Predictors of Pathologic Complete Response Rates in Patients Receiving Trimodality Therapy for Esophageal Cancer

2013 ◽  
Vol 87 (2) ◽  
pp. S289
Author(s):  
H. Boggs ◽  
C. Tarabolous ◽  
N. Horiba ◽  
W. Burrows ◽  
C. Morris ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Pathologic Complete Response ◽  
Response Rates ◽  
Complete Response ◽  
Trimodality Therapy

Changes in neutrophil-to-lympocyte and platelet-to-lymphocyte ratios to predict survival and pathologic complete response in esophageal cancer patients who receive trimodality therapy.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 170-170
Author(s):  
Jalal Hyder ◽  
Drexell Boggs ◽  
Andrew Hanna ◽  
Mohan Suntharalingam ◽  
Michael David Chuong
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Cox Regression ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Prognostic Significance ◽  
Progression Free Survival ◽  
Complete Response ◽  
Trimodality Therapy ◽  
Lymphocyte Ratio

170 Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) predict for survival in cancer patients. In patients receiving multi-modality therapy, the effect of each specific therapy on the NLR and PLR is not well understood. We therefore evaluated changes in NLR and PLR among locally advanced esophageal cancer patients who received trimodality therapy. Methods: We performed a retrospective analysis of non-metastatic patients with esophageal cancer who received neoadjuvant chemoradiation (CRT) followed by esophagectomy at our institution between March 2000 and April 2012. NLR and PLR values were obtained the following time points (TP): 1) at diagnosis before CRT, 2) after CRT prior to surgery, and 3) after surgery. We also evaluated change in NLR and PLR using the difference and ratio between TPs. Overall survival (OS) was evaluated by Kaplan-Meier analysis. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of NLR and PLR. Results: 83 patients with stage II-IV esophageal cancer and median age 60 years were included. Median follow up was 29.3 months. Median dose of 50.4 Gy (50.4-59.4) in 28 fractions (28-33) was used. Median NLR and PLR at the each TP: 1) 3.3 and 157.2, 2) 12 and 645, and 11.5 and 391.7, respectively. On multivariate analysis, inferior OS was associated with PLR ≥250 at TP 3 (p=.03), PLR decrease ≥609.2 from TP 2-3 (p=.02), and PLR ratio (TP 1/TP3) ≥1.08 (p=.03). Inferior progression free survival (PFS) was associated with NLR at TP 2 ≥36 (p=.0008), NLR increase ≥28.3 from TP 1-2 (p=.0005), PLR increase from TP 1-3 ≥19 (p=.01), and PLR ratio (TP 2/TP 3) ≥0.34 (p=0.1). Pathologic complete response (pCR) was less likely for adenocarcinoma histology (p=.03), NLR at TP 2 ≥10.6 (p=.04), and NLR increase from TP 1 to TP 2 ≥4.6 (p=.03). Conclusions: This is the first study to demonstrate that changes in NLR and PLR throughout trimodality therapy for esophageal cancer correlate with OS, PFS, and pCR. Further evaluation is warranted to better define which of the identified cut-off values are most clinically significant.

Timing after neoadjuvant therapy predicts mortality in patients undergoing esophagectomy.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 157-157
Author(s):  
Taylor Maramara ◽  
Jamie Huston ◽  
Ravi Shridhar ◽  
Kenneth L Meredith
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Pathologic Complete Response ◽  
Response Rates ◽  
Complete Response ◽  
Pathologic Response ◽  
Chi Square ◽  
Surgery Timing ◽  
Improvement In Survival ◽  
The Impact

157 Background: Neoadjuvant therapy (NT) prior to esophagectomy has dramatically improved survival in patients with esophageal cancer. Currently, most surgeons will allow 6-12 weeks after NT prior to recommending esophagectomy. Given that complete pathologic response (pCR) correlates to an improvement in survival, some have advocated a longer interval should be entertained to increase the pathologic response. The impact of an expanded NT-surgery timing is not currently well understood. Methods: Utilizing the National Cancer Database, we identified patients with esophageal cancer who underwent NT followed by esophagectomy. Patients were divided into 4 time intervals: < 6 wks, 6-12 wks, 3-6 mo, and > 6 mo. Mann-Whitney U, Kruskal Wallis, and Pearson’s Chi-square test were used as appropriate. Survival analyses were performed using the Kaplan-Meier method and p < 0.05 was considered significant. Results: We identified 9,256 patients who received NT followed by esophagectomy. There were 8,053 (87%) adenocarcinomas and N = 1203 (13%) squamous cell carcinomas. 7,858 (84.9%) were male and 1,398 (15.1%) female with a median age was 62 (24-88). R0 resections decreased as the NT-Surgery interval increased: < 6 wks, 6-12 wks, 2-6 mos, and > 6 mos at 93%, 94.1%, 94.1%, and 86.2% respectfully p = 0.004. Additionally, the median lymph nodes harvested decreased as timing increased: 12, 12, 10, and 9 p < 0.001 and the median nodes positive decreased as timing increased 1.5, 1.3, 1.1, and 2.4 p = 0.01. The complete response rates increased as timing increased 15.5%, 20.1%, 22.7%, and 25.8% p < 0.001. However, this improvement in pCR did not translate into an increase in median survival: < 6 wks 40.9 mos, 6-12 weeks 38.5 mos, 3-6 mos 34.8 mos, and > 6 mos 39.8 mos of survival, p = 0.94 90-day mortality increased as the timing from neoadjuvant therapy increased: 6.4%, 7.9%, 9.4%, and 16.0%, respectively p = 0.001. Conclusions: Our data demonstrates that patients who have a prolonged NT- esophagectomy interval will have a substantial increase in 90-day mortality. While there was an increase in pathologic complete response rates, this did not translate into an improvement in survival. The current recommendations of a NT-surgery timing of 6-12 weeks should remain.

scholarly journals Analysis of pathological complete response rates with paclitaxel-based regimens in trimodality therapy for esophageal cancer

2014 ◽  
Vol 28 (7) ◽  
pp. 619-625 ◽  
Author(s):  
D. H. Boggs ◽  
C. Tarabolous ◽  
C. G. Morris ◽  
A. Hanna ◽  
W. Burrows ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Pathological Complete Response ◽  
Response Rates ◽  
Complete Response ◽  
Trimodality Therapy

Effect of increased time from chemoradiation to surgery on the pathologic complete response rate in patients with esophageal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 84-84 ◽  
Author(s):  
Talha Shaikh ◽  
Karen Ruth ◽  
Walter Joseph Scott ◽  
Barbara Burtness ◽  
Steven J. Cohen ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Dose ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Distant Recurrence ◽  
Trimodality Therapy ◽  
T2 Lesions ◽  
Resectable Esophageal ◽  
Pathologic Complete Response Rate ◽  
Clinical Records

84 Background: Studies have demonstrated that pathologic complete response (pCR) in patients undergoing tri-modality treatment for esophageal cancer predicts for decreased local and distant recurrence, as well as increased survival. Increased time from chemoradiation (CRT) to surgery has been shown to increase pCR rates in rectal cancer. This study assessed the effect of the time between the end of CRT and surgery on pCR rates in esophageal cancer. Methods: Clinical records identified 231 patients with resectable esophageal cancer who were treated with CRT from 2000 to 2011, of which 89 underwent subsequent surgery. The records were analyzed for predictors of pCR. Univariate and multivariable analyses were used to determine the significance of all predictors of pCR. Results: Of 89 patients completing trimodality therapy, 76 were male, and the median age was 61 years (range=36-80). Adenocarcinomas comprised 75 patients, and 14 were squamous cell carcinomas. Nine patients had T1/T2 lesions and 80 patients had T3/T4 lesions; 68 patients had node positive tumors. 72 patients received 5FU-based therapy and 17 patients received carboplatin-based therapy. The median radiation dose was 5040 cGy (720-6000) and median follow-up was 24 months. Overall, pCR was seen in 21 patients (24%). The median time from CRT to surgery for a pCR was 102 days vs. 87 days for less than a pCR (p=0.06). By quartile of time from CRT to surgery, pCRs were 18% for <81 days, 13% for 81-88 days, 18% for 89-102 days, and 45% for 103+ days (p=0.05). Multivariable logistic regression showed a trend towards a difference in pCR rates by interval quartile (p=0.06); OR for the highest vs lowest quartile was 5.3 (95% CI=1.1 to 25.6). T stage, N stage, histology, radiation dose and type of chemotherapy were not predictive of a pCR. Conclusions: In this retrospective study, increased time between CRT and surgery was associated with a trend toward increased pCR rates; patients in the longest interval quartile (103+ days) had more pCRs than patients in the shortest interval quartile (<81 days). These data suggest further evaluation of time from CRT to surgery is warranted.

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