Surveillance versus esophagectomy in esophageal cancer patients with a clinical complete response after induction chemoradiation

Semenkovich, Tara R.; Meyers, Bryan F.

doi:10.21037/atm.2018.01.31

Cited by 21 publications

(13 citation statements)

References 42 publications

(52 reference statements)

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“…The current treatment strategy for locally advanced esophageal cancer is neoadjuvant chemoradiotherapy followed by surgery. If complete metabolic response follows neoadjuvant treatment, then an active surveillance strategy can be considered (2). However, with the commonly used metabolic imaging methods, such as positron-emitted tomography/computed tomography, it is difficult to differentiate between inflammation and residual malignancy after concurrent chemoradiotherapy.…”

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confidence: 99%

A Meta-Analysis for Using Radiomics to Predict Complete Pathological Response in Esophageal Cancer Patients Receiving Neoadjuvant Chemoradiation

Kao

Hsu

2021

In Vivo

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Background: Preservation of organ function is important in cancer treatment. The 'watch-and-wait' strategy is an important approach in management of esophageal cancer. However, clinical imaging cannot accurately evaluate the presence or absence of residual tumor after neoadjuvant chemoradiation. As a result, using radiomics to predict complete pathological response in esophageal cancer has gained in popularity in recent years. Given that the characteristics of patients and sites vary considerably, a meta-analysis is needed to investigate the predictive power of radiomics in esophageal cancer. Patients and Methods: PRISMA guidelines were used to conduct this study. PubMed, Cochrane, and Embase were searched for literature review. The quality of the selected studies was evaluated by the radiomics quality score. I 2 score and Cochran's Q test were used to evaluate heterogeneity between studies. A funnel plot was used for evaluation of publication bias. Results: A total of seven articles were collected for this meta-analysis. The pooled area under the receiver operating characteristics curve of the seven selected articles for predicting pathological complete response in eosphageal cancer patient was quite high, achieving a pooled value of 0.813 (95% confidence intervaI=0.761-0.866). The radiomics quality score ranged from −2 to 16 (maximum score: 36 points). Three out of the seven studies used machine learning algorithms, while the others used traditional biostatistics methods. One of the seven studies used morphology class features, while four studies used first-order features, and five used second-order features. Conclusion: Using radiomics to predict complete pathological response after neoadjuvant chemoradiotherapy in esophageal cancer is feasible. In the future, prospective, multicenter studies should be carried out for predicting pathological complete response in patients with esophageal cancer.

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confidence: 99%

A Meta-Analysis for Using Radiomics to Predict Complete Pathological Response in Esophageal Cancer Patients Receiving Neoadjuvant Chemoradiation

Kao

Hsu

2021

In Vivo

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“…Currently, despite the standard treatment for those patients that experience recurrence after pCR implies esophagectomy, there is increasing interest from both the patient and provider for active surveillance with so-called "salvage" esophagectomies for local recurrence as an alternative treatment paradigm. 36 Therefore, the identification of recurrence markers is of primary interest. In the present work, we observed that CD38, CD69, and Tbet mRNA relative levels were significantly lower in patients with mucosal complete response (TRG1) who recurred.…”

Section: Discussionmentioning

confidence: 99%

“… 37 These data and those obtained in our series seem to suggest that CD38 and CD69 expression in the healthy mucosa surrounding the cancer or in the site of the previous cancer might reveal the immune status of the esophageal mucosa microenvironment, which is directly related to the immune tumor response. Therefore, since the clinical decision-making in this specific patient population includes the accuracy of post-induction clinical restaging, 36 these markers might further be tested in a large prospective trial as predictors of recurrence after mucosal complete response. In fact, with improved diagnostic accuracy, nonsurgical treatment can become a solid option for patients identified as cCR after treatment administered in a neoadjuvant setting.…”

Section: Discussionmentioning

confidence: 99%

Immune surveillance activation after neoadjuvant therapy for esophageal adenocarcinoma and complete response

et al. 2020

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After neoadjuvant chemoradiotherapy for esophageal adenocarcinoma, up to 29% of patients have a pathological complete response (pCR). What to do afterward is still under debate. The aim of this prospective study was to define which local markers of immune response might act as predictors of pCR and of recurrence after pCR. The peritumoral healthy mucosa of the surgical specimen was sampled at esophagectomy and analyzed by immunohistochemistry, flow cytometry and Real-Time PCR. One hundred and twenty-three patients received neoadjuvant therapy for esophageal adenocarcinoma and were included in the study. Significantly higher rate of natural killer (NK) cells (CD57+), intraepithelial CD8 + T lymphocytes and degranulating T-and NK-cells (CD107+) were observed in the healthy mucosa of patients with pCR. Moreover, pCR was characterized by a lower immune-check points gene expression level. T-cell activation markers mRNA levels were significantly lower in patients with pCR and recurrent disease, showing an excellent accuracy in the prediction of the postoperative recurrence. Costimulatory molecules mRNA relative levels tended to be lower in patients with pCR and recurrent disease, showing a good accuracy in the prediction of postoperative recurrence in patients with pCR. The immune profile identified in this study might further be tested in large prospective trials as marker of pCR after neoadjuvant therapy and as predictor of recurrence after pCR.

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“…Only eradication of the infectious tissue enables the anastomosis to recover. But management of this complication still remains controversial (16,23), some surgeons prefer conservative methods and some prefer reoperation. According to published data, mortality of patients who received reoperation is pretty high (24).…”

Section: Discussionmentioning

confidence: 99%

Endoscope-assisted mediastinal drainage therapy for anastomosis leakage after esophagectomy: a retrospective cohort study

Guo

Zhu

et al. 2019

Ann Transl Med

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Background: Anastomosis leakage after esophagectomy is a major threat which leads to many subsequent complications even mortality. But current diagnosis and treatment methods are inefficient. This retrospective study aims to evaluate the utilization of endoscope-assisted mediastinal drainage therapy in treatment for anastomosis leakage after esophagectomy. Methods: Between January 2014 and June 2018, 51 patients were confirmed anastomosis leakage using gastroscopy. Of them, 23 patients were treated with endoscope-assisted mediastinal drainage therapy (drainage group); and the other 28 patients received endoscope-assisted biomedical fibrin glue occlusion (occlusion group). Short-term clinical outcomes were examined. Factors related to length of postoperative hospitalization (LPH) was analyzed.Results: Endoscope provided highly accurate information on the condition of anastomosis leakage. And there was no evidence that early endoscopy could cause damage to the anastomosis or gastric conduit.One patient from drainage group and two from occlusion group discharged against medical advice. Other 48 patients were completely cured without reoperation or mortality. The median LPH was 32 days in drainage group (range from 17 to 80 days) and 81 days in occlusion group (range from 32 to 190 days), respectively (P<0.05). Linear regression indicated statistically significant correlation between LPH and length from diagnosis to drainage or occlusion (R=0.688, P<0.001).Conclusions: Endoscope-assisted mediastinal drainage therapy is a satisfactory treatment for anastomosis leakage. Early diagnosis and treatment may facilitate the recovery of anastomosis leakage and reduce LPH.

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Surveillance versus esophagectomy in esophageal cancer patients with a clinical complete response after induction chemoradiation

Cited by 21 publications

References 42 publications

A Meta-Analysis for Using Radiomics to Predict Complete Pathological Response in Esophageal Cancer Patients Receiving Neoadjuvant Chemoradiation

A Meta-Analysis for Using Radiomics to Predict Complete Pathological Response in Esophageal Cancer Patients Receiving Neoadjuvant Chemoradiation

Immune surveillance activation after neoadjuvant therapy for esophageal adenocarcinoma and complete response

Endoscope-assisted mediastinal drainage therapy for anastomosis leakage after esophagectomy: a retrospective cohort study

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