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

Abstract Background: Surgery is the gold standard treatment for local advanced disease, while definitive concurrent chemoradiotherapy (DCRT) is recommended for those who are medically unable to tolerate major surgery or medically fit patients who decline surgery. The primary aim of this trial is to compare the outcomes in Chinese oesophageal squamous cell cancer patients with locally advanced resectable disease who have received either surgery or DCRT. Methods/design: One hundred ninety-six patients with T1bN+M0 or T2-4aN0-2M0 oesophageal squamous cell cancer will be randomized to the DCRT group or the surgery group. In the DCRT group, patients will be given intensity modulation radiation therapy (IMRT) with 50 Gy/25 fractions and basic chemotherapy with 5-fluorouracil (5-FU) regimens. In the surgery group, patients will receive neoadjuvant chemoradiotherapy (NCRT) and standard oesophagectomy. Five years of follow-up will be scheduled for patients. The primary endpoints are 2-year/5-year overall survival; the secondary endpoints are 2-year/5-year progression-free survival, treatment-related adverse events and the patients’ quality of life. The main evaluation methods include oesophagoscopy, endoscopic ultrasonography and biopsy, oesophageal barium meal, CT, PET-CT, blood tests, and questionnaires. Discussion: The preponderant oesophageal cancer pathology type is dramatically different in western Caucasian and Asian oesophageal cancer patients: Caucasian patients present with 80% adenocarcinomas, and Asians patients present with 95% squamous cell carcinomas. This phenomenon needs more in-depth studies to elucidate the differences in these populations. Based on the results of this study, we will show whether DCRT will benefit patients more than oesophagectomy. It will contribute more evidence to the management of oesophageal squamous cell cancer.

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Factors affecting pathological response and survival following neoadjuvant chemoradiotherapy in rectal cancer patients

Indian Journal of Cancer ◽

10.4103/ijc.ijc_435_19 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0

Author(s):

Meryem Aktan ◽

BerrinBenli Yavuz ◽

Gul Kanyilmaz ◽

Pembe Oltulu

Keyword(s):

Rectal Cancer ◽

Cancer Patients ◽

Neoadjuvant Chemoradiotherapy ◽

Pathological Response ◽

Factors Affecting

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RA07.06: BASELINE FDG-PET/CT PARAMETERS AS PREDICTOR FOR RESIDUAL TUMOUR AFTER NEOADJUVANT CHEMORADIOTHERAPY IN OESOPHAGEAL CANCER PATIENTS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra07.06 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 35-35

Author(s):

Maria Valkema ◽

B Noordman ◽

Bas P L Wijnhoven ◽

M C W Spaander ◽

Sjoerd M Lagarde ◽

...

Keyword(s):

Cancer Patients ◽

Lean Body Mass ◽

Body Mass ◽

Oesophageal Cancer ◽

Fdg Pet ◽

Neoadjuvant Chemoradiotherapy ◽

Tumour Mass ◽

Residual Tumour ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Background An optimal model for predicting pathologic response after neoadjuvant chemoradiotherapy (nCRT) in oesophageal cancer has not been defined yet. FDG-PET/CT is frequently used in response assessments. The aim of this side study of the preSANO trial (NL41732.078.13) was to investigate if the FDG-PET parameters SUVmax, total lesion glycolysis (TLG) and metabolic tumour volume (MTV) were predictive for residual tumour in the resected specimen of oesophageal cancer patients treated with nCRT. Methods Patients underwent FDG-PET/CT at baseline according to the European Association of Nuclear Medicine guidelines 1.0 (2.3MBq/kg F-18-FDG; scanning 60 ± 5min.). All parameters were corrected for lean body mass. MTV was defined as the volume within a 41% of SULmax ( = SUV/lean body mass) isocontour threshold at tumour and lymph nodes. TLG was calculated as SULmean x MTV. Logarithmic transformation was performed because of non-normal distribution of TLG and MTV. Baseline PET parameters were compared to tumour regression grade in the resection specimen (TRG3–4 = > 10% residual tumour vs. TRG1 = complete response). Peroperatively irresectable tumours were recoded as TRG4. Analyses were performed using an independent-samples T-test. Results From a total of 207 patients who underwent FDG-PET/CT before nCRT, 197 were included for analysis (5 were non-FDG avid, 5 had incomplete data). Histological type of tumour: adenocarcinoma (AC) n = 154, squamous cell carcinoma (SCC) n = 42, and one adenosquamous carcinoma. Thirty-seven patients (19%) had TRG1 and 41 patients (21%) had TRG3–4. In complete responders (TRG1), SULmax, TLG and MTV (mean ± SD) were 9.6 ± 5.8, 85.3 ± 85.5 and 13.0 ± 9.9, respectively. In patients with TRG3–4, SULmax, TLG and MTV were 9.4 ± 5.4145.8 ± 164.6 and 21.9 ± 16.2, respectively. SULmax was not significantly different between both groups (P = 0.8), but log(TLG) and log(MTV) (P = 0.008 and P = 0.001) were. In adenocarcinomas, log(TLG) did not differ between groups (P = 0.1). Conclusion Initial FDG tumour mass, expressed as MTV, (rather than SULmax) is the most contributing factor in predicting residual disease after nCRT in both SCC and AC. The effect is stronger in SCC. Therefore, baseline FDG tumour mass should be included in a prediction model, besides other clinical and tumour parameters. Disclosure All authors have declared no conflicts of interest.

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Evaluation of survival and recurrence patterns in esophageal cancer patients with pathological response to neoadjuvant chemoradiotherapy

Polish Journal of Cardio-Thoracic Surgery ◽

10.5114/kitp.2019.91388 ◽

2019 ◽

Vol 16 (4) ◽

pp. 186-193

Author(s):

Ali Kermani ◽

Reza Bagheri ◽

Hessam Taheri ◽

Mohsen Aliakbarian ◽

Ehsan Soltani ◽

...

Keyword(s):

Esophageal Cancer ◽

Cancer Patients ◽

Neoadjuvant Chemoradiotherapy ◽

Pathological Response ◽

Recurrence Patterns

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Chemoradiation versus Oesophagectomy for Locally Advanced Oesophageal Cancer in Chinese patients: study protocol for a randomized controlled trial

10.21203/rs.2.172/v2 ◽

2019 ◽

Author(s):

Ruinuo Jia ◽

Weijiao Yin ◽

Shuoguo Li ◽

Ruonan Li ◽

Junqiang Yang ◽

...

Keyword(s):

Cancer Patients ◽

Oesophageal Cancer ◽

Squamous Cell ◽

Squamous Cell Cancer ◽

Cell Cancer ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Chinese Patients ◽

Cancer Trial ◽

Surgery Group

Abstract Background: Surgery is the gold standard treatment for local advanced disease, while definitive concurrent chemoradiotherapy (DCRT) is recommended for those who are medically unable to tolerate major surgery or medically fit patients who decline surgery. The primary aim of this trial is to compare the outcomes in Chinese oesophageal squamous cell cancer patients with locally advanced resectable disease who have received either surgery or DCRT. Methods/design: One hundred ninety-six patients with T1bN+M0 or T2-4aN0-2M0 oesophageal squamous cell cancer will be randomized to the DCRT group or the surgery group. In the DCRT group, patients will be given intensity modulation radiation therapy (IMRT) with 50 Gy/25 fractions and basic chemotherapy with 5-fluorouracil (5-FU) regimens. In the surgery group, patients will receive neoadjuvant chemoradiotherapy (NCRT) and standard oesophagectomy. Five years of follow-up will be scheduled for patients. The primary endpoints are 2-year/5-year overall survival; the secondary endpoints are 2-year/5-year progression-free survival, treatment-related adverse events and the patients’ quality of life. The main evaluation methods include oesophagoscopy, endoscopic ultrasonography and biopsy, oesophageal barium meal, CT, PET-CT, blood tests, and questionnaires. Discussion: The preponderant oesophageal cancer pathology type is dramatically different in western Caucasian and Asian oesophageal cancer patients: Caucasian patients present with 80% adenocarcinomas, and Asians patients present with 95% squamous cell carcinomas. This phenomenon needs more in-depth studies to elucidate the differences in these populations. Based on the results of this study, we will show whether DCRT will benefit patients more than oesophagectomy. It will contribute more evidence to the management of oesophageal squamous cell cancer. Trial registration: ClinicalTrials.gov identifier NCT02972372; registered on November 26, 2016；the URL of the trial registry record: https://clinicaltrials.gov/ct2/show/NCT02972372?term=shegan+gao&rank=1

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