761 PATIENT PREFERENCES FOR ACTIVE SURVEILLANCE VERSUS STANDARD SURGERY AFTER NEOADJUVANT CHEMORADIOTHERAPY IN ESOPHAGEAL CANCER TREATMENT

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Merel Hermus ◽  
Berend Wilk ◽  
Gerlise Collee ◽  
Rebecca Chang ◽  
Bo Noordman ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Active Surveillance ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Treatment Preference ◽  
Patient Treatment ◽  
Treatment Preferences ◽  
Future Health ◽  
Depth Interviews

Abstract   The need for standard surgical resection in esophageal cancer patients after neoadjuvant chemoradiotherapy (nCRT) is subject of debate. Possibly, active surveillance (AS) is an option for patients with a clinically complete response (cCR), in whom no vital tumor cells are detected after nCRT. In a large Dutch multicenter randomized trial (SANO trial), standard surgery is compared to AS in patients with a cCR. Within this trial, we performed a side-study on patient treatment preferences. Methods Esophageal cancer patients, who declined participation in the SANO-trial due to a strong treatment preference for either AS or surgery were included. In-depth interviews were held on patient’s motives for their treatment choice. First, personal motives were addressed in an open manner, and later specific topics were addressed: earlier experiences with illness and health care, future health expectations, emotional motives, religious or spiritual believes and values in life. Data was recorded, transcribed verbatim and qualitatively analyzed according to the grounded theory principles. In addition, questionnaires on health literacy, coping, anxiety and decision regret were administered at two time points. Results Forty patients participated: twenty preferred AS and twenty standard surgery. The central principle for all patients is striving for safety while dealing with the threat of cancer. However, patients express different coping strategies in dealing with this threat. Patients preferring AS rely on trusting their bodies and good outcomes, while questioning the need for surgery. Patients preferring surgery try to minimize insecurity by eliminating the source of the cancer, while arguing that chances for undergoing surgery are high anyway. Interestingly, for either treatment option comparable arguments were used, with the most striking one of wishing ‘not to become a patient’. Conclusion Patients’ preferences in the treatment of esophageal cancer are determined by the way they cope with the threat of cancer. Since the arguments given for either AS or standard surgery can be comparable or even similar, the need for healthcare professionals to discuss what truly matters to their patients is of high importance. Subsequently, attuning to the personal needs of esophageal cancer patients will benefit the decision making process on future treatment.

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.

Su1618 Restaging PET-CT After Neoadjuvant Chemoradiotherapy Can Prevent Non-Curative Surgical Interventions in Esophageal Cancer Patients

2013 ◽  
Vol 144 (5) ◽  
pp. S-1075
Author(s):  
Martinus C. Anderegg ◽  
Roelof J. Bennink ◽  
Hanneke van Laarhoven ◽  
Jean H. Klinkenbijl ◽  
Maarten C. Hulshof ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Neoadjuvant Chemoradiotherapy ◽  
Surgical Interventions ◽  
Pet Ct

PS02.249: VARIATION IN BODY COMPOSITION IN ESOPHAGEAL CANCER PATIENTS RECEIVING SUPPLEMENTARY JEJUNOSTOMY FEEDING DURING NEOADJUVANT CHEMORADIOTHERAPY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 194-194
Author(s):  
Piers R Boshier ◽  
M F J Seesing ◽  
Vickie E Baracos ◽  
Donald E Low
Keyword(s):  
Esophageal Cancer ◽  
Body Composition ◽  
Cancer Patients ◽  
Neoadjuvant Chemoradiotherapy ◽  
The Body ◽  
Tissue Loss ◽  
Tube Placement ◽  
Average Weight ◽  
Term Survival ◽  
Jejunostomy Feeding

Abstract Background Cancer of the esophagus has one of the highest known associations with cancer–related malnutrition. The aim of the current study was to investigate variation in the body composition of esophageal cancer patients receiving supplementary jejunostomy feeding during neoadjuvant chemoradiotherapy (nCRT) and to assess its correlation with outcomes. Methods Retrospective review of esophageal cancer patient's receiving jejunal feeding during nCRT. Patients selected for jejunal feeding tube placement were considered at high nutritional risk according to ASPEN criteria. Assessment of body composition was performed using L3-axial CT images acquired at diagnosis and after nCRT. Results Eighty-one patients were eligible for inclusion (67 M, 65.9 ± 9.7 yrs). Average weight loss and BMI at diagnosis was 11.4 ± 6.5 Kg and 26.1 ± 4.6 Kg/m2 respectively. Failure to complete nCRT as prescribed occurred in one patient. Following nCRT the prevalence of sarcopenia increased significantly in males despite jejunal feeding (69% vs. 87%; P = 0.013) but fell in females (57% vs. 50%; P = 0.705). Patients could be categorized into three distinct groups according to the degree of skeletal muscle loss (ΔSMM) during nCRT: minor-loss/no-change (n = 28; Δ > −6 cm2); moderate loss (n = 27; Δ−17 to −6 cm2), and; severe loss (n = 26; Δ<17 cm2). A female predominance was observed amongst patients with minor-loss/no-change in SMM compared to patients with moderate and severe losses during nCRT (36% vs. 11% vs. 4%; P = 0.005). Visceral obesity was also less common in patients with minor-loss/no-change in SMM compared to patients with moderate and severe losses during nCRT (39% vs. 48% vs. 58%; P = 0.401). Compared to patients with moderate and severe SMM losses patients in whom SMM was persevered by jejunal feeding during nCRT tended to have lower rates of over-all complications (62% vs. 59% vs. 43%; P = 0.318); pneumonia (27% vs. 11% vs. 11%; P = 0.186), and; pulmonary embolism (15% vs. 0% vs. 0%; P = 0.012). Long-term survival was not affected by either sarcopenia or SMM and adipose tissue loss during nCRT (P > 0.05). Conclusion This is the first study to report variation in body composition in esophageal cancer patients receiving a defined nutritional intervention during nCRT. In selected patients jejunal feeding appeared to stabilize parameters of body composition whilst other patients experienced significant losses. Observed changes in body composition predominantly reflect sex differences and may offer an opportunity to improve nutritional monitoring and future patient care. Disclosure All authors have declared no conflicts of interest.

Different recurrence pattern after neoadjuvant chemoradiotherapy compared to surgery alone in esophageal cancer patients.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 82-82
Author(s):  
John Theodorus Plukker ◽  
Justin Smit ◽  
Sahin Guler ◽  
Jannet Beukema ◽  
Veronique E. Mul ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Neoadjuvant Chemoradiotherapy ◽  
Distant Recurrence ◽  
Rank Test ◽  
Skeletal Metastases ◽  
Recurrence Pattern ◽  
Common Site ◽  
Historical Cohort ◽  
Log Rank Test

82 Background: Neoadjuvant chemoradiotherapy (CRT) is currently considered standard treatment in esophageal cancer patients who are eligible for surgical resection with curative intent. Objective was to evaluate the recurrence pattern after neoadjuvant CRT in patients with esophageal cancer. Methods: We analyzed the results and recurrence patterns from a single center (N=152) in a propensity score matched study between patients treated with neoadjuvant CRT (N=44) and surgery alone (44 from the 108),in the period 2002-2010. Patients treated with neoadjuvant (CROSS schedule) carboplatin/paclitaxel and 41.4 Gy radiotherapy, were compared with a historical cohort of patients with curative intended surgery alone. Surgery was performed through a transthoracic approach with 2-field lymphadenectomy. Results: After matching, the baseline characteristics were equally distributed between both groups (table 1). The response to CRT was 63%, with a pathological complete response of 26%. After a median follow-up of 23 months (7-74 months), lung was the most common site of distant recurrence (16%, N=7), followed by distant lymph nodes (11%, N=5) in the neoadjuvant CRT group, whereas skeletal metastases were the most common site of distant recurrence (18%, N=8), followed by skin or soft tissue (16%, N=7) in the surgical alone group. The estimated 3 and 5 year overall survival was 62% and 55% in the neoadjuvant CRT group, compared to 37% and 31% in the surgery group (Log-rank test: P=0.018). The estimated locoregional free recurrence survival (LRFS) after 3 and 5 years was 79% and 68% in the neoadjuvant CRT group, compared to 44% and 40% in the surgery alone group (Log-rank test: P=0.049). The estimated distant recurrence free survival (DRFS) was 63% and 54% after 3 and 5 years in the neoadjuvant CRT group, compared to 50% and 35% in the surgery alone group (Log-rank test: P=0.314). Conclusions: This neoadjuvant CRT regimen significantly improved oncological outcome compared to surgery alone. An important shift in recurrence pattern was observed from relatively high locoregional recurrences (LRFS) to relatively more distant recurrences (DRFS) in the CRT group compared to the surgery alone group.

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