Recurrence patterns and associated factors of locoregional failure following neoadjuvant chemoradiation and surgery for esophageal cancer

Blackham, Aaron U.; Naqvi, Syeda Mahrukh Hussnain; Schell, Michael J.; Jin, William; Gangi, Afshin; Almhanna, Khaldoun; Fontaine, Jacques; Hoffe, Sarah E.; Frakes, Jessica M.; Venkat, Puja; Pimiento, José M.

doi:10.1002/jso.24808

Cited by 20 publications

(19 citation statements)

References 30 publications

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“…showed better local PFS in the CRT + surgery (two‐year PFS 64.3%, 95% CI 52.1–76.5%) than in the CRT group (two‐year PFS 40.7%, 95% CI 28.9–52.5%; P = 0.003) . Furthermore, some studies on esophageal SCC discovered that the amount of residual cancer, as measured by tumor regression grade, increased significantly after a longer interval between nCRT and surgery . This may have been one of the reasons why the short‐term outcome was less favorable in the non‐surgery than in the surgery group.…”

Section: Discussionmentioning

confidence: 99%

Clinical complete response after chemoradiotherapy for carcinoma of thoracic esophagus: Is esophagectomy always necessary? A systematic review and meta‐analysis

et al. 2018

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BackgroundAlthough a clinical complete response (cCR) after chemoradiotherapy (CRT) could lead to a better prognosis, the choice of a following strategy, such as surgical or non‐surgical approach, remains controversial.MethodsAll articles relevant to a comparison of surgical and non‐surgical treatment (including further definitive chemoradiotherapy or active surveillance) for esophageal carcinoma patients with a cCR after CRT were retrieved for meta‐analysis. The final date for data retrieval was 30 June 2018.ResultsFour retrospective studies including 648 patients met the inclusion criteria: 620 with squamous cell carcinoma and 28 with adenocarcinoma. The CRT + surgery group had an advantage over the non‐surgery group in regard to two‐year disease‐free survival (DFS); however, the two groups showed similar results in five‐year DFS. The CRT + surgery group had an advantage over the non‐surgery group in two‐year overall survival (OS); nevertheless, the two groups showed similar results in five‐year OS.ConclusionsBased on the available evidence, the addition of surgery to thoracic locally advanced esophageal carcinoma patients with a cCR after neoadjuvant CRT provided no advantage to long‐term survival. As an exception, the two‐year DFS and OS could be improved. This research conclusion might be more suitable to patients with squamous cell carcinoma.

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Section: Discussionmentioning

confidence: 99%

Clinical complete response after chemoradiotherapy for carcinoma of thoracic esophagus: Is esophagectomy always necessary? A systematic review and meta‐analysis

et al. 2018

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“…This was not consistent with the previous description in which a higher radiotherapy dose was required for the patients with a large tumor size ( 26 ). As previously described, pathological staging was a prognostic factor for EC ( 27 , 28 ). Nevertheless, in this study, TGLN with a diameter ≤2 cm (HR = 0.108; 95% CI, 0.047–0.249) and HFR (HR = 0.236; 95% CI, 0.105–0.528) were independent risk factors for better prognosis.…”

Section: Discussionmentioning

confidence: 98%

Hypofractionated Radiotherapy in Combination With Chemotherapy Improves Outcome of Patients With Esophageal Carcinoma Tracheoesophageal Groove Lymph Node Metastasis

Wang

Jiang³

et al. 2020

Front. Oncol.

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This study investigated the efficiency and safety of hypofractionated radiotherapy (HFR) combined with paclitaxel chemotherapy for the treatment of postsurgery tracheoesophageal groove lymph node (TGLN) metastasis in patients with esophageal cancer (EC). Fifty-three EC patients with TGLN metastasis after surgery admitted to the Yancheng Third People’s Hospital from January 2013 to June 2015 were included in this study. They were randomly divided into the HFR group ( n = 25) and conventional fractioned radiotherapy (CFR) group ( n = 28) based on the random grouping method. Patients in the HFR group received treatment with radiation of 60 Gy (5 fractions per week, total 20 fractions) combined with paclitaxel chemotherapy at a dose of 50 mg once per week for 4 weeks. Patients in the CFR group received radiation of 60 Gy (5 fractions per week, total 30 fractions) combined with paclitaxel chemotherapy at a dose of 50 mg once per week for 6 weeks. The adverse events and treatment outcomes in these two groups were analyzed. It was found that there was no significant difference in the incidence of radiation esophagitis in the HFR group compared with that of the CFR group (grades 3–4, 44.0 vs. 25.0%; P = 0.149). There was no statistical difference in the incidence of radiation pneumonitis between these two groups (grades 3–4, 16.0 vs. 7.1%; P = 0.314). No statistical difference was noticed in complete response (CR), partial response (PR), and no response (NR) between these two groups. The median overall survival (OS) in the HRF group was significantly longer compared with that of the CRF group (24.2 months (95% CI, 16.2–32.1 months) vs. 11.8 months (95% CI, 9.2–14.4 months); P = 0.024). Our results indicated that the combination of HFR and chemotherapy improved the prognosis of EC patients with TGLN metastasis with no increased adverse events.

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“…Several recent, single institution studies have identified characteristics that portend higher risk for recurrence and mortality after resection in esophageal adenocarcinoma which include high tumor grade, presence of LVI, and presence of perineural invasion. [13][14][15] Although these characteristics correlate with high risk factors as defined by the NCCN, no previous studies have validated that adjuvant therapy improves survival for patients with completely resected, pT2-4aN0M0 esophageal adenocarcinoma who have tumors with high risk characteristics. Despite the NCCN recommendations, our findings suggest there is no benefit to adjuvant therapy in these patients.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Adjuvant Therapy on Survival After Esophagectomy for Node-negative Esophageal Adenocarcinoma

Rucker

Raman²,

Jawitz³

et al. 2020

Annals of Surgery

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Objective: Determine whether adjuvant chemotherapy is associated with a survival benefit in high risk T2-4a, pathologically node-negative distal esophageal adenocarcinoma. Summary of Background Data: There is minimal literature to substantiate the NCCN guidelines recommending adjuvant therapy for patients with distal esophageal adenocarcinoma and no pathologic evidence of nodal disease. Methods: The National Cancer Database was used to identify adult patients with pT2-4aN0M0 esophageal adenocarcinoma who underwent definitive surgery (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) and had characteristics considered high risk by the NCCN. Patients were stratified by receipt of adjuvant chemotherapy with or without radiation. The primary outcome was overall survival, which was evaluated using Kaplan-Meier and multivariable Cox Proportional Hazards models. A 1:1 propensity score-matched analysis was also performed to compare survival between the groups. Results: Four hundred three patients met study criteria: 313 (78%) without adjuvant therapy and 90 who received adjuvant chemotherapy with or without radiation (22%). In both unadjusted and multivariable analysis, adjuvant chemotherapy with or without radiation was not associated with a significant survival benefit compared to no adjuvant therapy. In a subgroup analysis of 335 patients without high risk features by NCCN criteria, adjuvant chemotherapy was not independently associated with a survival benefit. Conclusion: In this analysis, adjuvant chemotherapy with or without radiation was not associated with a significant survival benefit in completely resected, pathologically node-negative distal esophageal adenocarcinoma, independent of presence of high risk characteristics. The risks and benefits of adjuvant therapy should be weighed before offering it to patients with completely resected pT2-4aN0M0 esophageal adenocarcinoma.

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Recurrence patterns and associated factors of locoregional failure following neoadjuvant chemoradiation and surgery for esophageal cancer

Abstract: Although aggressive tumor biology plays a significant role in LRR, optimizing neoadjuvant treatments to obtain a complete pathologic response may lead to improved locoregional control.

Cited by 20 publications

References 30 publications

Clinical complete response after chemoradiotherapy for carcinoma of thoracic esophagus: Is esophagectomy always necessary? A systematic review and meta‐analysis

Clinical complete response after chemoradiotherapy for carcinoma of thoracic esophagus: Is esophagectomy always necessary? A systematic review and meta‐analysis

Hypofractionated Radiotherapy in Combination With Chemotherapy Improves Outcome of Patients With Esophageal Carcinoma Tracheoesophageal Groove Lymph Node Metastasis

The Impact of Adjuvant Therapy on Survival After Esophagectomy for Node-negative Esophageal Adenocarcinoma

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