Radiation dose and pathological response in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy followed by surgery: a multi-institutional analysis

Thomas, Melissa L.; Borggreve, Alicia S; Rossum, Peter S.N. van; Perneel, Christiaan; Moons, Johnny; Daele, Elke Van; Hillegersberg, Richard van; Deng, Wei; Pattyn, Piet; Mook, Stella; Boterberg, Tom; Ruurda, Jelle P.; Nafteux, Philippe; Lin, Steven H.; Haustermans, Karin

doi:10.1080/0284186x.2019.1646432

Cited by 13 publications

(10 citation statements)

References 36 publications

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“…17,18 Similarly, the pCR group in our study demonstrated significantly better 5-year OS and DFS than did the non-pCR group. Although there had been several studies on the relevant factors affecting pCR, [19][20][21] few had investigated the predictive value of the percentage decrease of maximal esophageal wall thickness for ESCC treated with NCRT. In this study, the pCR rate was significantly higher in those with a >40% decrease of maximal esophageal wall thickness than in those with ≤40%.…”

Section: Discussionmentioning

confidence: 99%

Change in Maximal Esophageal Wall Thickness Provides Prediction of Survival and Recurrence in Patients with Esophageal Squamous Cell Carcinoma After Neoadjuvant Chemoradiotherapy and Surgery

2021

CMAR

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This study aimed to evaluate the relationship of the percentage decrease of maximal esophageal wall thickness with pathological complete response (pCR) and recurrence in esophageal squamous cell carcinoma (ESCC). Patients and Methods: A total of 146 ESCC patients treated with neoadjuvant chemoradiotherapy (NCRT) and surgery were included. The prognostic factors for overall survival (OS) and disease-free survival (DFS) were analyzed. The recurrence site, time, and frequency were included in the analysis. The percentage decrease of maximal esophageal wall thickness after NCRT was determined with the formula: [(pre-post)/pre] × 100. Results: Overall, only 42 patients achieved pCR. Multivariable logistic analyses showed that the percentage decrease of maximal esophageal wall thickness (HR: 2.504; 95% CI: 1.112-5.638, P=0.027) was independently correlated with pCR. In multivariable Cox analyses, a ≤40% percentage decrease of maximal esophageal wall thickness was an independent adverse factor for both OS (HR: 1.907, 95% CI: 1.149-3.165; P=0.012) and DFS (HR: 2.054, 95% CI: 1.288-3.277; P=0.003). Compared with patients with a ≤40% percentage decrease, those with a >40% percentage decrease had better 5-year OS (29.0% vs 60.1%, P<0.05) and DFS (27.8% vs 54.4%, P<0.05). Perineural invasion (PNI) was also an unfavorable factor for OS (HR: 2.138, 95% CI: 0.094-4.178; P=0.026). Lymph vessel invasion (HR: 2.874, 95% CI: 1.574-5.248; P=0.001) and PNI (HR: 2.050; 95% CI: 1.044-4.023; P=0.037) were independent prognosticators for DFS. The rates of local and distant recurrence were also significantly difference between those with a percentage decrease of ≤40% and of >40% (P<0.05). Conclusion: The percentage decrease of maximal esophageal wall thickness is associated with pCR and recurrence in ESCC patients who undergo NCRT and surgery and can thus be used to independently predict prognosis.

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Section: Discussionmentioning

confidence: 99%

Change in Maximal Esophageal Wall Thickness Provides Prediction of Survival and Recurrence in Patients with Esophageal Squamous Cell Carcinoma After Neoadjuvant Chemoradiotherapy and Surgery

2021

CMAR

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“…Recently, several studies using National Cancer Data Base reported different results concerning the impact of radiation dose on the survival or pCR rate in esophageal cancer patients receiving neoadjuvant chemoradiation therapy (19)(20)(21)(22); three studies found irradiation dose had no impact on survival of before or after propensity matching, and one study even concluded that 41.4 Gy is associated with superior overall survival, compared to 50.4 Gy (19). Another two retrospective studies also revealed that higher neoadjuvant radiation dose did not enhance pCR rate in esophageal cancer (23,24).…”

Section: Discussionmentioning

confidence: 99%

Impact of Radiation Dose on Survival for Esophageal Squamous Cell Carcinoma Treated With Neoadjuvant Chemoradiotherapy

Yang

Xiao-fang

et al. 2020

Front. Oncol.

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Purpose: Radiation dose used in the neoadjuvant chemoradiotherapy (NCRT) for patients with locally advanced esophageal squamous cell carcinoma (ESCC) varies in different trials and clinical practice. Methods and Materials: Data from patients diagnosed with ESCC receiving NCRT followed by esophagectomy were retrospectively collected from February 2013 to December 2017. Lower dose (LD) radiotherapy was defined as ≤45 Gy, and >45 Gy was considered as higher dose (HD). Survival rates were calculated by the Kaplan-Meier method and compared with long-rank test. Multivariate Cox regression analyses were performed to identify variables associated with survival. Results: A total of 118 patients treated with NCRT were included in our analysis: 62 patients received LD radiotherapy, and 56 patients received HD radiotherapy. The median follow-up time was 24.3 months (0.67-65.3 m). Two-years overall survival (OS) rates were 75.0 and 79.0% in HD and LD group, respectively (P = 0.360), and complete pathological remission (pCR) rates in two groups were 42.9 and 30.6%, respectively (P = 0.17). The incidences of toxic effects including post-operative complications were not significantly different between two groups. Multivariate analysis showed that tumor T stage, M1a disease, smoking history, and pCR rate were significantly associated with OS. Conclusions: In ESCC patients treated with NCRT followed by surgery, higher radiation dose was not significantly associated with a higher pCR rate and longer survival. Lower radiation dose might be a preferable time-dose fraction scheme. Our finding needs to be further validated by randomized trials.

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“…As a result, changes in pathological features of the primary disease and lymph nodes in response to NCRT, as well as their prognostic value, have attracted the attention of some researchers. The rate of pathological complete response (pCR; no vital tumor cells in resected specimens or lymph nodes) after NCRT ranges from 27% to 49% (1)(2)(3)(4)(5), indicating that more than half of patients have persistent residual disease after NCRT. Recent evidence suggests that patients with ESCC who reach pCR after NCRT have longer median OS than those with residual tumor (6).…”

Section: Introductionmentioning

confidence: 99%

Moderately differentiated esophageal squamous cell carcinoma has a poor prognosis after neoadjuvant chemoradiotherapy

He¹,

Mao²,

Yan³

et al. 2021

Ann Transl Med

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Background: Neoadjuvant chemoradiotherapy (NCRT) plus surgery is the standard treatment for esophageal squamous cell carcinoma (ESCC); however, further analysis is needed to detail the histopathological characteristics of ESCC and their clinical significance after NCRT. This study aimed to present the pathological characteristics of ESCC and their association with prognosis after NCRT.Methods: All patients with ESCC who underwent NCRT followed by surgical resection at Sichuan Cancer Hospital (China) from January 2018 to December 2019 were included. Resection specimens of both the primary disease and lymph nodes were re-evaluated by an experienced pathologist. After NCRT, the pathological characteristics of the residual tumor were evaluated based on the Japanese residual tumor pattern, Mandard tumor regression grade (Mandard-TRG), local inflammatory infiltration classification, and lymph node status.Results: Among the 103 patients with ESCC included in this study, the pathological complete response (pCR) rate was 34% (35/103). The pCR rate of patients with poorly differentiated tumors (31/72) was higher (43.1%) than that of patients with well or moderately differentiated tumors (P<0.05). The residual tumor rate was 66% (68/103). A positive correlation was noted between the Japanese residual tumor pattern and Mandard-TRG (Kendall's tau-b =0.857, P<0.001). Tumor infiltration depth, lymph node positivity, moderate differentiation, and tumor recurrence were associated with poor oncological outcomes (P<0.05).Conclusions: Patients with poorly differentiated tumors can obtain an excellent short-term response; however, they have extremely poor long-term survival. For patients with moderately differentiated tumors, both the short-and long-term outcomes are poor. Lymph node status after NCRT is a prognostic factor for ESCC treated with NCRT.

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Radiation dose and pathological response in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy followed by surgery: a multi-institutional analysis

Cited by 13 publications

References 36 publications

Change in Maximal Esophageal Wall Thickness Provides Prediction of Survival and Recurrence in Patients with Esophageal Squamous Cell Carcinoma After Neoadjuvant Chemoradiotherapy and Surgery

Change in Maximal Esophageal Wall Thickness Provides Prediction of Survival and Recurrence in Patients with Esophageal Squamous Cell Carcinoma After Neoadjuvant Chemoradiotherapy and Surgery

Impact of Radiation Dose on Survival for Esophageal Squamous Cell Carcinoma Treated With Neoadjuvant Chemoradiotherapy

Moderately differentiated esophageal squamous cell carcinoma has a poor prognosis after neoadjuvant chemoradiotherapy

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