Characteristics, treatment, and outcome of recurrent gastro-oesophageal adeno-carcinoma after perioperative chemotherapy and radical resection

BACKGROUND: Evidence of treatment of patients with relapse following multimodal treatment for oesophageal, gastro-oesophageal junctional and gastric adenocarcinoma is almost absent. METHODS: In a nationwide consecutive cohort of 202 patients, radically resected after perioperative chemotherapy (CTx) and followed-up without scheduled imaging, we identified 89 patients with recurrence within 12 years. We registered prior clinico-pathological and treatment characteristics, alarming symptoms, work-up, recurrence patterns, treatment of recurrence, and outcome. RESULTS: Median time to recurrence was 15.2 months, 91% of relapses occurred within 3 years. Frequent alarming symptoms were pain, weight loss and loss of appetite. Fifty-four percent recurred at multiple sites, 36% at a single anatomic site, and 10% were solitary. Recurrence was a 99% fatal event with a median overall survival (OS) of only 4.6 months. Older age, ypN3 at surgery, poor performance status, weight loss, non-solitary recurrence, no postoperative CTx, and no palliative CTx, were associated with short OS. Three patients had initial surgery, but all progressed; one additional patient was cured by salvage surgery after palliative CTx. Sixty percent (53 patients) were treated with CTx yielding a median progression-free survival and OS of 4.0 and 5.8 months, respectively; the overall response rate was 35%. Pleuroperitoneal metastases predicted poor prognosis. Non-platinum-based, first-line palliative CTx was used in 38%, mostly in patients with short treatment-free interval. INTERPRETATION: In this national cohort, recurrence was a 99% fatal event and only 60% of patients received palliative CTx. Efficacy of palliative CTx at relapse after multi-modal treatment is poor and needs further investigations.