Complete Pathological Response Rates and Outcome of Two Cycles Neoadjuvant Chemotherapy Followed by Long Course Concurrent Chemoradiotherapy in Patients of Locally Advanced Carcinoma Rectum

202 Background: Neoadjuvant chemotherapy with or without radiotherapy are the common treatments for locally advanced squamous-cell esophageal cancer(ESCC). There is no sufficient data to choose between these two effective therapies. The aim of our retrospective study was to compare the clinical efficacy between these two strategies of complete pathological response (pCR), postoperative morbidity, mortality, and overall and disease-free survival in patients with locally advanced ESCC. Methods: Patients with stage T2-4N0-1M0 squamous-cell esophageal cancer at our institution were recruited, including patients who underwent NCRT (1 cycle of cisplatin and 5-fluorouracil with concurrent radiotherapy) or NCT (2 cycles of cisplatin and 5-fluorouracil only ) before esophagectomy. Results: From January 2009 to October 2015, a total of 177 patients were analyzed, with 72 received NCRT and the remaining 105 received NCT. The pathological complete response (pCR) rate was 22.2% (n = 16) in NCRT group and 9.5% (n = 10) in NCT group ( P= 0.019). The postoperative mortality was 1.4% in NCRT group, versus 4.8% in NCT group. The postoperative morbidity was 20.8% in NCRT group, versus 27.6% in NCT group. There was no significant difference in recurrence between the two groups ( P= 0.397). 1-,2-,3-year overall survival rates in NCRT and NCT group were 87%, 74%, 51% and 81%, 64%, 51%, respectively ( P= 0.527), and 1-,2-,3-year DFS rates were 77%, 54%, 50% and 65%, 54%, 46%, respectively( P= 0.379). Conclusions: For patients with locally advanced squamous-cell esophageal cancer, the addition of radiotherapy to neoadjuvant chemotherapy may result in higher complete pathological response with acceptable postoperative mortality and morbidity, while the long-term survival benefit is not significant.

Download Full-text

Pathological response rate in patients who achieve clinical response after neoadjuvant concurrent chemoradiotherapy in localized esophageal cancer

Journal of Fatima Jinnah Medical University ◽

10.37018/qsqy1921 ◽

2020 ◽

Vol 14 (03) ◽

pp. 114-118

Author(s):

Ravisha Bai ◽

Ghulam Haider ◽

Kanwal Satyawan ◽

Ammara Manzoor ◽

Shahid Hussain ◽

...

Keyword(s):

Esophageal Cancer ◽

Clinical Response ◽

Stable Disease ◽

Concurrent Chemoradiotherapy ◽

Response Rate ◽

Locally Advanced ◽

Pathological Response ◽

Complete Clinical Response ◽

Complete Pathological Response ◽

Progression Of Disease

Background: The incidence of esophagus carcinoma is raising and it is the 6th leading cause of mortality. The objective of this study is to determine pathological response rate in patients who achieve clinical response after neo-adjuvant concurrent chemoradiotherapy in locally advanced esophageal cancer presented at a single tertiary care centre in Karachi. Patients and methods: It was a longitudinal study conducted at the Department of Oncology of Jinnah Postgraduate Medical College from May 2017 to July 2018. Thirty five patients with locally advanced carcinoma involving lower and middle esophagus had concurrent chemoradiotherapy. Induction of concurrent chemoradiotherapy with radiations in which carboplatin and paclitaxel was given weekly. After 6 weeks at the end of irradiation, the clinical response was assessed on CT scan. All patients who had achieved stable, partial and complete clinical response after completion of concurrent chemoradiotherapy (CCRT) underwent surgery within 6-8 weeks. After surgery, pathologist evaluated resected specimen and staging was done on the basis of residual tumor. To grade the response to therapy, the degree of histomorphologic regression classified into four categories as Pathological complete response (pCR), pathological partial response, stable disease as no pathological response and progression of disease. Statistical analysis was performed using SPSS version 23. Chi-square test was applied to assess association between effect modifiers and complete pathological response. Results: Total of 35 patients were included in the study. Mean age of the patients was 42.42±14.16 years. There was female preponderance (57.4%) with male to female ratio of 17:18. Eleven patients (31%) achieved complete clinical response and 2 patients (6%) had stable disease. After surgery, complete pathological response was observed in 21 (60%) patients. However, 10 (28.6%) patients achieved partial pathological response, 1 (2.9%) patient had stable disease and 3 (8.6%) patients showed progression of disease. Conclusion: The achievement of complete pathological response was comparatively higher than partial response among locally advanced EC patients who had neoadjuvant CCRT followed by surgery.

Download Full-text