relapse. Methods: We retrospectively reviewed pts with LAEC treated at the Gastroesophageal Tumors Functional Unit of Catalan Institute of Oncology, Bellvitge University Hospital and integrated centers who underwent NA CRT followed by surgery from 2000 to 2014. We analyzed recurrence rate (RR), median time to relapse (mTTR) and pattern of recurrence (PR): locoregional recurrence (LRR), distant recurrence (DR) or synchronic LR and DR (SR); results were stratified by histology. Clinical data and salvage therapy (ST) were also collected, including surgery, radiotherapy and palliative chemotherapy (PCT). Kaplan Meier for median overall survival (mOS) and median time to progression (mTTP) were performed. Results: 83/100(83%) pts receiving NA CRT underwent surgery: ADC 33(40%), SCC 44(53%), undifferentiated 6(7%). 88% R0, pathologic complete response (ypT0N0): 20 (24%): ADC 18,2 %, SCC 33,3%, p0,22. After a median follow-up of 26 months (m) (1-126) 1-year and 3-year RR were 36 (ADC 40,9%, SCC 27,3%) and 43% (ADC 47,7%, SCC 36,4%) respectively. mTTR 6 m (4,1-7,8), PR (%) of the 36 (43%) pts who relapse: LRR 31% (ADC 18%,SCC 55%, 37% ND) DR 50 % (ADC 72, SCC 28) SR 19 % (ADC 86, SCC 14), logRank for histology 0,032.median OS was 32 m (IC 95% 14,1-49,3): 26,8m ADC vs 45,4m SCC (p < 0,001). Median number of metastatic sites at relapse: 2. Data of 26/36 pts who relapse was available: 13/26 (50%) received ST: radical radiotherapy1 (7%), salvage surgery 1(7%). 11 (86%) receivedPCT. 90% had performance status ≤1, 100% had albumin serum levels ≥34g/l and Hemoglobin > 12g/L. PCT schedule: Docetaxel (46%), Cisplatin plus 5-fluoracyl (23%), Carboplatin plus 5-fluoracyl (15%). Median time on treatment was 10.7m (1-22). 5/13 (38%) pts received subsequent lines of PCT. Median OS was 11m (6,3-16,5): 26m (12,2-41,5) for patients who received ST versus 6,5m (1,3-11,4) for those who received best supportive care (p < 0,026). Conclusion: ADC and SCC differ significantly in their pattern of recurrence, being ADC more frequent in distant recurrence which confers a poor prognosis. A lower rate of pathologic complete response and a higher RR was observed for the group of ADC compared to SCC, although those differences were not statistical significant. Pts who relapse and maintain favorable prognostic clinical factors clearly benefit from salvage therapy if feasible and PCT.