scholarly journals Temporal validation of metabolic nodal response of esophageal cancer to neoadjuvant chemotherapy as an independent predictor of unresectable disease, survival, and recurrence

2019 ◽  
Vol 29 (12) ◽  
pp. 6717-6727 ◽  
Author(s):  
John M. Findlay ◽  
Edward Dickson ◽  
Cristina Fiorani ◽  
Kevin M. Bradley ◽  
Somnath Mukherjee ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Independent Predictor ◽  
Unresectable Disease ◽  
Temporal Validation

Utility of radiation after neoadjuvant chemotherapy for surgically resectable esophageal cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 172-172
Author(s):  
Francis Igor Macedo ◽  
Kristin Kelly ◽  
Danny Yakoub ◽  
Dido Franceschi ◽  
Alan S Livingstone ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Neoadjuvant Therapy ◽  
Randomized Clinical Trials ◽  
Cox Regression ◽  
Independent Predictor ◽  
Locally Advanced ◽  
Pathological Response ◽  
Term Survival ◽  
Cancer Data

172 Background: Neoadjuvant chemotherapy (NAC) is the gold standard approach for locally advanced esophageal cancer (EC), however the addition of radiation remains largely controversial. We sought to investigate the role of neoadjuvant radiation in resectable EC by comparing outcomes of patients who underwent neoadjuvant chemotherapy with (NACR) or without radiation (NAC) using a large nationwide cohort. Methods: National Cancer Data Base (NCDB) was queried for patients with non-metastatic EC between 2010 and 2014. Kaplan-Meier, log-rank and Cox multivariable regression analysis were performed to calculate overall survival (OS). Logistic regression was used to identify factors associated with 90-day mortality and complete pathological response (pCR). Results: A total of 12,546 EC patients who underwent neoadjuvant therapy were included: the majority were males (84%), Caucasians (90.3%), and had adenocarcinoma (81.1%), cT3 (60.6%) and cN1 (49.1%). 11,269 (89.8%) patients had NACR, whereas 969 (7.7%), NAC alone. pCR rate was 14.1% (19.2%, NACR vs. 6.3%, NAC, p < 0.001). Neoadjuvant radiation was an independent predictor for improved pCR [HR 0.305, 95% CI 0.205-0.454, p < 0.001], however OS was similar in patients undergoing NAC with or without radiation (35.9 vs. 37.6 months, respectively, p = 0.393). This persisted regardless of tumor staging. There was a trend towards worse 90-day mortality after radiation (8.2%, NACR vs. 7.7%, NAC; HR 1.410, 95% CI 0.975-2.038, p = 0.068). In Cox regression, controlling for patient and disease-related factors, neoadjuvant radiation was an independent predictor of worse OS (HR 1.322, 965% CI 1.177-1.485, p < 0.001). Conclusions: This is the largest study comparing NACR versus NAC in resected EC. The addition of radiation to neoadjuvant chemotherapy is associated with improved pathological response rates, however it had deleterious effects in long-term and possibly, short-term survival. Our findings suggest that NAC without radiation may be the optimal neoadjuvant therapy in resectable EC, however further evidence with randomized clinical trials is warranted.

Impact of Synbiotics Treatment on the Bacterial Translocation Induced During Neoadjuvant Chemotherapy for Esophageal Cancer

2019 ◽  
Author(s):  
Masahide Fukaya ◽  
Yukihiro Yokoyama ◽  
Hiroaki Usui ◽  
Hironori Fujieda ◽  
Yayoi Sakatoku ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Bacterial Translocation

Tumor response to neoadjuvant chemotherapy in patients with esophageal cancer assessed with CT and FDG-PET/CT – RECIST 1.1 vs. PERCIST 1.0

2018 ◽  
Vol 101 ◽  
pp. 65-71 ◽  
Author(s):  
Soichi Odawara ◽  
Kazuhiro Kitajima ◽  
Takayuki Katsuura ◽  
Yasunori Kurahashi ◽  
Hisashi Shinohara ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Fdg Pet ◽  
Tumor Response ◽  
Recist 1.1 ◽  
Pet Ct ◽  
Percist 1.0 ◽  
Fdg Pet Ct ◽  
Response To Neoadjuvant Chemotherapy

P214 ESOPHAGECTOMY FOR ESOPHAGEAL CANCER IN AN UPPER GI UNIT OF THE NATIONAL AND KAPODISTRIAN UNIVERSITY OF ATHENS DURING THE PERIOD 2004-2019

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
K Mylonas ◽  
D Schizas ◽  
N Hashemaki ◽  
E Mpaili ◽  
V Ntomi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cox Regression ◽  
Gastroesophageal Junction ◽  
Recurrence Time ◽  
R0 Resection ◽  
Neoadjuvant Radiotherapy ◽  
Female Ratio ◽  
Upper Gi ◽  
All Cause Mortality

Abstract Aim To describe the clinicopathological features and outcomes of patients registered in the esophageal cancer database of an academic upper GI unit in Greece. Methods We performed a retrospective analysis of patients that underwent esophagectomy for esophageal or gastroesophageal junction (GEJ) cancer at an upper GI unit of the National and Kapodistrian University of Athens, during the period January 2004-June 2019. Time-to-event analyses were performed to explore trends in survival and recurrence. Results A total of 146 patients were identified. Mean patient age was 62.3 xxx 10.3 years. Male to female ratio was 6.3:1. Overall, Ivor-Lewis, McKeown, and left thoracoabdominal esophagectomy was performed in 98 (67.1%), 34 (23.3%), 12 (8.2%), patients, respectively. Pharyngolaryngoesophagectomy was performed in 2 (1.4%) cases. R0 resection was achieved in 142 (97.7%) patients. Postoperative complications developed in 62 (45.3%) patients. Neoadjuvant chemotherapy and radiation were administered to 35 (26.9%) and 11 (8.5%) patients, respectively. Postoperative chemotherapy and radiation were administered to 68 (54.8%) and 17 (13.7%) patients, respectively. In total, 4 (2.7%), 23 (15.8%), 30 (20.6%), 55 (37.7%) 34 (23.3%) patients were Stage 0, I, II, III, IV respectively. Among patients with available follow-up information, overall recurrence and all-cause mortality rates were 41.2% and 46.2%, respectively. Median recurrence time and median time of death were 11.3 months and 2.5 years, respectively. On multivariate Cox regression, presence of positive lymph nodes (HR: 1.1, p=0.03) was predictive of higher recurrence rates, while neoadjuvant chemotherapy had a protective effect on disease relapse (HR=0.4, p=0.04). On multivariate Cox regression, need for neoadjuvant radiotherapy (HR: 6.9, p=0.001) and recurrence (HR: 3.4, p=0.002) were independently associated with higher risk of all-cause mortality. Conclusions In this study, we explored outcomes of patients undergoing esophagectomy for esophageal and GEJ cancer in an upper GI unit in Greece over a 15-year period. Outcomes were comparable to those reported from major referral centers across the globe.

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