605. neoadjuvant flot for locally advanced esophageal cancers: a systematic review and meta-analysis

Abstract Whilst multimodality treatment is established as standard of care for locally advanced esophageal cancers the precise choice of oncological neoadjuvant treatment remains unclear. Uptake of FLOT is increasing, yet collective experience in patients with esophageal cancer is unclear. This study aimed to assess the effectiveness of FLOT as first-line treatment in this patient population. A systematic review was performed using Embase, MEDLINE (OvidSP), Web of Science, Scopus, PubMed Publisher, Cochrane, and Google Scholar until 28st December 2021, for studies of treatment-naive patients of any age who received FLOT as first-line treatment of locally advanced esophageal or gastric cancer. The primary outcome was overall survival. Secondary outcomes were progression-free survival, rates of grade 3 or 4 adverse events; and oncological outcomes This systematic review included six studies comprising 895 patients, of which 479 (54%) patients received FLOT. All studies included patients with distal or gastroesophageal junction esophageal and 441 (92%) had esophageal adenocarcinoma. Pooled overall survival at 1-year, 2-year and 3-year were 81.7% (CI95%: 71.1% - 88.9%), 59.2% (CI95%: 47.4% - 69.9%), and 49.8% (CI95%: 28.9 - 70.8%). Pooled recurrence rates from three studies were 22.6% (CI95%: 12.3% - 37.7%). Oncological outcomes were reported for margin-negative resections (overall: 94.1%, CI95%: 88.1% - 97.2%), complete pCR (overall: 15.2%, CI95%: 7.1% - 29.7%), major pathological response (overall: 41.6%, CI95%: 24.6% - 60.8%). There is limited evidence on FLOT for patients with esophageal or gastroesophageal cancers, despite the increasing use of FLOT in clinical practice. Standardisation in reporting oncological and surgical outcomes following FLOT are needed and future research and randomised controlled trials comparing FLOT are required.