854 OPTIMIZATION OF SURGICAL DELAY AFTER INDUCTION CHEMORADIATION FOR ESOPHAGEAL CANCER: 10 YEARS RETROSPECTIVE MULTI-CENTER STUDY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Alexis Legault-Dupuis ◽  
Philippe Bouchard ◽  
Frederic Nicodeme ◽  
Jean-Pierre Gagne ◽  
Serge Simard ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Disease Free Survival ◽  
Pathologic Response ◽  
Complete Pathologic Response ◽  
Free Survival ◽  
Surgical Delay ◽  
Multi Center Study ◽  
Disease Free ◽  
Center Study

Abstract   The treatment of esophageal cancer is in constant evolution. Most of the esophageal cancer receive induction chemoradiation therapy. Surgical delay has been studied but the optimal timing has not been clarified. Through the years, surgical delay has been modified by surgeons in our institutions, going from an average of 6 weeks delay to an average of 10 weeks delay. It is time to ask if this change has a real positive impact on our patient. Methods In this retrospective multi-center study, we combined data from two center in Quebec city that performs oncologic esophagectomy. The surgical delay went from 6 to 10 weeks around 2014. All surgeons changed their practice at that moment. We retrospectively analysed 5 years before and after the change of practice and created two cohorts of patients. Our primary outcome compared complete pathologic response rate. Our secondary outcomes were surgical complications, anastomotic leak, disease free survival and overall survival. Results Thirty-eight patients had surgery under 8 weeks (mean: 6 weeks) after their induction chemoradiation compared to 64 patients that had surgery after 8 weeks (mean: 10 weeks). There was no statistical significant difference between groups for the complete pathologic response (32% vs 25%, p = 0,16). Important complications were similar, with a rate of 24% vs 28% (p = 0,69). Anastomotic leaks were less frequent in the less than 8 weeks group, but no statistical significance was obtained (13% vs 27%, p = 0,14). No difference in disease-free survival rate and overall survival rate was noted (DFS 40% vs 55% (p = 0,32), OS 38% vs 38% (p = 0,29)). Conclusion The treatment of esophageal cancer is in constant evolution, induction therapy and surgical technics involve over time. Surgical delay has no impact on complete pathologic response, complication and overall survival. There is no advantage to wait longer before surgery.

855 OPTIMIZATION OF SURGICAL DELAY AFTER INDUCTION CHEMORADIATION FOR ESOPHAGEAL CANCER: 10 YEARS RETROSPECTIVE MULTI-CENTER STUDY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Alexis Legault-Dupuis ◽  
Philippe Bouchard ◽  
Frederic Nicodème ◽  
Jean-Pierre Gagne ◽  
Serge Simard ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Disease Free Survival ◽  
Pathologic Response ◽  
Complete Pathologic Response ◽  
Free Survival ◽  
Surgical Delay ◽  
Multi Center Study ◽  
Disease Free ◽  
Center Study

Abstract   The treatment of esophageal cancer is in constant evolution. Most of the esophageal cancer receive induction chemoradiation therapy. Surgical delay has been studied but the optimal timing has not been clarified. Through the years, surgical delay has been modified by surgeons in our institutions, going from an average of 6 weeks delay to an average of 10 weeks delay. It is time to ask if this change has a real positive impact on our patient. Methods In this retrospective multi-center study, we combined data from two center in Quebec city that performs oncologic esophagectomy. The surgical delay went from 6 to 10 weeks around 2014. All surgeons changed their practice at that moment. We retrospectively analysed 5 years before and after the change of practice and created two cohorts of patients. Our primary outcome compared complete pathologic response rate. Our secondary outcomes were surgical complications, anastomotic leak, disease free survival and overall survival. Results Thirty-eight patients had surgery under 8 weeks (mean: 6 weeks) after their induction chemoradiation compared to 64 patients that had surgery after 8 weeks (mean: 10 weeks). There was no statistical significant difference between groups for the complete pathologic response (32% vs 25%, p = 0,16). Important complications were similar, with a rate of 24% vs 28% (p = 0,69). Anastomotic leaks were less frequent in the less than 8 weeks group, but no statistical significance was obtained (13% vs 27%, p = 0,14).No difference in the disease-free survival rate and overall survival rate was noted (DFS 40% vs 55% (p = 0,32), OS 38% vs 38% (p = 0,29)). Conclusion The treatment of esophageal cancer is in constant evolution, induction therapy and surgical technics involve over time. Surgical delay has no impact on complete pathologic response, complication and overall survival. There is no advantage to wait longer before surgery.

Long-Term Results of RTOG Trial 8911 (USA Intergroup 113): A Random Assignment Trial Comparison of Chemotherapy Followed by Surgery Compared With Surgery Alone for Esophageal Cancer

2007 ◽  
Vol 25 (24) ◽  
pp. 3719-3725 ◽  
Author(s):  
David P. Kelsen ◽  
Katryn A. Winter ◽  
Leonard L. Gunderson ◽  
Joanne Mortimer ◽  
Norman C. Estes ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Preoperative Chemotherapy ◽  
Disease Free Survival ◽  
R0 Resection ◽  
Free Survival ◽  
R1 Resection ◽  
The Relationship ◽  
Disease Free

Purpose We update Radiation Therapy Oncology Group trial 8911 (USA Intergroup 113), a comparison of chemotherapy plus surgery versus surgery alone for patients with localized esophageal cancer. The relationship between resection type and between tumor response and outcome were also analyzed. Patients and Methods The chemotherapy group received preoperative cisplatin plus fluorouracil. Outcome based on the type of resection (R0, R1, R2, or no resection) was evaluated. The main end point was overall survival. Disease-free survival, relapse pattern, the influence of postoperative treatment, and the relationship between response to preoperative chemotherapy and outcome were also evaluated. Results Two hundred sixteen patients received preoperative chemotherapy, 227 underwent immediate surgery. Fifty-nine percent of surgery only and 63% of chemotherapy plus surgery patients underwent R0 resections (P = .5137). Patients undergoing less than an R0 resection had an ominous prognosis; 32% of patients with R0 resections were alive and free of disease at 5 years, only 5% of patients undergoing an R1 resection survived for longer than 5 years. The median survival rates for patients with R1, R2, or no resections were not significantly different. While, as initially reported, there was no difference in overall survival for patients receiving perioperative chemotherapy compared with the surgery only group, patients with objective tumor regression after preoperative chemotherapy had improved survival. Conclusion For patients with localized esophageal cancer, whether or not preoperative chemotherapy is administered, only an R0 resection results in substantial long-term survival. Even microscopically positive margins are an ominous prognostic factor. After a R1 resection, postoperative chemoradiotherapy therapy offers the possibility of long-term disease-free survival to a small percentage of patients.

Outcomes associated with T4 esophageal cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 130-130
Author(s):  
K. Meredith ◽  
J. Weber ◽  
R. Shridhar ◽  
S. E. Hoffe ◽  
K. Almhanna ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Locally Advanced ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Pathologic Response ◽  
Additional Patient ◽  
Free Survival ◽  
T4 Esophageal Cancer ◽  
Disease Free

130 Background: Esophageal cancer often presents as locally advanced disease with 15% of patients having T4 tumors upon diagnosis. Esophagectomy was often reserved for palliation given the dismal survival rates and high rates of R1/R2 resections. However, neoadjuvant therapy (NT) has the potential to significantly downstage esophageal cancers and thus increase complete resection rates. We report our experience with surgically resected T4 cancers of the esophagus. Methods: Using a comprehensive esophageal cancer database, we identified patients who underwent an esophagectomy for T4 tumors between 1994 and 2008. Neoadjuvant therapy and pathologic response were recorded and denoted as complete (pCR), partial (pPR), and non-response (NR). Clinical and pathologic data were compared using Fisher's exact and chi-square when appropriate while Kaplan Meier estimates were used for survival analysis. Results: We identified 39 patients with T4 tumors who underwent esophagectomy of which 38 (97%) underwent NT. The median age was 61 (31-79) years with a median follow-up of 32 (5-97) months. There were 3 (7.9%) pCR, 17 (44.7%) pPR, and 18 (47.4%) NR. R0 resections were accomplished in 37 (94.9%). Two patients had incomplete resections. One patient had a R2 resection after NT and was deemed as NR. An additional patient had a R1 resection after NT and was a pPR with a residual 0.2 cm tumor on permanent pathology. There were 14 (35.9%) recurrences with a median time to recurrence of 19.5 (4-71) months. Complete pathologic response represented 1 (7.1%), whereas pPR and NR represented 6 (42.9%), and 7 (50%) respectively of all recurrences. The overall and disease free survival for all patients with T4 tumors was 28% and 34% respectively. Patients achieving a pCR had a 5-year overall and disease free survival of (43% and 47%), compared to pPR (30% and 21%) while there were no 5-year survivors in the NR cohort. Conclusions: T4 esophageal cancer often portends a dismal prognosis even after surgical resection. Historical incomplete resections and dismal survival rates often make surgery palliative rather then curative. However, we have demonstrated that neoadjuvant therapy and down staging of T4 tumors leads to increased R0 resections and improvements in overall and disease free survival. No significant financial relationships to disclose.

Effect of lymph node harvest for squamous cell cancer of the esophagus on survival.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 102-102
Author(s):  
Jeremiah Lee Deneve ◽  
Jill M. Weber ◽  
Sarah E. Hoffe ◽  
Ravi Sridhar ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Disease Free Survival ◽  
Pathologic Response ◽  
Carcinoma Of The Esophagus ◽  
Free Survival ◽  
The Impact ◽  
Disease Free

102 Background: The optimal number of lymph nodes harvested remains controversial in patients with esophageal cancer. Pathologic response to neoadjuvant therapy (NT) has demonstrated improved survival. However, little is known regarding the impact of NT or nodal harvest in patients with squamous cell carcinoma (SCC) of the esophagus. We examined the extent of LN harvest and outcome in patients who underwent esophagectomy for SCC. Methods: After IRB approval, using a comprehensive esophageal cancer database we identified patients who underwent esophagectomy between 1994-2011. Clinical and pathologic data were compared using Fisher’s exact and chi-square when appropriate while Kaplan-Meier estimates were utilized for survival analysis. Nodal strata were set at 12 (ST-1), 15 (ST-2), and 20 nodes (ST-3). Pathologic response to NT was defined as complete (pCR), partial (pPR), or non-response (pNR). Results: We identified 76 patients who underwent esophagectomy for SCC between 1994-2011. The median age was 62.5 years (40-85 months) with median follow up of 18.5 months (1-157 months). 48 (63%) were male and 28 (37%) were female. Twenty-eight patients (37%) underwent primary esophagectomy alone (PE) while 48 (63%) patients were treated with NT. Extent of lymphadenectomy had no significant impact on overall survival (OS) or disease free survival (DFS) for the entire cohort ST-1 p=0.8 and p=0.9, ST-2 p=0.5 and p=0.4, and ST-3 p=0.5 and 0.4, respectively. Among the patients who received NT, pCR was observed in 28 (58%), pPR in 14 (29)%, and pNR in 6 (13)%. When examining the degree of pathologic response to treatment, extent of LN harvest had no significant impact on OS or DFS for patients who underwent esophagectomy after NT (p=ns across all strata). Conclusions: The extent of LN harvest failed to demonstrate an overall or disease free survival benefit in patients with squamous cell carcinoma of the esophagus. Moreover, patients treated with NT also did not benefit from increased nodal resection irrespective of their pathologic response.

scholarly journals Complete Pathologic Response Predicts Disease-Free Survival for Melanoma Patients Undergoing Neoadjuvant Therapy

2021 ◽  
Vol 233 (5) ◽  
pp. S246
Author(s):  
Kristen E. Rhodin ◽  
Elizabeth M. Gaughan ◽  
Vignesh Raman ◽  
April K. Salama ◽  
Brent A. Hanks ◽  
...  
Keyword(s):  
Neoadjuvant Therapy ◽  
Disease Free Survival ◽  
Pathologic Response ◽  
Complete Pathologic Response ◽  
Free Survival ◽  
Melanoma Patients ◽  
Disease Free

Effect of lymphadenectomy on survival in patients with esophageal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 65-65
Author(s):  
Khaldoun Almhanna ◽  
Jill M. Weber ◽  
Ravi Shridhar ◽  
Sarah E. Hoffe ◽  
Richard C. Karl ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Survival Benefit ◽  
Disease Free Survival ◽  
Gastrointestinal Malignancies ◽  
Free Survival ◽  
Nodal Harvest ◽  
The Impact ◽  
Disease Free

65 Background: The number of resected lymph nodes is associated with overall and disease-free survival in some gastrointestinal malignancies. The impact of nodal harvest during esophagectomy remains to be determined. We examined the influence of lymphadenectomy on overall survival in patients with esophageal cancer. Methods: Utilizing a prospectively maintained comprehensive esophageal cancer database we identified patients who underwent esophagectomy with between 1994 and 2011. The association between disease free survival (DFS), overall survival (OS) and nodal harvest was evaluated using multivariable Cox regression models. The number of harvested nodes was examined as a categorical variable based on strata(S): 1) ≤8, 2) 9-12, 3) 13-20, and 4) >20. Results: We identified 635 patients, 541 males and 94 females with a median age of 65 years (28-86) and median follow-up of 22 months (0-168). Adenocarcinoma 559 (88 %) was the predominant histology where as squamous cell carcinoma represented 76 (12%) of the cases. The 5-year OS and DFS rate for S1-S4 was (43%, 42%, 55%, and 36%, p=0.1836) and (44%, 37%, 46%, and 36%, p=0.5166) respectively. There were 209 patients with metastatic disease in 1 or more lymph nodes. The 5-year OS and DFS for S1-S4 was (17%, 31%, 21%, and 27%, p=0.4372) and (17%, 23%, 16%, and 25%, p=0.2726). There were 418 node negative patients. The 5-year OS and DFS rates by S1-S4 was (54%, 51%, 79%, and 26%, p=0.0538) and (55%, 48%, 64%, and 27%, p=0.3703). Multivariate analysis revealed that patients within S3 exhibited a survival benefit adjusted odds ratio (AOR) 0.57 (CI 0.360-0.916, p=0.020). However patients within S1 were more likely to die, AOR 1.74 (CI 1.09-2.78, p=0.020). No survival benefit was demonstrated for patients within (S4) AOR 1.11 (CI 0.60-2.09, p=0.731). There were 171 (27.5%) recurrences with a median time to recurrence of 12.2 (1-101) months. There were no differences in recurrences between strata p=0.129. Conclusions: We demonstrated that patients with ≤8 lymph nodes resected were more likely to die of their disease compared to those with 13-20 nodes resected. Additionally, extended lymphadenectomy (>20 nodes) does not increase the likelihood of proper staging and does not improve patient outcome.

scholarly journals NEOADJUVANT CHEMORADIOTHERAPY FOLLOWED BY TRANSHITAL ESOPHAGECTOMY IN LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA: IMPACT OF PATHOLOGICAL COMPLETE RESPONSE

2021 ◽  
Vol 34 (3) ◽  
Author(s):  
Iuri Pedreira Fillardi ALVES ◽  
Valdir TERCIOTI JUNIOR ◽  
João de Souza COELHO NETO ◽  
José Antonio Possatto FERRER ◽  
José Barreto Campello CARVALHEIRA ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Complete Response ◽  
Pathological Response ◽  
Complete Pathological Response ◽  
Free Survival ◽  
Disease Free

ABSTRACT Background Multimodal therapy with neoadjuvant chemoradiotherapy, followed by esophagectomy has offered better survival results, compared to isolated esophagectomy, in advanced esophageal cancer. In addition, patients who have a complete pathological response to neoadjuvant treatment presented greater overall survival and longer disease-free survival compared to those with incomplete response. Aim: To compare the results of overall survival and disease-free survival among patients with complete and incomplete response, submitted to neoadjuvant chemoradiotherapy, with two therapeutic regimens, followed by transhiatal esophagectomy. Methods: Retrospective study, approved by the Research Ethics Committee, analyzing the medical records of 56 patients with squamous cell carcinoma of the esophagus, divided into two groups, submitted to radiotherapy (5040 cGY) and chemotherapy (5-Fluorouracil + Cisplatin versus Paclitaxel + Carboplatin) neoadjuvants and subsequently to surgical treatment, in the period from 2005 to 2012, patients. Results The groups did not differ significantly in terms of gender, race, age, postoperative complications, disease-free survival and overall survival. The 5-year survival rate of patients with incomplete and complete response was 18.92% and 42.10%, respectively (p> 0.05). However, patients who received Paclitaxel + Carboplatin, had better complete pathological responses to neoadjuvant, compared to 5-Fluorouracil + Cisplatin (47.37% versus 21.62% - p = 0.0473, p <0.05). Conclusions There was no statistical difference in overall survival and disease-free survival for patients who had a complete pathological response to neoadjuvant. Patients submitted to the therapeutic regimen with Paclitaxel and Carboplastin, showed a significant difference with better complete pathological response and disease progression. New parameters are indicated to clarify the real value in survival, from the complete pathological response to neoadjuvant, in esophageal cancer.

scholarly journals Preoperative Multimodality Therapy Improves Disease-Free Survival in Patients With Carcinoma of the Rectum: NSABP R-03

2009 ◽  
Vol 27 (31) ◽  
pp. 5124-5130 ◽  
Author(s):  
Mark S. Roh ◽  
Linda H. Colangelo ◽  
Michael J. O'Connell ◽  
Greg Yothers ◽  
Melvin Deutsch ◽  
...  
Keyword(s):  
Rectal Carcinoma ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Preoperative Chemoradiotherapy ◽  
Pathologic Response ◽  
Adjuvant Chemoradiotherapy ◽  
Optimal Time ◽  
Complete Pathologic Response ◽  
Free Survival ◽  
Disease Free

Purpose Although chemoradiotherapy plus resection is considered standard treatment for operable rectal carcinoma, the optimal time to administer this therapy is not clear. The NSABP R-03 (National Surgical Adjuvant Breast and Bowel Project R-03) trial compared neoadjuvant versus adjuvant chemoradiotherapy in the treatment of locally advanced rectal carcinoma. Patients and Methods Patients with clinical T3 or T4 or node-positive rectal cancer were randomly assigned to preoperative or postoperative chemoradiotherapy. Chemotherapy consisted of fluorouracil and leucovorin with 45 Gy in 25 fractions with a 5.40-Gy boost within the original margins of treatment. In the preoperative group, surgery was performed within 8 weeks after completion of radiotherapy. In the postoperative group, chemotherapy began after recovery from surgery but no later than 4 weeks after surgery. The primary end points were disease-free survival (DFS) and overall survival (OS). Results From August 1993 to June 1999, 267 patients were randomly assigned to NSABP R-03. The intended sample size was 900 patients. Excluding 11 ineligible and two eligible patients without follow-up data, the analysis used data on 123 patients randomly assigned to preoperative and 131 to postoperative chemoradiotherapy. Surviving patients were observed for a median of 8.4 years. The 5-year DFS for preoperative patients was 64.7% v 53.4% for postoperative patients (P = .011). The 5-year OS for preoperative patients was 74.5% v 65.6% for postoperative patients (P = .065). A complete pathologic response was achieved in 15% of preoperative patients. No preoperative patient with a complete pathologic response has had a recurrence. Conclusion Preoperative chemoradiotherapy, compared with postoperative chemoradiotherapy, significantly improved DFS and showed a trend toward improved OS.

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