257 CHEMORADIOTHERAPY FOLLOWED BY ACTIVE SURVEILLANCE VERSUS SURGERY FOR ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW AND INDIVIDUAL PATIENT DATA META-ANALYSIS

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
B Van Der Wilk ◽  
B Eyck ◽  
W Hofstetter ◽  
J Ajani ◽  
G Piessen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Active Surveillance ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Random Effect ◽  
Neoadjuvant Chemoradiotherapy ◽  
Patient Data ◽  
Surveillance Strategy ◽  
Recurrence Rates

Abstract   Up to 50% of patients with esophageal cancer have a pathologically complete response after neoadjuvant chemoradiotherapy (nCRT) plus surgery. An active surveillance strategy may be feasible in patients with a complete clinical response (cCR) after nCRT. The aim of this study was to perform a meta-analysis using data of individual patients that underwent active surveillance with surgery for recurrent disease versus standard surgery after nCRT. Methods A systematic search was performed in Embase, Medline, Web of Science, Scopus and Cochrane from inception to February 2020. Studies were sought that reported on overall survival and recurrence rates in patients with cCR after nCRT that underwent active surveillance versus standard surgery. Authors were contacted to supply individual patient data. Pooled hazard ratio (HR) comparing survival outcomes and distant dissemination rates (DDR) between patients with cCR undergoing active surveillance or standard surgery were estimated using a random-effect meta-analysis. Cumulative incidence of locoregional recurrences in active surveillance were assessed using a Cox Frailty model. Results Seven studies including 788 patients (256 active surveillance and 532 surgery) were identified. All authors provided anonymized patient data. Pooled two- and five-year overall-survival was 75% and 58% for active surveillance and 76% and 60% for standard surgery with a pooled HR of 1.04 (95%CI:0.73–1.49) (Figure 1). Two-years DDR was 18% and 19% for active surveillance and standard surgery, respectively (HR 1.10,95%CI:0.75–1.63). Locoregional recurrence rate necessitating esophagectomy in patients undergoing active surveillance was 24% at one year, 33% at two years and 38% at five years. Active surveillance patients undergoing postponed surgery had R0 in 91% of cases. Conclusion Overall survival is comparable in patients undergoing active surveillance with postponed surgery compared to standard surgery after neoadjuvant chemoradiation. Distant dissemination rate is also comparable between both groups. During active surveillance, local regrowths developing after two years are rare. Although these data support an active surveillance strategy, randomized trials have to be completed before an active surveillance strategy can be actively proposed to patients with esophageal cancer.

Rituximab maintenance improves overall survival of patients with follicular lymphoma—Individual patient data meta-analysis

2017 ◽  
Vol 76 ◽  
pp. 216-225 ◽  
Author(s):  
Liat Vidal ◽  
Anat Gafter-Gvili ◽  
Gilles Salles ◽  
Sami Bousseta ◽  
Bernice Oberman ◽  
...  
Keyword(s):  
Overall Survival ◽  
Follicular Lymphoma ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Rituximab Maintenance

scholarly journals Surrogate End Points for Overall Survival in Loco-Regionally Advanced Nasopharyngeal Carcinoma: An Individual Patient Data Meta-analysis

2016 ◽  
Vol 109 (4) ◽  
Author(s):  
Federico Rotolo ◽  
Jean-Pierre Pignon ◽  
Jean Bourhis ◽  
Sophie Marguet ◽  
Julie Leclercq ◽  
...  
Keyword(s):  
Overall Survival ◽  
Nasopharyngeal Carcinoma ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
End Points

How accurate are published recurrence rates after rectal prolapse surgery? A meta-analysis of individual patient data

2006 ◽  
Vol 191 (6) ◽  
pp. 773-778 ◽  
Author(s):  
Giuseppe DiGiuro ◽  
Dejan Ignjatovic ◽  
Jan Brogger ◽  
Roberto Bergamaschi
Keyword(s):  
Rectal Prolapse ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Prolapse Surgery ◽  
Recurrence Rates

Chemoradiotherapy followed by active surveillance versus standard surgery for oesophageal cancer: a systematic review and individual patient data meta-analysis

2021 ◽  
Vol 47 (2) ◽  
pp. e26
Author(s):  
Berend Van Der Wilk ◽  
Ben M. Eyck ◽  
Wayne L. Hofstetter ◽  
Jaffer A. Ajani ◽  
Guillaume Piessen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Active Surveillance ◽  
Oesophageal Cancer ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data

Magnetic Resonance Imaging Improves Breast Screening Sensitivity in BRCA Mutation Carriers Age ≥ 50 Years: Evidence From an Individual Patient Data Meta-Analysis

2015 ◽  
Vol 33 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Xuan-Anh Phi ◽  
Nehmat Houssami ◽  
Inge-Marie Obdeijn ◽  
Ellen Warner ◽  
Francesco Sardanelli ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Breast Screening ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Random Effect ◽  
Patient Data ◽  
Resonance Imaging ◽  
Mutation Carriers ◽  
Screening Sensitivity

Purpose There is no consensus on whether magnetic resonance imaging (MRI) should be included in breast screening protocols for women with BRCA1/2 mutations age ≥ 50 years. Therefore, we investigated the evidence on age-related screening accuracy in women with BRCA1/2 mutations using individual patient data (IPD) meta-analysis. Patients and Methods IPD were pooled from six high-risk screening trials including women with BRCA1/2 mutations who had completed at least one screening round with both MRI and mammography. A generalized linear mixed model with repeated measurements and a random effect of studies estimated sensitivity and specificity of MRI, mammography, and the combination in all women and specifically in those age ≥ 50 years. Results Pooled analysis showed that in women age ≥ 50 years, screening sensitivity was not different from that in women age < 50 years, whereas screening specificity was. In women age ≥ 50 years, combining MRI and mammography significantly increased screening sensitivity compared with mammography alone (94.1%; 95% CI, 77.7% to 98.7% v 38.1%; 95% CI, 22.4% to 56.7%; P < .001). The combination was not significantly more sensitive than MRI alone (94.1%; 95% CI, 77.7% to 98.7% v 84.4%; 95% CI, 61.8% to 94.8%; P = .28). Combining MRI and mammography in women age ≥ 50 years resulted in sensitivity similar to that in women age < 50 years (94.1%; 95% CI, 77.7% to 98.7% v 93.2%; 95% CI, 79.3% to 98%; P = .79). Conclusion Addition of MRI to mammography for screening BRCA1/2 mutation carriers age ≥ 50 years improves screening sensitivity by a magnitude similar to that observed in younger women. Limiting screening MRI in BRCA1/2 carriers age ≥ 50 years should be reconsidered.

scholarly journals Towards an Organ-Sparing Approach for Locally Advanced Esophageal Cancer

2018 ◽  
Vol 36 (6) ◽  
pp. 462-469 ◽  
Author(s):  
Berend Jan van der Wilk ◽  
Ben M. Eyck ◽  
Manon C.W. Spaander ◽  
Roelf Valkema ◽  
Sjoerd M. Lagarde ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Active Surveillance ◽  
Residual Disease ◽  
Tumor Regression ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Distant Metastases ◽  
Phase Iii ◽  
Tumor Regression Grade ◽  
Surveillance Strategy

Background: Active surveillance after neoadjuvant therapies has emerged among several malignancies. During active surveillance, frequent assessments are performed to detect residual disease and surgery is only reserved for those patients in whom residual disease is proven or highly suspected without distant metastases. After neoadjuvant chemoradiotherapy (nCRT), nearly one-third of esophageal cancer patients achieve a pathologically complete response (pCR). Both patients that achieve a pCR and patients that harbor subclinical disseminated disease after nCRT could benefit from an active surveillance strategy. Summary: Esophagectomy is still the cornerstone of treatment in patients with esophageal cancer. Non-surgical treatment via definitive chemoradiotherapy (dCRT) is currently reserved only for patients not eligible for esophagectomy. Since salvage esophagectomy after dCRT (50–60 Gy) results in increased complications, morbidity and mortality compared to surgery after nCRT (41.4 Gy), the latter seems preferable in the setting of active surveillance. Clinical response evaluations can detect substantial (i.e., tumor regression grade [TRG] 3–4) tumors after nCRT with a sensitivity of 90%, minimizing the risk of development of non-resectable recurrences. Current scarce and retrospective literature suggests that active surveillance following nCRT might not jeopardize overall survival and postponed surgery could be performed safely. Key Message: Before an active surveillance approach could be considered standard treatment, results of phase III randomized trials should be awaited.

Interferon-α as adjuvant therapy for melanoma: An individual patient data meta-analysis of randomised trials

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8526-8526 ◽  
Author(s):  
K. Wheatley ◽  
N. Ives ◽  
A. Eggermont ◽  
J. Kirkwood ◽  
N. Cascinelli ◽  
...  
Keyword(s):  
Overall Survival ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Disease Stage ◽  
Current Evidence ◽  
Interferon Α ◽  
Published Data ◽  
Randomised Trials ◽  
Subgroup Analyses

8526 Background: Many randomised trials have evaluated the role of adjuvant interferon-a (IFN) in high-risk melanoma, some suggesting benefit and others not. To assess the totality of current evidence, an individual patient data (IPD) meta-analysis of all available trials was performed. Methods: Standard IPD meta-analysis methods were used to assess event-free (EFS) and overall survival (OS), with odds ratios (OR) and 95% confidence intervals (CI) calculated. Trials were divided by dose of IFN - high (20 MU/m2), intermediate (5–10 MU), low (3 MU) and very low (1 MU). Subgroup analyses by patient age, gender and disease characteristics were also performed. Results: IPD was provided for 10 of 13 reported trials of IFN vs. no IFN (for the other 3 trials published data were used). 6067 patients (IPD available for 85%) were included in the analysis, with over 3,700 and 3,000 events for EFS and OS. There was statistically significant benefit for IFN for both EFS (OR=0.87, CI=0.81–0.93, p=0.00006) and OS (0.9, 0.84–0.97, p=0.008). There was no evidence of differences according to dose (Table 1; trend p>0.1) or duration of IFN. This proportional survival advantage translates into an absolute benefit of about 3% (CI 1%-5%) at 5 years. The effect of IFN did not differ with age, gender, tumor site, Breslow thickness, clinical nodes or disease stage. Only for ulceration was there some evidence of an interaction (p=0.03); patients with ulcerated tumors had greater benefit from IFN (EFS: OR=0.76, OS: OR=0.77) than those with no ulceration (EFS: OR=0.94, OS: OR=0.98). Conclusions: This meta-analysis provides evidence that adjuvant IFN significantly reduces the risk of relapse and improves overall survival, although the absolute survival benefit is relatively small. This analysis does not however, clarify the optimal (high, intermediate or low) dose of IFN. Given the large number of subgroup analyses performed, the apparent increased benefit in patients with ulceration requires confirmation. No significant financial relationships to disclose.

FA03.04: ACTIVE SURVEILLANCE VS SURGERY IN CLINICALLY COMPLETE RESPONDERS AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER: A PROPENSITY-MATCHED STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 7-7
Author(s):  
Berend Van Der Wilk ◽  
Lisanne Neijenhuis ◽  
B Noordman ◽  
Grard A P Nieuwenhuijzen ◽  
M N Sosef ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Propensity Score ◽  
Active Surveillance ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Surgery Group ◽  
Significant Difference ◽  
Matched Study ◽  
Dissemination Rate

Abstract Background Nearly one third of esophageal cancer patients show a pathologically complete response in their resection specimens after neoadjuvant chemoradiotherapy (nCRT) according to CROSS regimen. This raises questions whether all patients benefit from surgery or if active surveillance can be applied to patients with a clinically complete response (cCR) after nCRT. This retrospective-multicenter propensity matched study compared outcomes of patients with a cCR after nCRT undergoing active surveillance or standard surgery. Methods Patients that refused surgery after nCRT between 2012–2017 from 4 hospitals were included. For the standard surgery group, patients from the preSANO trial were enrolled. A cCR was defined as endoscopies with multiple (bite-on-bite) biopsies, EUS-FNA and PET-CT showing no residual disease 6 and 12 weeks after completion of nCRT. Optimal propensity-score matching generated a matched cohort (1:2) matched for age, comorbidities, cT, cN, histology of the tumor and biopsy type. For comparison of severity of complications according to Clavien-Dindo (CD) classification, a separate optimal propensity-score matching cohort was generated (1:2) for all patients in the active surveillance group that underwent surgery. Primary outcome was overall survival, secondary outcomes were rate of radically resected tumors, distant dissemination rate and rate of postoperative complications according to the CD-classification. Results 75 patients were identified of whom 50 patients underwent standard surgery and 25 patients underwent active surveillance. 13 of 25 patients in the active surveillance group underwent surgery for locoregional recurrent disease. Median follow-up was 23.7 months for the standard surgery group and 18.8 months for the active surveillance group. There was no statistically significant difference between the groups in overall survival (HR = 0.48, 95%C.I. 0.10–2.2, P = 0.96). In both groups, all tumors were radically resected. There were no statistically significant differences in distant dissemination rate between the active surveillance and standard surgery group (16.0% versus 22.0%, P = 0.76) or in severity of complications (CD ≥ 3;46.2% versus 23.1%, P = 0.16). Conclusion There was no statistically significant difference in overall survival, distant dissemination rate and severity of complications between patients undergoing standard surgery or active surveillance after nCRT. However, since sample sizes were small, especially for the severity of complications, these results should be interpreted with caution. Disclosure All authors have declared no conflicts of interest.

scholarly journals Gefitinib or Erlotinib vs Chemotherapy for EGFR Mutation-Positive Lung Cancer: Individual Patient Data Meta-Analysis of Overall Survival

2017 ◽  
Vol 109 (6) ◽  
Author(s):  
Chee Khoon Lee ◽  
Lucy Davies ◽  
Yi-Long Wu ◽  
Tetsuya Mitsudomi ◽  
Akira Inoue ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Egfr Mutation ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data
Sign in / Sign up

Export Citation Format

Share Document