Neoadjuvant Chemoradiotherapy Followed by Transhital Esophagectomy in Locally Advanced Esophageal Squamous Cell Carcinoma: Impact of Pathological Complete Response

Alves, Iuri Pedreira Filardi; Tercioti, Valdir; Neto, João de Souza Coelho; Ferrer, José Antônio Possatto; Carvalheira, José Barreto Campello; Pereira, Eduardo Baldon; Lopes, Luiz Roberto; Andreollo, Nelson Adami

doi:10.1590/0102-672020210002e1621

Cited by 6 publications

(6 citation statements)

References 26 publications

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“…The occurrence of cancer is in the areas of narrowing and strictures in the esophagus, therefore, it is in these places that endoscopists, during the exams, need to focus their attention, in order to search for pre-neoplastic lesions (5,9,16) The survival rate of patients with esophageal squamous cell carcinoma depends on the staging at the time of diagnosis and oncological and surgical treatment options (13,19). However, the authors have reported a 5-year survival rate of 45-50% and a 10-year survival rate of approximately 15% in patients undergoing esophagectomy with neoplasms associated with caustic ingestion.…”

Section: Cancer Riskmentioning

confidence: 99%

“…MRI can be used, but there are no advantages. Bronchoscopy is indicated to assess invasion of the trachea and bronchi (9,17,19,(28)(29)(30).…”

Section: Diagnostic Testsmentioning

confidence: 99%

“…Esophagocoloplasty is an option when the stomach cannot be used. Ruol et al reported in the analyzed series that the gastrointestinal tract was reconstructed with intrathoracic esophagogastroplasty in 8 cases, cervical esophagogastroplasty in 7 cases and cervical esophagogastroplasty in 2 cases (19).…”

Section: Treatmentmentioning

confidence: 99%

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Caustic stenosis of the esophagus and malignant neoplasia: A dilemma

et al. 2022

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Caustic ingestion remains a complex public health issue worldwide, in adults and children. Caustic agent (acids and alkalis) is a product that causes tissue damage, and its ingestion will damage the mouth, pharynx, hypopharynx, esophagus, stomach, duodenum, and may reach the jejunum. Concomitant gastric and intestinal injuries can occur in 20 to 60% (1-3) Acid products, most of the times, cause coagulative necrosis of the mucosa, while alkalis cause a liquefaction/saponification effect on the mucosa, reaching the entire wall of the organ. The most accessible acids are hydrochloric, sulfuric and oxalic acid, widely used in civil construction and factories. Products that contain alkali are those used in household cleaning, containing sodium hydroxide, also known as caustic soda. Therefore, caustic stenosis of the esophagus depends on the product ingested, the amount that was ingested and its concentration (1, 4-6).Ingestion of these products damages the esophagus, in different extensions, and the final consequence is progression to stenosis and fibrosis of the organ. The most common symptom is dysphagia, and the intensity of dysphagia depends on the degree of stenosis. Odynophagia is also present. The nutritional status injury is evident, due to significant weight loss (1,2,4,7).Developing countries have a higher incidence of this kind of accident. In children under 10 years of age, ingestion is most often accidental, however, in adolescents and adults, the etiology of ingestion is due to attempted suicide. In the United States, despite the decline in caustic intake in children (5,000 to 15,000 per year), the incidence is 15.8 cases per 100,000 peoples (8).

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Section: Cancer Riskmentioning

confidence: 99%

“…MRI can be used, but there are no advantages. Bronchoscopy is indicated to assess invasion of the trachea and bronchi (9,17,19,(28)(29)(30).…”

Section: Diagnostic Testsmentioning

confidence: 99%

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Caustic stenosis of the esophagus and malignant neoplasia: A dilemma

et al. 2022

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“…Several studies have found that pathological tumor response (PTR), such as tumor regression grade (TRG) and downstaging, was a prognostic factor for patients with esophageal cancer who received neoadjuvant treatment [16][17][18][19]. This study compared the differences in pCR rate, major pathological response (MPR) rate, TRG, downstaging, and event-free survival (EFS) between nICT and nCT groups to investigate whether neoadjuvant immunochemotherapy was superior to chemotherapy alone in patients with esophageal cancer.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant PD-1 blockade combined with chemotherapy is not superior to neoadjuvant chemotherapy alone in resectable locally advanced esophageal carcinoma

et al. 2023

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Background Neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy followed by surgery has been recommended as standard treatment in patients with locally advanced esophageal cancer (LAEC). But the risk of tumor recurrence still remained, and many patients refused or abandoned radiotherapy because of the intolerable adverse effects in China. Neoadjuvant immunochemotherapy (nICT) followed by surgery has become an emerging treatment in patients with esophageal cancer. There was still no consensus on whether nICT was superior to nCT alone in patients with esophageal cancer. Methods In this retrospective study, patients with resectable esophageal cancer who received surgery after nICT (n=26, 40%) or nCT alone (n=39, 60%) were included. The patients were classified as nICT or nCT arm. The primary endpoints were pathological tumor response (PTR) and event-free survival (EFS). The different clinic-pathological features were compared by the Kruskal-Wallis test for continuous variables and the Chi-square (χ2) test for categorical variables. Kaplan-Meier curves were used to estimate EFS from the date of treatment to recurrence or death. All tests were 2-sided with a significative P-value defined <.05. Results Three (11.5%) of the 26 patients achieved pathological complete remission (pCR) in the nICT group, and four (10.3%) of the 39 patients achieved pCR in the nCT group, respectively (P=1.000). Six (23.1%) of the 26 patients achieved major pathological response (MPR) in the nICT group, and 11 (28.2%) of the 39 patients achieved MPR in the nCT group, respectively (P=0.645). Downstaging was achieved in 13 (44.8%) patients in the nICT group and 16 (55.2%) patients in the nCT group, respectively (P=0.732). To verify the tumor regression grade (TRG) results, we compared them with MPR and pCR, which showed a significant dependency (P< 0.001). Patients who achieved downgrading showed better MPR and pCR rates (P<0.001 and P =0.010). There was no significant difference in EFS between the nICT and nCT groups (HR=1.011, 95% CI: 0.421–2.425, P = 0.981). Conclusions Neoadjuvant PD-1 blockade combined with chemotherapy was not superior to chemotherapy alone for patients with resectable locally advanced esophageal carcinoma. However, more studies with long-term follow-up were needed to confirm this result.

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“…Several studies have found that pathological tumor response (PTR), such as tumor regression grade (TRG) and downstaging, was a prognostic factor for patients with esophageal cancer who received neoadjuvant treatment [8][9][10][11]. This study compared the differences in pathological complete remission (pCR) rate, major pathological response (MPR) rate, tumor regression grade (TRG), downstaging, and event-free survival (EFS) between nICT and nCT groups to investigate whether neoadjuvant immunochemotherapy was superior to chemotherapy alone in patients with esophageal cancer.…”

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confidence: 99%

Neoadjuvant PD-1 blockade combined with chemotherapy or chemotherapy alone for patients with resectable locally advanced esophageal carcinoma: A real-world data analysis

Cheng

Zhao

Chen

et al. 2022

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Background Neoadjuvant concurrent chemoradiotherapy with surgery was the standard of therapy for esophageal cancer. But many patients refused or abandoned radiotherapy because of the intolerable adverse effects in China. Neoadjuvant immunochemotherapy (nICT) followed by surgery has become an emerging treatment in patients with esophageal cancer. There was still no consensus on whether neoadjuvant immunochemotherapy was superior to neoadjuvant chemotherapy (nCT) alone in patients with esophageal cancer. Methods In this retrospective study, patients with resectable esophageal cancer received surgery after neoadjuvant immunochemotherapy (nICT) (n = 26, 40%) or neoadjuvant chemotherapy (nCT) alone (n = 39, 60%) were included. The patients were classified as nICT or nCT arm. The primary end points were pathological tumor response (PTR) and event-free survival (EFS). The different clinic-pathological features were compared by the Kruskal-Wallis test for continuous variables and the Chi-square (χ2) test for categorical variables. Kaplan-Meier curves were used to estimate EFS from the date of treatment to recurrence or death. All tests were 2-sided with a significative P-value defined < .05. Results Three (11.5%) of the 26 patients achieved pathological complete remission (pCR) in the nICT group, and four (10.3%) of the 39 patients achieved pCR in the nCT group, respectively (P = 1.0). Six (23.1%) of the 26 patients achieved major pathological response (MPR) in the nICT group, and eleven (28.2%) of the 39 patients achieved MPR in the nCT group, respectively (P = 0.645). Downstaging was achieved in 13 (44.8%) patients in the nICT group and 16 (55.2%) patients in the nCT group, respectively (P = 0.732). To verify the TRG results, we compared them with MPR and pCR, which showed a significant dependency (P < 0.001). Patients who achieved downgrading showed better MPR and pCR rates (P<0.001 and P = 0.010). There was no significant difference in EFS between nICT and nCT group (HR = 1.011, 95%CI: 0.421–2.425, P = 0.981). Conclusions

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Neoadjuvant Chemoradiotherapy Followed by Transhital Esophagectomy in Locally Advanced Esophageal Squamous Cell Carcinoma: Impact of Pathological Complete Response

Cited by 6 publications

References 26 publications

Caustic stenosis of the esophagus and malignant neoplasia: A dilemma

Caustic stenosis of the esophagus and malignant neoplasia: A dilemma

Neoadjuvant PD-1 blockade combined with chemotherapy is not superior to neoadjuvant chemotherapy alone in resectable locally advanced esophageal carcinoma

Neoadjuvant PD-1 blockade combined with chemotherapy or chemotherapy alone for patients with resectable locally advanced esophageal carcinoma: A real-world data analysis

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