scholarly journals Complete Pathologic Response After Neoadjuvant Chemoradiotherapy for Esophageal Cancer Is Associated With Enhanced Survival

2009 ◽  
Vol 87 (2) ◽  
pp. 392-399 ◽  
Author(s):  
James M. Donahue ◽  
Francis C. Nichols ◽  
Zhuo Li ◽  
David A. Schomas ◽  
Mark S. Allen ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemoradiotherapy ◽  
Pathologic Response ◽  
Complete Pathologic Response

855 OPTIMIZATION OF SURGICAL DELAY AFTER INDUCTION CHEMORADIATION FOR ESOPHAGEAL CANCER: 10 YEARS RETROSPECTIVE MULTI-CENTER STUDY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Alexis Legault-Dupuis ◽  
Philippe Bouchard ◽  
Frederic Nicodème ◽  
Jean-Pierre Gagne ◽  
Serge Simard ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Disease Free Survival ◽  
Pathologic Response ◽  
Complete Pathologic Response ◽  
Free Survival ◽  
Surgical Delay ◽  
Multi Center Study ◽  
Disease Free ◽  
Center Study

Abstract   The treatment of esophageal cancer is in constant evolution. Most of the esophageal cancer receive induction chemoradiation therapy. Surgical delay has been studied but the optimal timing has not been clarified. Through the years, surgical delay has been modified by surgeons in our institutions, going from an average of 6 weeks delay to an average of 10 weeks delay. It is time to ask if this change has a real positive impact on our patient. Methods In this retrospective multi-center study, we combined data from two center in Quebec city that performs oncologic esophagectomy. The surgical delay went from 6 to 10 weeks around 2014. All surgeons changed their practice at that moment. We retrospectively analysed 5 years before and after the change of practice and created two cohorts of patients. Our primary outcome compared complete pathologic response rate. Our secondary outcomes were surgical complications, anastomotic leak, disease free survival and overall survival. Results Thirty-eight patients had surgery under 8 weeks (mean: 6 weeks) after their induction chemoradiation compared to 64 patients that had surgery after 8 weeks (mean: 10 weeks). There was no statistical significant difference between groups for the complete pathologic response (32% vs 25%, p = 0,16). Important complications were similar, with a rate of 24% vs 28% (p = 0,69). Anastomotic leaks were less frequent in the less than 8 weeks group, but no statistical significance was obtained (13% vs 27%, p = 0,14).No difference in the disease-free survival rate and overall survival rate was noted (DFS 40% vs 55% (p = 0,32), OS 38% vs 38% (p = 0,29)). Conclusion The treatment of esophageal cancer is in constant evolution, induction therapy and surgical technics involve over time. Surgical delay has no impact on complete pathologic response, complication and overall survival. There is no advantage to wait longer before surgery.

scholarly journals DW-MRI and DCE-MRI are of complementary value in predicting pathologic response to neoadjuvant chemoradiotherapy for esophageal cancer

2018 ◽  
Vol 57 (9) ◽  
pp. 1201-1208 ◽  
Author(s):  
Sophie E. Heethuis ◽  
Lucas Goense ◽  
Peter S. N. van Rossum ◽  
Alicia S. Borggreve ◽  
Stella Mook ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemoradiotherapy ◽  
Pathologic Response ◽  
Dce Mri ◽  
Complementary Value

Neoadjuvant chemotherapy versus chemoradiation prior to esophagectomy: Impact on rate of complete pathologic response and survival in esophageal cancer patients.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. 4054-4054
Author(s):  
Albert C. Lockhart ◽  
Pamela Parker Samson ◽  
Cliff Grant Robinson ◽  
Jeffrey D. Bradley ◽  
Varun Puri ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Pathologic Response ◽  
Complete Pathologic Response

Interim FDG-PET imaging during neoadjuvant chemoradiotherapy for esophageal cancer: Correlation with pathologic response.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 175-175
Author(s):  
Daniel Tandberg ◽  
Julian C. Hong ◽  
Yunfeng Cui ◽  
Brad Ackerson ◽  
Brian G. Czito ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Fdg Pet ◽  
Tumor Response ◽  
Neoadjuvant Chemoradiotherapy ◽  
Pathologic Response ◽  
Relative Reduction ◽  
Interim Pet ◽  
Significant Difference ◽  
Manual Contour ◽  
Pre Treatment

175 Background: In this prospective study we evaluated whether changes in metabolic tumor parameters on interim flurodeoxyglucose positron emission tomography (FDG-PET) performed during neoadjuvant chemoradiotherapy (CRT) for esophageal cancer correlates with histopathologic tumor response. Methods: From February 2012 to February 2016, 60 patients with esophageal cancer underwent PET scans before therapy and after 30-36 Gy. Patients who underwent surgery after carboplatin/paclitaxel CRT were eligible for the current analysis. PET metrics of the primary site including maximum standardized uptake value (SUVmax), SUV mean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were extracted from the pre-treatment and interim PET based on a manual contour and SUV 2.5 threshold. Patients were called histopathologic responders if they had a complete or near complete tumor response based on the modified Ryan scheme. Relative changes in PET metrics between pre-treatment and interim PET were compared between histopathologic responders and non-responders using the Mann-Whitney test and binary logistic regression. Results: Twenty-six patients were included in the analysis. Adenocarcinoma was the most common histology (n = 23). Eleven patients (42%) had a complete or near complete pathologic response to CRT (histopathologic responders). Changes in PET metrics from pre-treatment to interim PET based on the manual contour were not significantly different between responding and nonresponding tumors. The relative reduction of SUVmax (Mean ± SD) was 38.2% ± 28.4% for histopathologic responders and 27.9% ± 31.4% for non-responders. The relative reduction in MTV, SUV mean and TLG was 36.1% ± 26.2%, 23.5% ± 21.3%, and 49.3% ± 28.3% for histopathologic responders and 28.6% ± 32.0%, 11.8% ± 19.1%, and 33.1% ± 38.5% for histopathologic non-responders, respectively. When analyzed based on the SUV 2.5 threshold there continued to be no significant difference in PET metrics. Conclusions: In this pilot study we observed changes in metabolic tumor parameters on PET performed during CRT for esophageal cancer. However, these changes did not predict for histopathologic responders.

Patterns and predictors of locoregional recurrence following neoadjuvant chemoradiation for esophageal cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 173-173
Author(s):  
Aaron Udell Blackham ◽  
Will Jin ◽  
Khaldoun Almhanna ◽  
Jacques-Pierre Fontaine ◽  
Sarah E. Hoffe ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymphovascular Invasion ◽  
Lymph Node Ratio ◽  
Distant Recurrence ◽  
Neoadjuvant Chemoradiation ◽  
Pathologic Response ◽  
Complete Pathologic Response ◽  
Predicting Factors ◽  
Node Ratio

173 Background: Despite neoadjuvant chemoradiation (nCRT) followed by esophagectomy for locally advanced esophageal cancer, locoregional recurrences (LRR) are common. Specific risk factors for LRR have yet to be identified. Methods: Patients with esophageal cancer who were treated with nCRT and esophagectomy were identified from a single institution, prospectively maintained database(1996-2013). Timing and locations of recurrences were described and predicting factors of LRR were analyzed. Results: Out of 456 patients treated with nCRT for esophageal cancer, 167 patients developed known recurrence. Locoregional and distant recurrences were observed in 69(15.1%) and 140(30.9%) patients, respectively. Median recurrence-free survival was 38.5 months with a median follow-up of 30.4 months. Sixty-eight patients(40.7%) developed recurrence at multiple sites. The median time to recurrence was 13.5 months and survival following recurrence was only 8.0 months in the 27 patients(16.2%) with solitary LRR. Overall survival in patients with solitary LLR was 23.6 months, compared to 20.8 months in all patients who developed distant recurrence. Univariate analysis identified lymph node ratio > 0.5(OR 2.42, p = 0.030), non-complete pathologic response(OR 1.90, p = 0.022), positive margins(OR 3.58, p = 0.028) and lymphovascular invasion(OR 2.82, p = 0.001) as significant predicting factors for LRR. While perineural invasion(p = 0.055), nodal stage(0.053) and use of adjuvant therapy(p = 0.060) approached significance, other factors such as tumor stage, type of surgery (Ivor-Lewis vs transhiatal), radiation dose and use of IMRT were not significant predictors of LRR. Only lymphovascular invasion was an independent predictor of LRR. Conclusions: Prognosis following LRR in patients with esophageal cancer treated with nCRT is poor but is better than in patients who develop distant recurrence. High lymph node ratio, positive margin status, non-complete pathologic response and the presence of lymphovascular invasion are predictive of LRR following nCRT for esophageal cancer.

177 CT RADIOMICS BASED ON MACHINE LEARNING PREDICTING PATHOLOGIC COMPLETE RESPONSE AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Xue-Feng Leng ◽  
Qi-Feng Wang ◽  
Jin-Yi Lang ◽  
Tao Li ◽  
Yong-Tao Han ◽  
...  
Keyword(s):  
Machine Learning ◽  
Esophageal Cancer ◽  
Squamous Cell ◽  
Pathologic Complete Response ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Pathologic Response ◽  
Training Set ◽  
Term Survival ◽  
Training Cohort

Abstract   Neoadjuvant chemoradiotherapy (nCRT) has become the standard treatment for patients with locally advanced squamous cell esophageal cancer (LA-ESCC). Patients with the complete pathologic response (pCR) have significantly improved long-term survival. All efforts should be to improve the accuracy of predicting pCR. In this study, we investigate the use of radiomics based on machine learning to identify the pathologic complete response of patients with esophageal squamous cell carcinoma (ESCC) based on Computed Tomography (CT). Methods The study included 155 patients with pathologically confirmed LA-ESCC. All 155 patients underwent simulation CT before nCRT, Quantitative radiomics features were extracted from CT images of each patient. To explore the relationship between radiomics features and the pCR, we used five-fold cross validation to classify the training and the testing cohorts. The Least Absolute Shrinkage and Selectionator operator (Lasso) were used to select features useful for the grading of pCR in the training cohort. Different models were measured in the training cohort using accuracy, sensitivity, specificity, and area under the curve of the receiver operating characteristic curve (AUC). Results There were 155 patients. The pretreatment clinical stage was II in 16 patients (10.3%), III in 132 (85.2%), and IV in 7 (4.5%). Pathologic response was complete in 69 patients (44.5%), near-partial complete in 86 (55.5%). A total of 2193 radiomics features were extracted in the training set. After the use of statistical dimensionality reduction, five radiomics features were selected by Lasso to build radiomics signature. Prediction models for pCR were developed, and the model was able to predict pCR well in the training set(AUC = 0.902). In the testing cohorts, the model had a good performance in predicting pCR (AUC = 0.78). Conclusion This study showed that CT-based radiomics features could be used as biomarkers to predict the complete pathological response of esophageal cancer underwent Neoadjuvant chemoradiotherapy.

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