Residual Esophageal Cancer after Neoadjuvant Chemoradiotherapy Frequently Involves the Mucosa and Submucosa

Shapiro, Joël; Kate, Fiebo J.W. ten; Hagen, Pieter van; Biermann, Katharina; Wijnhoven, Bas P. L.; Lanschot, J. Jan B. van

doi:10.1097/sla.0b013e3182a6191d

Cited by 72 publications

(55 citation statements)

References 45 publications

(47 reference statements)

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“…At times, when a clinical complete response is achieved, there is the temptation on the part of the patient, and sometime physicians, to delay/avoid surgery. However, based on our results and those of others, 9 it is clear that EAC is a highly resistant cancer and 70% of the time, residual cancer is found. Our data also contradict the conclusions made by Shapiro et al that we can implement wait and see approach in some trimodality-eligible patients.…”

Section: Discussionsupporting

confidence: 76%

“…Shapiro et al reported one noteworthy effort 9 in which 102 consecutive patients with EC (squamous and adenocarcinoma both and they included cases that did not have any residual cancer in the specimen) were analyzed for geographic distribution of EC after chemoradiation. Only 74 patients had EAC (it is not clear how many of these had resistant EAC).…”

Section: Introductionmentioning

confidence: 99%

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Distribution of Resistant Esophageal Adenocarcinoma in the Resected Specimens of Clinical Stage III Patients after Chemoradiation: Its Clinical Implications

Neishaboori¹,

Wadhwa²,

Nogueras‐González

et al. 2015

Oncology

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Background: We have limited knowledge of the geographic distribution of resistant esophageal adenocarcinoma (EAC) in resected specimens, but its clinical importance can be enormous. Method: We selected patients with baseline stage III EAC who had had chemoradiation followed by surgery and had residual EAC (resistant cases only). Outcomes were correlated with various endpoints (percentage of resistant EAC and anatomic distribution). Results: A total of 100 clinical stage III patients were studied; 90% had an R0 resection, and 99% had either moderate or poorly differentiated EAC. Twelve percent had >50% residual cancer, 31% had 11-50% residual cancer, 53% had 1-10% residual cancer, and 3% had positive nodes only. Each compartment was frequently involved: mucosa/submucosa (66%), muscularis propria (76%), and serosa (62%); all compartments were involved in 35% of the cases. Lack of EAC (meaning response) was observed in the mucosa/submucosa (34%), muscularis propria (24%), serosa (38%), and nodes (42%). Although the endoscopic biopsies prior to surgery showed no EAC in 79% of the patients, in the surgical specimens, resistant EAC was frequently occurring in the mucosa/submucosa (66%). Conclusion: Contrary to our hypothesis that resistant EAC would be frequent in the nodes, our data show that its distribution is heterogeneous and unpredictable. Most importantly, the postchemoradiation biopsies are misleading, and a decision to delay/avoid surgery based on negative biopsies can be detrimental for the patients.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Distribution of Resistant Esophageal Adenocarcinoma in the Resected Specimens of Clinical Stage III Patients after Chemoradiation: Its Clinical Implications

Neishaboori¹,

Wadhwa²,

Nogueras‐González

et al. 2015

Oncology

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“…Shapiro and Joel et al observed that after NACRT, residual oesophageal cancer frequently involves mucosa and submucosa, whereas surrounding stroma and regional lymph nodes had highest pathological complete response. This regression pattern supports a wait and see approach after NACRT 13. A study by Oppedijk et al 14 revealed that NACRT followed by surgery significantly reduced haematogenous dissemination and locoregional recurrence when compared to surgery alone.…”

Section: Discussionmentioning

confidence: 78%

Carcinoma of the oesophagus, with multiple cutaneous metastases

et al. 2015

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A 42-year-old woman was referred, for adjuvant treatment, by an oncosurgeon (outside our centre) after a transhiatal oesophagectomy and gastric pull-up for middle one-third squamous cell carcinoma of the oesophagus pT3N1M0. She underwent adjuvant chemoradiotherapy (CRT) to the tumour bed, regional nodes and scar. RT dose planned was 45 Gy in 25 fractions over 5 weeks. During the second week of RT, a painful nodule was observed over the lower back and cytology was positive for squamous cell carcinoma. Hypofractionated radiotherapy (RT) was planned for this skin nodule as 30 Gy in 10 fractions over 2 weeks using electron beams for pain palliation. Two months later, another nodule developed at the surgical scar on the anterior abdominal wall along with lung and liver metastases. This nodule was also given palliative RT. The patient tolerated the treatment well and had partial pain relief, and, in view of poor prognosis, was advised best supportive care.

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“…For the assessment of the pathological tumor and node downstaging, the initial tumor area, before nCRT, was estimated based on the extent of regressional changes (eg, fibrosis, keratin pearls, mucous lakes, and/or foreign body cell reactions) and on the residual tumor cells in the resection specimen, as has been described previously. 30,31 These measurements were expressed as prepT and prepN, reflecting the assumed original depth of the primary tumor and the assumed number of originally involved lymph nodes, respectively. PrepT and prepN were compared with the eventual pathological ypT and ypN stages in the resection specimen after nCRT.…”

Section: Assessment Of Treatment Responsementioning

confidence: 99%

P53 and SOX2 Protein Expression Predicts Esophageal Adenocarcinoma in Response to Neoadjuvant Chemoradiotherapy

et al. 2017

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Residual Esophageal Cancer after Neoadjuvant Chemoradiotherapy Frequently Involves the Mucosa and Submucosa

Cited by 72 publications

References 45 publications

Distribution of Resistant Esophageal Adenocarcinoma in the Resected Specimens of Clinical Stage III Patients after Chemoradiation: Its Clinical Implications

Distribution of Resistant Esophageal Adenocarcinoma in the Resected Specimens of Clinical Stage III Patients after Chemoradiation: Its Clinical Implications

Carcinoma of the oesophagus, with multiple cutaneous metastases

P53 and SOX2 Protein Expression Predicts Esophageal Adenocarcinoma in Response to Neoadjuvant Chemoradiotherapy

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