Tumor regression grading after neoadjuvant treatment of esophageal and gastroesophageal junction adenocarcinoma: results of an international Delphi consensus survey

Abstract Multimodality treatment combining surgery and oncologic treatment has become widely applied in curative treatment of esophageal and gastroesophageal junction adenocarcinoma. There is a need for a standardized tumor regression grade scoring system for clinically relevant effects of neoadjuvant treatment effects. There are numerous tumor regression grading systems in use and there is no international standardization. This review has found nine different international systems currently in use. These systems all differ in detail, which inhibits valid comparisons of results between studies. Tumor regression grading in esophageal and gastroesophageal junction adenocarcinoma needs to be improved and standardized. To achieve this goal, we have invited a significant group of international esophageal and gastroesophageal junction adenocarcinoma pathology experts to perform a structured review in the form of a Delphi process. The aims of the Delphi include specifying the details for the disposal of the surgical specimen and defining the details of, and the reporting from, the agreed histological tumor regression grade system including resected lymph nodes. The second step will be to perform a validation study of the agreed tumor regression grading system to ensure a scientifically robust inter- and intra-observer variability and to incorporate the consented tumor regression grading system in clinical studies to assess its predictive and prognostic role in treatment of esophageal and gastroesophageal junction adenocarcinomas. The ultimate aim of the project is to improve survival in esophageal and gastroesophageal adenocarcinoma by increasing the quality of tumor regression grading, which is a key component in treatment evaluation and future studies of individualized treatment of esophageal cancer.

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Gastric Lavage Malignant Cells (yGL) and Hypohemoglobinemia (yAnemia) as New Systems of Tumor Regression Grading and Prognostic Prediction for Gastric Cancer After Neoadjuvant Treatment

Anticancer Research ◽

10.21873/anticanres.13208 ◽

2019 ◽

Vol 39 (2) ◽

pp. 1019-1027 ◽

Cited By ~ 1

Author(s):

EDOARDO VIRGILIO ◽

ENRICO GIARNIERI ◽

MARIA ROSARIA GIOVAGNOLI ◽

MONICA MONTAGNINI ◽

ANTONELLA PROIETTI ◽

...

Keyword(s):

Gastric Cancer ◽

Tumor Regression ◽

Neoadjuvant Treatment ◽

Gastric Lavage ◽

Malignant Cells ◽

Regression Grading ◽

Prognostic Prediction

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Efficacy and safety of camrelizumab combined with FOLFOX as neoadjuvant therapy for patients with resectable locally advanced gastric and gastroesophageal junction adenocarcinoma who received D2 radical gastrectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16549 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16549-e16549

Author(s):

Yuzhou Zhao ◽

Guangsen Han ◽

Jing Zhuang ◽

Zhimeng Li ◽

Gangcheng Wang ◽

...

Keyword(s):

Lymph Node ◽

Neoadjuvant Therapy ◽

Gastroesophageal Junction ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

R0 Resection ◽

Lymph Node Yield ◽

D2 Lymph Node Dissection ◽

Gastroesophageal Junction Adenocarcinoma ◽

The Mean

e16549 Background: Neoadjuvant chemotherapy for patients with locally advanced gastric and gastroesophageal junction adenocarcinoma (GC/GEJC) can improve the overall survival without increasing operation risk. Nowadays, immunotherapy has become a new promising neoadjuvant treatment. Therefore, we intended to evaluate the safety and efficacy of camrelizumab (anti-PD-1 antibody) combined with FOLFOX as the neoadjuvant therapy for patients with locally advanced GC/GEJC who received D2 radical gastrectomy. Methods: Patients who were diagnosed as resectable locally advanced GC/GEJC received the neoadjuvant treatment of camrelizumab and FOLFOX every 2 weeks for 4 cycles. Imaging evaluation was performed in 2-4 weeks after neoadjuvant therapy. Patients who had no progression disease (PD) were recruited. Eligible patients underwent gastrectomy with D2 lymph node dissection through laparotomy or laparoscopic surgery. The primary end points were safety and R0 resection rate. Results: From July 24 2019 to January 31 2020, 15 patients were recruited. The mean age was 57 years. A total of 10(67%) were males and 5(33%) were females. According to AJCC 8th, cT3 and cT4 were confirmed in 7(47%) patients and 8(53%) patients, N1 and N2 in 7(47%) patients and 8(53%) patients, respectively. During operation, intraperitoneal metastases were found in 2 patients. Of the 13 surgeries, only 2 were laparoscopic and the others were laparotomy. The surgical procedures included Roux-en-Y (9, 69.2%), Billroth II (1, 7.7%) and jejunum interposition (3, 23.1%). Thirteen patients underwent gastrectomy with D2 lymph node dissection and all of them were confirmed R0 resection by postoperative pathology results. The mean lymph node yield was 44.1±13.2 nodes, positive lymph node yield was 1.8±2.8 nodes. Duration time of surgery was 186.5±45.5 minutes, mean blood loss was 219.2±109 ml during the operation. Mean hospital stays were 13.2±2.4 days. Only 1 patient experienced grade 3 pneumonia. Neither serious intraoperative complications nor immune-related adverse events both prior and post operation were observed. There was no treatment-related death. Conclusions: Camrelizumab combined with FLOFOX as neoadjuvant treatment for patients with locally advanced GC/GEJC showed acceptable toxicity and promising efficacy with low complications and mortality. Clinical trial information: NCT03939962 .

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Risk factors and patterns of recurrence after curative resection in Gastroesophageal Junction Adenocarcinoma

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.5.963 ◽

2019 ◽

Vol 35 (5) ◽

Cited By ~ 1

Author(s):

Sadaf Batool ◽

Misbah Khan ◽

Sana Amir Akbar ◽

Ijaz Ashraf

Keyword(s):

Risk Factors ◽

Curative Resection ◽

Gastroesophageal Junction ◽

Neoadjuvant Treatment ◽

Distant Metastases ◽

Type I ◽

T Stage ◽

Gastroesophageal Junction Adenocarcinoma ◽

Siewert Classification ◽

Patterns Of Recurrence

Objectives: We looked at risk factors and patterns of recurrence following surgical treatment of Gastro-Oesophageal Junction carcinoma (GOJC). Methods: Electronic medical records of patients with GOJC undergoing resection with curative intent between Jan 2009 and June 2017 at Shaukat Khanum Memorial Cancer Hospital were reviewed. GOJ cancer was classified as per Siewert classification. Clinical and operative details were studied and data was analysed using SPSS 20. Results: During the study period, we identified 78 patients with GOJ adenocarcinoma (38 patients with GOJ Type-I, 16 with Type-II tumors and 24 patients with GOJ Type-III tumors). Median age was 56 years ± 1.1. Male to female distribution was 72 versus 28%. Carbo-Pacli /5-FU based XRT verses Magic protocol (p<0.015) and advanced pathological T.-stage (p-value<0.032) were found to be statistically significant risk factors for recurrence. After a median follow up of 17.8 months+/- 1.5, 20 patients developed recurrence of which five had local recurrence, three had regional recurrence, eight had distant metastases and four had both local and distant metastases. Conclusion: The incidence of recurrence following curative resection of GOJC is 25%. Type of neoadjuvant treatment, waiting time for surgery and advanced T-stage are a risk factor for recurrence. doi: https://doi.org/10.12669/pjms.35.5.963 How to cite this:Batool S, Khan M, Akbar SA, Ashraf I. Risk factors and patterns of recurrence after curative resection in Gastroesophageal Junction Adenocarcinoma. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.963 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Tumor Regression Grading of Gastrointestinal Carcinomas after Neoadjuvant Treatment

Frontiers in Oncology ◽

10.3389/fonc.2013.00262 ◽

2013 ◽

Vol 3 ◽

Cited By ~ 62

Author(s):

Svenja Thies ◽

Rupert Langer

Keyword(s):

Tumor Regression ◽

Neoadjuvant Treatment ◽

Gastrointestinal Carcinomas ◽

Regression Grading

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Multiphoton microscopy for tumor regression grading after neoadjuvant treatment for colorectal carcinoma

World Journal of Gastroenterology ◽

10.3748/wjg.v21.i14.4210 ◽

2015 ◽

Vol 21 (14) ◽

pp. 4210 ◽

Cited By ~ 8

Author(s):

Lian-Huang Li

Keyword(s):

Colorectal Carcinoma ◽

Tumor Regression ◽

Multiphoton Microscopy ◽

Neoadjuvant Treatment ◽

Regression Grading

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Preoperative Chemoradiotherapy for Gastroesophageal Junction Adenocarcinoma Modified by PET/CT: Results of Virtual Planning Study

Medicina ◽

10.3390/medicina57121334 ◽

2021 ◽

Vol 57 (12) ◽

pp. 1334

Author(s):

Marek Slavik ◽

Petr Burkon ◽

Iveta Selingerova ◽

Pavel Krupa ◽

Tomas Kazda ◽

...

Keyword(s):

Tumor Regression ◽

Gastroesophageal Junction ◽

Left Lung ◽

Preoperative Chemoradiotherapy ◽

Planning Study ◽

Virtual Planning ◽

Dose Volume Histograms ◽

Gastroesophageal Junction Adenocarcinoma ◽

Pet Ct ◽

Peritoneal Space

Background and Objectives: The treatment of gastroesophageal junction (GEJ) adenocarcinoma consists of either perioperative chemotherapy or preoperative chemoradiotherapy. Radiotherapy (RT) in the neoadjuvant setting is associated with a higher probability of resections with negative margins (R0) and better tumor regression rate, which might be enhanced by incrementing RT dose with potential impact on treatment results. This virtual planning study demonstrates the feasibility of increasing the dose to GEJ tumor and involved nodes using PET/CT imaging. Materials and Methods: 16 patients from the chemoradiotherapy arm of the phase II GastroPET study were treated by a prescribed dose of 45.0 Gray (Gy) in 25 fractions. PET/CT was performed before treatment. The prescribed dose was virtually boosted on PET/CT-positive areas to 54.0 Gy by 9 Gy in 5 fractions. Dose-volume histograms (DVH) were compared, and normal tissue complication (NTCP) modeling was performed for both dose schedules. Results: DVHs were exceeded in mean heart dose in one case for 45.0 Gy and two cases for 54.0 Gy, peritoneal space volume criterion V45Gy < 195 ccm in three cases for 54.0 Gy and V15Gy < 825 ccm in one case for both dose schedules. The left lung volume of 25 Gy isodose exceeded 10% in most cases for both schedules. The NTCP values for the heart, spine, liver, kidneys and intestines were zero for both schemes. An increase in NTCP value was for lungs (median 3.15% vs. 4.05% for 25 × 1.8 Gy and 25 + 5 × 1.8 Gy, respectively, p = 0.013) and peritoneal space (median values for 25 × 1.8 Gy and 25 + 5 × 1.8 Gy were 3.3% and 14.25%, respectively, p < 0.001). Conclusion: Boosting PET/CT-positive areas in RT of GEJ tumors is feasible, but prospective trials are needed.

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