Sa1311 RADIATION DOSE IS NOT ASSOCIATED WITH THE SEVERITY OF ANASTOMOTIC STENOSIS AFTER NEOADJUVANT CHEMORADIOTHERAPY AND SURGICAL RESECTION IN ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CARCINOMA

167 Background: NIVO is the first adjuvant therapy to provide a statistically significant and clinically meaningful improvement in disease-free survival (DFS) versus PBO in resected EC/GEJC following neoadjuvant chemoradiotherapy as demonstrated by CheckMate 577. NIVO was well tolerated with an acceptable safety profile. This analysis provides additional information on the exploratory HRQoL endpoints in this clinical trial. Methods: The effect of NIVO versus PBO on HRQoL, including general and disease-related symptoms, functioning, disease burden, and overall QoL, was assessed using FACT-E and EQ-5D-3L patient-reported outcome (PRO) questionnaires administered at baseline (BL), every 4 weeks during the 12-month treatment period, and at post-treatment follow-up visits (up to 2 years after last dose). Longitudinal change from BL in PRO scores over 12 months was assessed using descriptive statistics. Additionally, mixed model for repeated measures and time to deterioration analyses evaluated the difference between treatment with NIVO and PBO (data not shown). Results: 794 pts with EC/GEJC were randomized 2:1 to NIVO (n = 532) or PBO (n = 262). PRO completion rates were ≥ 95% at BL and ~ 90% at 12 months on treatment. Mean (SD) BL HRQoL scores were similar between treatment arms for the FACT-E total score (NIVO: 133.40 [20.97]; PBO: 134.03 [20.40]); esophageal cancer subscale (ECS; NIVO: 50.2 [9.3]; PBO: 50.1 [8.9]); EQ-5D Visual Analogue Scale (NIVO: 70.4 [22.3]; PBO: 69.1 [24.1]); and EQ-5D Utility Index (NIVO: 0.820 [0.179]; PBO: 0.831 [0.163]) based on the UK value set. Descriptive analyses showed a trend for increases from baseline at most time points through week 49 for both NIVO and PBO treatment groups for FACT-E total score, ECS, and EQ-5D Visual Analogue Scale and Utility Index. Conclusions: Preliminary results from CheckMate 577 demonstrated that pts on NIVO treatment showed trends of improvement in both esophageal-specific and general HRQoL. Similar trends were also observed in pts treated with PBO over 1 year. Pts treated with NIVO did not experience a reduction in HRQoL, further supporting clinical data to demonstrate treatment benefit and tolerability for adjuvant NIVO in pts with resected EC/GEJC. Clinical trial information: NCT02743494.

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Watch-and-wait Strategy against Surgical Resection for Rectal Cancer Patients with Complete Clinical Response after Neoadjuvant Chemoradiotherapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2020.07.1821 ◽

2020 ◽

Vol 108 (3) ◽

pp. e596

Author(s):

Q. Wang ◽

R. Zhang ◽

W. Xiao ◽

S. Zhang ◽

M. Wei ◽

...

Keyword(s):

Rectal Cancer ◽

Clinical Response ◽

Cancer Patients ◽

Surgical Resection ◽

Neoadjuvant Chemoradiotherapy ◽

Complete Clinical Response ◽

Watch And Wait

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Radiation dose and pathological response in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy followed by surgery: a multi-institutional analysis

Acta Oncologica ◽

10.1080/0284186x.2019.1646432 ◽

2019 ◽

Vol 58 (10) ◽

pp. 1358-1365 ◽

Cited By ~ 2

Author(s):

Melissa Thomas ◽

Alicia S. Borggreve ◽

Peter S. N. van Rossum ◽

Christiaan Perneel ◽

Johnny Moons ◽

...

Keyword(s):

Radiation Dose ◽

Cancer Patients ◽

Oesophageal Cancer ◽

Institutional Analysis ◽

Neoadjuvant Chemoradiotherapy ◽

Pathological Response

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Effectiveness and safety of endoscopic radial incision and cutting for severe benign anastomotic stenosis after surgery for colorectal carcinoma: a three-case series

Endoscopy International Open ◽

10.1055/s-0043-124470 ◽

2018 ◽

Vol 06 (03) ◽

pp. E335-E339 ◽

Cited By ~ 3

Author(s):

Naoki Asayama ◽

Shinji Nagata ◽

Kenjiro Shigita ◽

Taiki Aoyama ◽

Akira Fukumoto ◽

...

Keyword(s):

Colorectal Carcinoma ◽

Surgical Resection ◽

Case Series ◽

Anastomotic Stenosis ◽

Endoscopic Dilation ◽

Limited Data ◽

Radial Incision ◽

Hiroshima City ◽

Median Interval

AbstractBenign colonic anastomotic stenosis sometimes occurs after surgical resection and usually requires surgical or endoscopic dilation. Limited data are available on the effectiveness and safety of the endoscopic radial incision and cutting (RIC) method at sites other than the esophagus. The aim of this retrospective study was to investigate the effectiveness and safety of RIC dilation for severe benign anastomotic colonic stenosis. Subjects were 3 men (median age 72 years, range 65 – 76 years) who developed severe benign anastomotic stenosis after surgical resection for colorectal carcinoma and were subsequently treated by RIC dilation at Hiroshima City Asa Citizens Hospital between May 2014 and December 2016. Severe anastomotic stenosis was defined as a narrowed anastomosis through which a standard colonoscope could not be passed. The median interval from surgery to RIC was 21 months (range 9 – 29 months). RIC was successful in all 3 patients and reduced the severity of dyschezia postoperatively; 2 patients experienced improvement after a single RIC session and the other after 6 RIC sessions. No treatment-related adverse events or re-stenosis requiring repeat dilation was noted during a median follow-up of 27 months (range 8 – 37 months). Our findings indicate that the RIC technique can be applied safely and effectively to various sites in the colon, avoiding the need for reoperation.

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A BAFfling liver aspirate: Metastatic high grade SMARCA4 deficient undifferentiated gastroesophageal junction carcinoma masquerading as a hematolymphoid malignancy

Diagnostic Cytopathology ◽

10.1002/dc.24174 ◽

2019 ◽

Author(s):

Ayse Irem Kilic ◽

Kamran Mirza ◽

Swati Mehrotra ◽

Stefan E. Pambuccian

Keyword(s):

Gastroesophageal Junction ◽

High Grade ◽

Gastroesophageal Junction Carcinoma

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Association between time interval from neoadjuvant chemoradiotherapy to surgery and complete histological tumor response in esophageal and gastroesophageal junction cancer: a national cohort study

Diseases of the Esophagus ◽

10.1093/dote/doz078 ◽

2019 ◽

Vol 33 (5) ◽

Cited By ~ 3

Author(s):

F Klevebro ◽

K Nilsson ◽

M Lindblad ◽

S Ekman ◽

J Johansson ◽

...

Keyword(s):

Overall Survival ◽

Cohort Study ◽

Gastroesophageal Junction ◽

Neoadjuvant Chemoradiotherapy ◽

Population Based ◽

R0 Resection ◽

Time Interval ◽

Histological Response ◽

Time To Surgery ◽

Prolonged Time

SUMMARY The optimal time interval from neoadjuvant therapy to surgery in the treatment of esophageal cancer is not known. The aim of this study was to investigate if a prolonged interval between completed neoadjuvant chemoradiotherapy and surgery was associated with improved histological response rates and survival in a population-based national register cohort. The population-based cohort study included patients treated with neoadjuvant chemoradiotherapy and esophagectomy due to cancer in the esophagus or gastroesophageal junction. Patients were divided into two groups based on the median time from completed neoadjuvant treatment to surgery. The primary outcome was complete histological response. Secondary outcomes were lymph node tumor response, postoperative complications, R0 resection rate, 90-day mortality, and overall survival. In total, 643 patients were included, 344 (54%) patients underwent surgery within 49 days, and 299 (47%) after 50 days or longer. The groups were similar concerning baseline characteristics except for a higher clinical tumor stage (P = 0.009) in the prolonged time to surgery group. There were no significant differences in complete histological response, R0 resection rate, postoperative complications, 90-day mortality, or overall survival. Adjusted odds ratio for ypT0 in the prolonged time to surgery group was 0.99 (95% confidence interval: 0.64–1.53). Complete histological response in the primary tumor (ypT0) was associated with significantly higher overall survival: adjusted hazard ratio: 0.55 (95% CI 0.41–0.76). If lymph node metastases were present in these patients, the survival was, however, significantly lower: adjusted hazard ratio for ypT0N1: 2.30 (95% CI 1.21–4.35). In this prospectively collected, nationwide cohort study of esophageal and junctional type 1 and 2 cancer patients, there were no associations between time to surgery and histological complete response, postoperative outcomes, or overall survival. The results suggest that it is safe for patients to postpone surgery at least 7 to 10 weeks after completed chemoradiotherapy, but no evidence was seen in favor of recommending a prolonged time to surgery after neoadjuvant chemoradiotherapy for esophageal cancer. A definitive answer to this question requires a randomized controlled trial of standard vs. prolonged time to surgery.

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