Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer: analysis in a large cohort

4086 Background: TMT strategy has the highest level-1 evidence for treating localized GEC. High rates of cCR (defined as post-chemoradiation negative endoscopic biopsy and physiologic uptake on PET) are common and have questioned the benefit from surgery in patients with cCR after chemoradiation. We hypothesized that cCR would be associated with a high rate of pathCR than < cCR. Methods: The data were analyzed retrospectively in 563 patients who had esophagectomy for GEC in between 2002 and 2010 at UTMDACC. Among them, 284 had TMT and post-chemoradiation endoscopic biopsies and PET (before surgery). Multiple statistical methods were used. Results: Of these 284 TMT patients, 218 (77%) patients achieved a cCR. However, only 67 (31%) of 218 had a pathCR. The sensitivity of cCR for pathCR was 97.1 % (67/69) but the specificity was low, 29.8 % (64/215). Intriguingly, 66 patients who had < cCR, only 2 patients (3%) had a pathCR. The difference in the rate of pathCR between the cCR and < cCR groups was significant (P < 0.001). Conclusions: Our data show that cCR is frequent after chemoradiation but the pathCR rate is not high and it is associated with specificity that is too low for clinical implementation. Therefore, all TMT-eligible patients, irrespective of the achievement of cCR or < cCR must be encouraged to undergo surgery. Therapies that overcome chemoradiation resistance and could increase the pathCR rate are needed for esophageal preservation in select GEC patients. Supported by UTMDACC and generous donors. [Table: see text]

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The effect of MRI or PET fusion in radiotherapy treatment planning on the pathological complete response rate in rectal adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.523 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 523-523

Author(s):

Zaker Hamid Rana ◽

Robert Hong ◽

Joon Han ◽

Isaac Chen ◽

Mohammed Nurhussien ◽

...

Keyword(s):

Rectal Cancer ◽

Treatment Planning ◽

Response Rate ◽

Pathological Complete Response ◽

Complete Response Rate ◽

Rectal Adenocarcinoma ◽

Complete Response ◽

Preoperative Chemoradiation ◽

Pathological Response ◽

Complete Pathological Response

523 Background: A pathological complete response rate of 10% to 30% has been noted to occur following preoperative chemoradiation with CT-based treatment planning in patients with rectal cancer. Fusion of the treatment planning CT with other imaging modalities like MRI or PET may help identify tumor location and improve tumor coverage. This retrospective study sought to evaluate the effect of adding MRI or PET imaging to CT-based treatment planning and its impact on pathological complete response rates in patients with rectal cancer. Methods: A retrospective analysis was performed on 39 patients, who received neoadjuvant chemoradiation for rectal adenocarcinoma from February 2009 to September 2013. Patients were divided into two groups. The first group was treated using CT-only based treatment 3D-Conformal or IMRT planning (n=9) and the second was treated using either PET or MRI fusion with the simulation CT scan (n=30). Patients were treated to a total of 5,040 cGy in 28 fractions. Pathological complete response rates (ypT0N0M0) were assessed using postoperative pathologic reports following resection. Results: 39 patients with a median age of 62 received preoperative chemoradiation with an interval to surgery ranging from 34-162 days and a median of 70 days. Patients treated with PET or MRI fusion treatment planning showed a complete pathological response rate at the primary site of 60% and a complete lymph node pathological response rate of 70.83% compared to 22.22% at the primary site and 66.66% at lymph node sites in patients with CT-only treatment planning. In patients treated using MRI or PET fusion, middle rectal cancer showed the best complete pathological response rate at 80%, followed by lower rectal cancer at 41.66%, and upper rectal cancer at 37.5%. Conclusions: Although the sample size was small, utilization of MRI or PET fusion resulted in a higher pathological complete response rate when compared to CT-only based treatment planning, especially in middle rectal cancers. Further studies are needed to accurately identify those patients with a complete pathologic response which may ultimately alter their treatment course.

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Is There a Correlation Between Clinical Complete Response and Pathological Complete Response After Neoadjuvant Chemoradiotherapy for Esophageal Squamous Cell Cancer?

Annals of Surgical Oncology ◽

10.1245/s10434-015-4764-0 ◽

2015 ◽

Vol 23 (1) ◽

pp. 273-281 ◽

Cited By ~ 10

Author(s):

Shi-Liang Liu ◽

Mian Xi ◽

Hong Yang ◽

Ya-Di Yang ◽

Ying-Jia Wu ◽

...

Keyword(s):

Squamous Cell ◽

Pathological Complete Response ◽

Squamous Cell Cancer ◽

Cell Cancer ◽

Neoadjuvant Chemoradiotherapy ◽

Complete Response ◽

Esophageal Squamous Cell Cancer ◽

Clinical Complete Response

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Omitting surgery for early breast cancer showing clinical complete response to primary systemic therapy

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa055 ◽

2020 ◽

Vol 50 (6) ◽

pp. 629-634

Author(s):

Hideo Shigematsu ◽

Tomomi Fujisawa ◽

Tadahiko Shien ◽

Hiroji Iwata

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Local Control ◽

Systemic Therapy ◽

Pathological Complete Response ◽

Complete Response ◽

Local Control Rate ◽

Primary Systemic Therapy ◽

Primary Tumor Site ◽

Clinical Complete Response

Abstract Breast cancer is highly sensitive to systemic therapy. High probability of pathological complete response suggests a clinical question that omitting surgery is an effective alternative to surgery in breast cancer showing clinical complete response to primary systemic therapy. However, the validity of omitting surgery for early breast cancer after primary systemic therapy has not been sufficiently established; thus, even if pathological complete response is expected in patients showing clinical complete response, excision of the primary tumor site remains the standard treatment of breast cancer. Inappropriate omitting surgery increases the incidence of local recurrence, which can be the risk of a subsequent distant metastasis and reduced overall survival. To achieve acceptable local control rate, omitting surgery should be investigated in patients with early breast cancer where a high percentage of pathological complete response, a high concordance rate between clinical complete response and pathological complete response and an acceptable local control rate are expected. This review presents concept and ongoing clinical trials for omitting surgery for patients with breast cancer showing clinical complete response to primary systemic therapy.

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