444 CORRELATION BETWEEN PATHOLOGIC COMPLETE RESPONSE TO NEOADJUVANT THERAPY AND RECURRENCE IN PATIENTS WITH ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Durgatosh Pandey ◽  
Rambha Pandey ◽  
Pramod Kumar Julka
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Neoadjuvant Therapy ◽  
Pathologic Complete Response ◽  
Neoadjuvant Chemoradiotherapy ◽  
Postoperative Mortality ◽  
Effective Treatment Option ◽  
Relative Significance ◽  
Carcinoma Esophagus ◽  
Pathological Cr

Abstract   Multimodal treatment options in carcinoma esophagus include neoadjuvant chemoradiotherapy or chemotherapy followed by surgery. The degree of pathologic response to different neoadjuvant options and its impact on the oncologic outcome is a matter of debate. With this background we carried out this study to analyze the rate of pathologic complete re-sponse (pCR) and its effect on recurrence in patients with carcinoma esophagus treated with various combinations of neoadjuvant chemotherapy/radiotherapy and surgery. Methods The records of all patients with carcinoma esophagus registered in our clinics between June 2012 and December 2014 were retrieved from a prospectively maintained database and were analyzed. of the 70 patients with histologically proven esophageal cancer who were treated with curative intent during this period, those with pCR (15) were followed up for a minimum of 5 years. These 15 patients are the subjects of this study. Results Forty eight (48) patients received neoadjuvant chemotherapy (NACT), 16 were treated with short course radiotherapy (SRT), and 3 patients received neoadjuvant chemoradiation (CRT). Four patients developed metastatic disease on neoadjuvant therapy. 66 patients (63 after neoadjuvant therapy and 3 upfront) underwent transthoracic esophagect-omy. Pathological CR was seen 12 patients (25%) in NACT-surgery arm, 2 (12%) in SRT-surgery and 1 (33%) in CRT-surgery groups. Three patients had postoperative mortality due to pulmo-nary complications. At 5 yrs, 14 out of 15 patients with pathological CR are alive and disease free. One patient developed brain metastases after 3 years and died. Conclusion Neoadjuvant therapy followed by radical surgery is a safe and effective treatment option for the management of carcinoma esophagus. Pathologic CR strongly correlates with recurrence-free survival. The relative significance of pCR after different types of neoadjuvant therapies need to be tested in future studies.

scholarly journals Effect of Extending the Original CROSS Criteria on Tumor Response to Neoadjuvant Chemoradiotherapy in Esophageal Cancer Patients: A National Multicenter Cohort Analysis

2020 ◽  
Author(s):  
Helena Hong Wang ◽  
◽  
Ellen C. de Heer ◽  
Jan Binne Hulshoff ◽  
Gursah Kats-Ugurlu ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cohort Analysis ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Neoadjuvant Chemoradiotherapy ◽  
Postoperative Mortality ◽  
Complete Response ◽  
Mortality And Morbidity ◽  
The Cross ◽  
The Impact

Abstract Background Extending the original criteria of the Chemoradiotherapy for Oesophageal Cancer followed by Surgery Study (CROSS) in daily practice may increase the treatment outcome of esophageal cancer (EC) patients. This retrospective national cohort study assessed the impact on the pathologic complete response (pCR) rate and surgical outcome. Patients and Methods Data from EC patients treated between 2009 and 2017 were collected from the national Dutch Upper Gastrointestinal Cancer Audit database. Patients had locally advanced EC (cT1/N+ or cT2-4a/N0-3/M0) and were treated according to the CROSS regimen. CROSS (n = 1942) and the extended CROSS (e-CROSS; n = 1359) represent patients fulfilling the original or extended CROSS criteria, respectively. The primary outcome was total pCR (ypT0N0), while secondary outcomes were local esophageal pCR (ypT0), surgical radicality, and postoperative morbidity and mortality. Results Overall, CROSS and e-CROSS did not differ in total or local pCR rate, although a trend was observed (23.2% vs. 20.4%, p = 0.052; and 26.7% vs. 23.8%, p = 0.061). When stratifying by histology, the pCR rate was higher in the CROSS group compared with e-CROSS in squamous cell carcinomas (48.2% vs. 33.3%, p = 0.000) but not in adenocarcinomas (16.8% vs. 16.9%, p = 0.908). Surgical radicality did not differ between groups. Postoperative mortality (3.2% vs. 4.6%, p = 0.037) and morbidity (58.3% vs. 61.8%, p = 0.048) were higher in e-CROSS. Conclusion Extending the CROSS inclusion criteria for neoadjuvant chemoradiotherapy in routine clinical practice of EC patients had no impact on the pCR rate and on radicality, but was associated with increased postoperative mortality and morbidity. Importantly, effects differed between histological subtypes. Hence, in future studies, we should carefully reconsider who will benefit most in the real-world setting.

scholarly journals Loss of Skeletal Muscle Mass During Neoadjuvant Chemoradiotherapy Predicts Postoperative Mortality in Esophageal Cancer Surgery

2015 ◽  
Vol 22 (13) ◽  
pp. 4445-4452 ◽  
Author(s):  
Kostan W. Reisinger ◽  
Joanna W. A. M. Bosmans ◽  
Martine Uittenbogaart ◽  
Abdulaziz Alsoumali ◽  
Martijn Poeze ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Esophageal Cancer ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Neoadjuvant Chemoradiotherapy ◽  
Postoperative Mortality ◽  
Cancer Surgery ◽  
Esophageal Cancer Surgery

563 VARIATION IN TREATMENT PATTERNS AND OUTCOMES FOR RESECTED ESOPHAGEAL CANCER AT DESIGNATED THORACIC SURGERY CENTERS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Vaibhav Gupta ◽  
Jordan Levy ◽  
Biniam Kidane ◽  
Alyson Mahar ◽  
Jolie Ringash ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Thoracic Surgery ◽  
Neoadjuvant Therapy ◽  
Surgical Outcomes ◽  
Postoperative Mortality ◽  
Positive Margin ◽  
Treatment Patterns ◽  
Case Mix

Abstract   Ontario defined designated thoracic surgery centres to provide high-volume care for patients undergoing esophageal cancer resection. The objective of this study was to compare thoracic centres’ performance to non-thoracic centres, and to assess variation in treatment patterns and outcomes across thoracic centres. Methods A retrospective cohort study (2002–2014) was conducted in Ontario, Canada (population 13.6 million), examining adults with resected esophageal cancer. Case mix, use of neoadjuvant therapy, surgical outcomes (lymph node yield and positive margin rates) and survival were described across the 15 thoracic centres. Multivariable regression was used to estimate the effect of having surgery at designated thoracic centres on postoperative (in-hospital & 90-day post-discharge) mortality and overall survival, adjusting for case mix. Results Of 3,880 patients meeting study criteria, 2,213 had pathology data available and were included in the analysis. Average age was 64 years, 85.7% had adenocarcinoma, 50.2% were pT3, and 38.4% were pN0. Patients at thoracic centres (82.6%) received more neoadjuvant therapy, but there was no difference in positive margin rates, lymph node harvest, postoperative mortality and overall survival between thoracic and non-thoracic centres. Across thoracic centres, rates of neoadjuvant therapy varied from 16.4–81.6%, positive margin rates varied from 8.2–29.6%, median lymph node harvest varied from 7–20 nodes, postoperative mortality varied from 0–18.7%, and median survival varied from 17–26 months. Conclusion There was significant variability in treatment patterns, surgical outcomes, and survival among patients treated at designated thoracic centres. Feedback of patient outcomes to surgeons and hospitals, and translating best practices from high-performing hospitals to other hospitals, is the next step in improving outcomes.

p53 adapted neoadjuvant therapy for esophageal cancer: Pilot study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4535-4535 ◽  
Author(s):  
D. Kandioler ◽  
M. Hejna ◽  
R. Zwrtek ◽  
S. Kappel ◽  
C. Bichler ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Neoadjuvant Therapy ◽  
Squamous Cell ◽  
Direct Sequencing ◽  
P53 Gene ◽  
P53 Mutation ◽  
Chemotherapy Response ◽  
Surgical Specimen ◽  
Overall Response

4535 Background: Randomized trials could not yet prove clinical efficacy of neoadjuvant chemotherapy for esophageal cancer. A survival benefit could be shown for treatment responders only. Using platinum based regimen, yet about 20 % of patients can achieve pathological complete remission which translates in reported 3-year survival rates of 64% in this group. Factors identifying this subgroup of responders and selecting optimal drugs for non responders could dramatically enhance treatment efficacy. Several studies suggest that mutations in the p53 gene may induce drug resistance especially for agents whose effect is based on apoptosis induction, like Cisplatin. Methods: In order to test the hypothesis that the p53 genotype is predictive for chemotherapy response, a prospective study was conducted. Thirty-eight patients with potentially respectable esophageal cancer were evaluated for the relation between p53 genotype and response to two different neoadjuvant treatments. P53 gene mutations were assessed by complete direct sequencing of DNA extracted from diagnostic biopsies. Response to neoadjuvant chemotherapy was assessed pathohistologically in the surgical specimen. Results: 20 squamous cell carcinoma and 18 adenocarcinoma were included. Overall the p53 mutation rate was 58% (22/38), with 66 % for squamous cell and 53% for adenocarcinomas, respectively. 30 patients received CIS/5FU (cisplatin 80mg/m2 d1 5-FU 1,000mg/m2 d 1–5, q21,2 cycles), 8 received docetaxel (75mg/m2, q21,2 cycles). The overall response rate was 48% (18/38). Patients with p53 mutation did not respond to CIS/5-FU (0/16), while all mutant patients responded to docetaxel (6/6). The overall response to p53 adapted neoadjuvant therapy was 94%. P53 adapted treatment was associated with a significant survival advantage (p=0,042) after a median follow up of 15,4 months. Conclusions: A prospective randomized trial was initiated to test the interaction between the predictive marker p53 and response to CIS/5-FU and Docetaxel, respectively. [Table: see text] No significant financial relationships to disclose.

Factors predictive of tumor recurrence and overall survival in patients with esophageal cancer who have pathologic complete response after neo-adjuvant therapy.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 170-170
Author(s):  
Alexandra Gangi ◽  
Sarah E. Hoffe ◽  
Jessica M. Frakes ◽  
Khaldoun Almhanna ◽  
Luis Pena ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Recurrent Disease ◽  
Systemic Disease ◽  
Cell Cancer ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Specific Information ◽  
Patient Demographics

170 Background: Pathologic complete response (pCR) to neoadjuvant therapy is presumably associated with favorable outcomes in patients (pts) with esophageal cancer, but reported survival rates vary. This study evaluates patterns of recurrence after curative esophagectomy and identifies factors predictive of recurrent disease and overall survival (OS) in patients with pCR. Methods: An IRB-approved, retrospective review of a prospective esophageal cancer database was conducted. Patient demographics, perioperative data, and outcomes were examined. Recurrences were classified as locoregional (LR) or systemic. Cox regression model and Kaplan–Meier (KM) plots were used for survival analysis. Results: 837 pts with invasive esophageal cancer treated at a single institution from 1994 to 2013 were identified. 176 pts underwent neoadjuvant therapy followed by surgery and had pCR. Of these, 93.7% had adenocarcinoma and 6.3% had squamous cell cancer. Mean age was 56.6 and most pts were white (96.6%) males (79.5%). Median follow up was 42.6 months. 95 pts were treated before 2007 and 81 after. Most pts (85%) underwent transthoracic esophagectomy. All 176 pts received chemotherapy and radiation; dose-specific information was available on 144 pts, of whom most received 50.4 Gy (45%). 170 pts had recurrence data available: 39 (22.9%) had recurrent disease at a mean of 18.3 months; 5 (2.9%) with LR and 34 (20%) with systemic disease. On multivariate analysis, when evaluating patient demographics, pretreatment stage, type of surgery, type of chemotherapy, and number of lymph nodes resected, only pretreatment stage was associated with recurrence (p = 0.04). Median time to recurrence was 26.3 months for LR disease and 10.9 months for systemic disease (p = 0.3). KM estimates determined that pre-treatment stage and time of treatment ( < 2007 or ≥ 2007) were predictive of improved OS (p < 0.01, = 0.03). Conclusions: The incidence of disease recurrence in pts who experience pCR is low. The pretreatment stage and time of treatment were independent predictors of improved OS. Enhancing treatment strategies to maximize pCR would improve outcomes in pts with esophageal cancer.

Association of specific gene expression profiles with a pathologic complete response to neoadjuvant therapy in esophageal adenocarcinoma.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 51-51
Author(s):  
Patrick James McLaren ◽  
Anthony P Barnes ◽  
Willy Z Terrell ◽  
Gina M. Vaccaro ◽  
Jack Wiedrick ◽  
...  
Keyword(s):  
Gene Expression ◽  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Esophageal Adenocarcinoma ◽  
Expression Profiles ◽  
Pathologic Complete Response ◽  
Gene Expression Profiles ◽  
Complete Response ◽  
Specific Gene ◽  
Specific Gene Expression

51 Background: Predicting prognosis in esophageal cancer remains an unrealized goal despite studies linking constellations of genes to therapeutic response. In this study, we analyzed specific predictor genes expressed in tumor specimens from our institutional repository. Our aim was to determine if specific gene expression profiles are associated with pathologic complete response (pCR) after neoadjuvant chemo-radiotherapy (CRT). Methods: We investigated eleven genes identified from prior studies (CCL28, SPARC, S100A2, SPRR3, SIRT2, NOV, PERP, PAPSS2, DCK, DKK3, ALDH1) that have significant association with esophageal cancer progression. Patients with esophageal adenocarcinoma treated with neoadjuvant CRT followed by esophagectomy at our institution between January 2011 and July 2015 were included. Quantitative real-time polymerase chain reaction was conducted on pre-treatment biopsy specimens to determine gene expression. Patients were classified into two groups: 1) pCR and, 2) no or poor response (NR) after CRT based on final pathology report. An omnibus test using Mahalanobis distance was applied to evaluate overall genetic expression differences between groups. Log-rank tests compared the differential expression of individual genes. Results: 29 patients (11 pCR and 18 NR) were analyzed. Overall, gene expression profiles were significantly different between pCR and NR patients (p < 0.01). In particular, CCL28 was over-expressed in pCR (Log-HR: 1.53, 95%CI: 0.46-2.59, p = 0.005), and DKK3-was under-expressed in pCR patients (Log-HR: -1.03 95%CI: -1.97, -0.10, p = 0.031). Conclusions: Esophageal adenocarcinoma patients with a pCR after neoadjuvant therapy have genetic profiles that are significantly different from typical NR profiles. In our population, the genes CCL28 and DKK3 are potential predictors of treatment response.

scholarly journals Analysis of the Curative Effect of Neoadjuvant Therapy on Pancreatic Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Liqiong Yang ◽  
Yun Bai ◽  
Qing Li ◽  
Jie Chen ◽  
Fangfang Liu ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Neoadjuvant Therapy ◽  
Adverse Reactions ◽  
Neoadjuvant Chemoradiotherapy ◽  
Primary Treatment ◽  
R0 Resection ◽  
Resectable Pancreatic Cancer ◽  
Recurrence Rates ◽  
Borderline Resectable

The prevalence of pancreatic cancer is sharply increasing recently, which significantly increases the economic burden of the population. At present, the primary treatment of resectable pancreatic cancer is surgical resection, followed by chemotherapy with or without radiation. However, the recurrence rates remain high even after R0 resection. This treatment strategy does not distinguish undetected metastatic disease, and it is prone to postoperative complications. Neoadjuvant therapies, including neoadjuvant chemotherapy and radiotherapy, is being increasingly utilized in borderline resectable as well as resectable pancreatic cancer. This review summarized and discussed clinical trials of neoadjuvant therapy for pancreatic cancer, comparing resection rates, outcome measures, and adverse reactions between neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy.

scholarly journals Effect of extending the original eligibility criteria for the “CROSS” neoadjuvant chemoradiotherapy on toxicity and survival in esophageal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 187-187
Author(s):  
Jan-Binne Hulshoff ◽  
Ellen C. de Heer ◽  
Daphne H. Klerk ◽  
Derk Jan De Groot ◽  
John Theodorus Plukker ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cox Regression ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Postoperative Mortality ◽  
Hematologic Toxicity ◽  
Eligibility Criteria ◽  
Cox Regression Analysis ◽  
Group I ◽  
The Cross

187 Background: Patients with curable esophageal cancer (EC) which proceed beyond the original CROSS eligibility criteria are also treated with neoadjuvant chemoradiotherapy (nCRT). This study assessed the effect of extending the CROSS eligibility criteria for nCRT on treatment related toxicity and overall survival (OS) in EC. Methods: Included were 161 patients with locally advanced EC (T1N1-3/T2-4aN0-3/M0), treated with the CROSS schedule followed by esophagectomy. Group 1 (N = 90) consisted of patients which met the CROSS criteria and patients in group 2 (N = 71) met the extended eligibility criteria, i.e. including a tumor length of > 8 cm (N = 23), > 10% weight loss (N = 35), > 2 – 4 cm extension in the stomach (N = 21), celiac lymph node metastasis (N = 13), and/or age > 75 years (N = 2). We assessed the differences in hematologic toxicity (≥ grade 3) and 90-day postoperative mortality. Moreover, we assessed the prognostic value on OS with multivariate Cox regression analysis. Results: No difference was found in hematologic toxicity and 90-day mortality. The OS differed significantly (P = 0.003), with a median of 37.3 (95% CI 10.56 – 64.0) and 17.2 (95% CI 13.8 – 20.6) months in group I and II, respectively. Pathological N-stage (P = 0.024), ypT-stage (P = 0.044), and group II (P = 0.006) were independent prognostic factors for OS. Conclusions: Extension of the CROSS study eligibility criteria for nCRT did not affect hematologic toxicity and postoperative mortality, but was prognostic for OS.

RA03.01: A POPULATION-BASED STUDY ON LYMPH NODE RETRIEVAL IN PATIENTS WITH ESOPHAGEAL CANCER: RESULTS FROM THE DUTCH UPPER GASTROINTESTINAL CANCER AUDIT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 22-23
Author(s):  
Leonie Van Der Werf ◽  
Johan Dikken ◽  
Mark I Van Berge Henegouwen ◽  
Valery Lemmens ◽  
Grard A P Nieuwenhuijzen ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Neoadjuvant Therapy ◽  
Hospital Volume ◽  
Conflicts Of Interest ◽  
Neoadjuvant Chemoradiotherapy ◽  
Charlson Score ◽  
Short Term ◽  
Lymph Node Retrieval

Abstract Background For esophageal cancer, the number of retrieved lymph nodes (LNs) is often used as a quality indicator. The aim of this study was to analyze the number of retrieved LNs in the Netherlands, to assess factors associated with LN yield and to explore the association with short-term outcomes. Methods For this retrospective national cohort study, patients with an esophageal carcinoma who underwent esophagectomy between 2011–2016 were included. Primary outcome was the number of retrieved LNs. Associations were tested with univariable and multivariable regression analysis for the association with ≥ 15 LNs. Results 3970 patients were included. Between 2011–2016 the median number of LNs increased from 15 to 20. Factors independently associated with ≥ 15 LNs were: 0–10 kg preoperative weight loss (versus: unknown weight loss, odds ratio [95% confidence interval]: 0.71[0.57–0.88]), Charlson-score 0 (versus: Charlson-score 2: 0.76[0.63–0.92]), cN2-category (reference: cN0, 1.32[1.05–1.65]), no neoadjuvant therapy and neoadjuvant chemotherapy (reference: neoadjuvant chemoradiotherapy, 1.73[1.29–2.32], 2.15[1.54–3.01]), minimally invasive transthoracic (reference: open transthoracic, 1.46[1.15–1.85]), open transthoracic (versus open and minimally invasive transhiatal, 0.29[0.23–0.36] and 0.43[0.32–0.59], hospital volume of 26–50 or > 50 resections/year (reference: 0–25, 1.94[1.55–2.42], 3.01[2.36–3.83]) and year of surgery (reference: 2011, ORs: 1.48, 1.53, 2.28, 2.44, 2.54). There was no association of ≥ 15 LNs with short-term outcomes. Conclusion The number of LNs retrieved increased between 2011 and 2016. Weight loss, Charlson score, cN-category, neoadjuvant therapy, surgical approach, year of resection and hospital volume were all associated with increased LN yield. The retrieval of ≥ 15 LNs was not associated with increased postoperative morbidity/mortality. Disclosure All authors have declared no conflicts of interest.

Sign in / Sign up

Export Citation Format

Share Document