scholarly journals Comparison of Pathologic Complete Response Rates and Oncologic Outcomes in Patients With Surgically Resectable Esophageal Cancer Treated With Neoadjuvant Chemoradiation to 50.4 Gy vs 41.4 Gy

Cureus ◽  
2021 ◽  
Author(s):  
Anthony D Nehlsen ◽  
Eric J Lehrer ◽  
Lucas Resende-Salgado ◽  
Kenneth E Rosenzweig ◽  
Michael Buckstein
Keyword(s):  
Esophageal Cancer ◽  
Pathologic Complete Response ◽  
Response Rates ◽  
Complete Response ◽  
Neoadjuvant Chemoradiation ◽  
Oncologic Outcomes ◽  
Resectable Esophageal ◽  
Resectable Esophageal Cancer

Randomized phase II study of preoperative concurrent chemoradiotherapy with or without induction chemotherapy with S-1 and oxaliplatin in patients with resectable esophageal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4093-4093
Author(s):  
Dok Hyun Yoon ◽  
Geundoo Jang ◽  
Jong Hoon Kim ◽  
Yong Hee Kim ◽  
Seyoung Son ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Induction Chemotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Pathologic Complete Response ◽  
Dose Intensity ◽  
Progression Free Survival ◽  
Complete Response ◽  
Preoperative Chemoradiotherapy ◽  
Resectable Esophageal ◽  
Resectable Esophageal Cancer

4093 Background: The value of adding induction chemotherapy (ICT) to preoperative chemoradiotherapy followed by surgery has not been delineated well. Methods: Patients with stage II, III or IVA (by AJCC 6th ed.) esophageal cancer were randomly allocated to either 2 cycles of ICT (oxaliplatin 130 mg/m2 on day 1 and S-1 at 40 mg/m2 bid on days 1-14, every 3 weeks), followed by concurrent chemoradiotherapy (CCRT) (46 Gy, 2 Gy/day with oxaliplatin 130 mg/m2 on day 1 and 21 and S-1 30 mg/m2 bid, 5 days/week during radiotherapy) and surgery (arm A, n=48), or the same chemoradiotherapy followed by surgery without ICT (arm B, n=49). Primary outcome was to compare pathologic complete response (pCR). Results: Thirty six and 35 patients underwent surgery with or without ICT, respectively. pCR rate among those who underwent surgery was significantly lower in arm A (30.6% vs. 54.3%, p=0.043). However, no difference in progression-free survival (PFS) and overall survival (OS) was observed with a median follow-up of 19.5 mo (95% CI, 19.1-22.4). Two-year PFS rate was 63.8% in arm A and 55.2% in arm B (p=0.626) and 2-year OS rate was 70.1% and 62.6%, respectively (p=0.515). While 47 (arm A) and 48 (arm B) patients received at least 44 Gy of radiotherapy, relative dose intensity (RDI) for oxaliplatin during CCRT was significantly lower in arm A vs. arm B (92.7% ± 19.6% vs. 99.7 ± 1.8%, p=0.017). RDI for S1 did not significantly differ (94.1% ± 17.3% vs. 98.5% ± 5.9%, p=0.095). G3/4 thrombocytopenia was significantly common in arm A (37.5% vs. 4.1%, p <0.001), which contributed to lower RDI of oxaliplatin. Three patients in arm A, compared to none in arm B, failed to survive for 90 days after surgery. Conclusions: Adding this ICT to preoperative chemoradiotherapy seems to cause lower pCR rate and higher toxicity during CCRT.

Assessment of macroscopic features in relation to tumor response to neoadjuvant chemoradiation therapy in rectal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 507-507
Author(s):  
Amanda Kathleen Arrington ◽  
Julio Garcia-Aguilar ◽  
Marjun Philip Duldulao ◽  
Carrie Luu ◽  
Julian Sanchez ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Tumor Response ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Neoadjuvant Chemoradiation ◽  
Chemoradiation Therapy ◽  
Oncologic Outcomes ◽  
Neoadjuvant Chemoradiation Therapy ◽  
Pathologic Features

507 Background: Several studies show locally advanced rectal cancer patients with clinical complete response (cCR) have comparable oncologic outcomes to pathologic complete response (pCR) to neoadjuvant chemoradiation therapy (NCRT). Thus, total mesorectal excision (TME) could potentially be avoided. Our objective was to validate macroscopic features of cCR. Methods: 164 patients with stage II/III rectal cancer were previously enrolled in a phase II trial and treated by NCRT and TME. Tumor response in the surgical specimens was assessed according to AJCC guidelines. A pCR was defined as absence of viable tumor cells. Gross macroscopic features by the pathologist were tabulated and our cohort was applied to previously published cCR criteria. Results: 25.0% (n = 41) had pCR; 75.0% (n = 123) had non-pCR. Descriptors were condensed into 14 macroscopic features by combining terms and excluding those rarely mentioned. Several reports affirm that scarring signifies cCR, while others suggest that fibrosis, edema, ulceration and nonpalpable tumor to be consistent with cCR. In our study, scarring was found in 6.1% of patients, 16.7% of which had pCR. We found that hyperemia, scarring, flat, smooth, and tan-pink mucosa were significantly associated with pCR (p < 0.05). In contrast, a firm lesion and ulceration were frequently observed in patients with non-pCR (p = 0.02 and 0.05 respectively). Conclusions: Our study suggests that macroscopic pathologic features do correlate with pCR. Although cCR has comparable oncologic outcomes as pCR with favorable outcomes, standard criteria of cCR should first be defined so NCRT patients can safely be selected for observation only. [Table: see text]

Practice patterns in the treatment of locally advanced resectable esophageal carcinoma: A national survey of Canadian thoracic surgeons.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14695-e14695
Author(s):  
Gordon Buduhan
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Practice Patterns ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiation ◽  
The Other ◽  
Insufficient Evidence ◽  
Canadian Association ◽  
Resectable Esophageal ◽  
Resectable Esophageal Cancer

e14695 Background: Many institutions have adopted a multimodality strategy for treating locally advanced resectable esophageal cancer including surgery, chemotherapy and radiation. While many neoadjuvant protocols have been studied, there is no well defined standard treatment. In order to determine current practices and clinician opinions regarding treatment of esophageal cancer, a survey study of practicing Canadian thoracic surgeons was performed. Methods: Members of the Canadian Association of Thoracic Surgeons were contacted by email; those who currently treat esophageal cancer were asked to complete an online survey. Three separate emails were sent to maximize participation. Results: The response rate was 54% (56 /104). Of the respondents, 85% exclusively practiced general thoracic surgery, 87% worked at a University-affiliated hospital. We presented a hypothetical patient with bulky, resectable distal esophageal adenocarcinoma with enlarged paraesophageal lymph nodes (T3N1M0). 54% stated that neoadjuvant chemoradiation followed by surgery was their institution’s treatment of choice, while 33% used neoadjuvant chemotherapy plus surgery. When asked to choose the best treatment for this patient based on available evidence, 33% chose neoadjuvant chemoradiation, 33% favored neoadjuvant chemotherapy, 31% were undecided. Regarding neoadjuvant chemotherapy vs. chemoradiation, 63% strongly agreed or agreed there was insufficient evidence to decide whether or not one treatment was superior to the other. 73% strongly agreed or agreed to support a future randomized trial of preoperative chemotherapy vs. preoperative chemoradiation for esophageal cancer patients. Conclusions: Most Canadian thoracic surgeons use either neoadjuvant chemotherapy or chemoradiation followed by surgery for locally advanced resectable esophageal cancer. There is wide variation in practice patterns with no clear standard approach. 63% feel there is insufficient evidence to decide whether or not one treatment is superior to the other, and the majority support a future trial of neoadjuvant chemotherapy vs. chemoradiation. A pilot study is being planned to determine feasibility.

Timing after neoadjuvant therapy predicts mortality in patients undergoing esophagectomy.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 157-157
Author(s):  
Taylor Maramara ◽  
Jamie Huston ◽  
Ravi Shridhar ◽  
Kenneth L Meredith
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Pathologic Complete Response ◽  
Response Rates ◽  
Complete Response ◽  
Pathologic Response ◽  
Chi Square ◽  
Surgery Timing ◽  
Improvement In Survival ◽  
The Impact

157 Background: Neoadjuvant therapy (NT) prior to esophagectomy has dramatically improved survival in patients with esophageal cancer. Currently, most surgeons will allow 6-12 weeks after NT prior to recommending esophagectomy. Given that complete pathologic response (pCR) correlates to an improvement in survival, some have advocated a longer interval should be entertained to increase the pathologic response. The impact of an expanded NT-surgery timing is not currently well understood. Methods: Utilizing the National Cancer Database, we identified patients with esophageal cancer who underwent NT followed by esophagectomy. Patients were divided into 4 time intervals: < 6 wks, 6-12 wks, 3-6 mo, and > 6 mo. Mann-Whitney U, Kruskal Wallis, and Pearson’s Chi-square test were used as appropriate. Survival analyses were performed using the Kaplan-Meier method and p < 0.05 was considered significant. Results: We identified 9,256 patients who received NT followed by esophagectomy. There were 8,053 (87%) adenocarcinomas and N = 1203 (13%) squamous cell carcinomas. 7,858 (84.9%) were male and 1,398 (15.1%) female with a median age was 62 (24-88). R0 resections decreased as the NT-Surgery interval increased: < 6 wks, 6-12 wks, 2-6 mos, and > 6 mos at 93%, 94.1%, 94.1%, and 86.2% respectfully p = 0.004. Additionally, the median lymph nodes harvested decreased as timing increased: 12, 12, 10, and 9 p < 0.001 and the median nodes positive decreased as timing increased 1.5, 1.3, 1.1, and 2.4 p = 0.01. The complete response rates increased as timing increased 15.5%, 20.1%, 22.7%, and 25.8% p < 0.001. However, this improvement in pCR did not translate into an increase in median survival: < 6 wks 40.9 mos, 6-12 weeks 38.5 mos, 3-6 mos 34.8 mos, and > 6 mos 39.8 mos of survival, p = 0.94 90-day mortality increased as the timing from neoadjuvant therapy increased: 6.4%, 7.9%, 9.4%, and 16.0%, respectively p = 0.001. Conclusions: Our data demonstrates that patients who have a prolonged NT- esophagectomy interval will have a substantial increase in 90-day mortality. While there was an increase in pathologic complete response rates, this did not translate into an improvement in survival. The current recommendations of a NT-surgery timing of 6-12 weeks should remain.

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