Outcome of 58 trimodality-eligible esophagogastric cancer (EC) patients who achieved clinical complete response (cCR) after preoperative chemoradiation but then declined surgery.
4078 Background: For patients with EC who can withstand surgery, the preferred therapy is trimodality. However, after achieving a cCR (defined as post-chemoradiation negative endoscopic biopsy for cancer and post-chemoradiation physiologic FDG uptake by PET), some patients are tempted to decline surgery. Literature is sparse on the outcome of such patients. Methods: Between 2002 and 2011, we identified 621 trimodality-eligible EC patients in our prospective database. All patients had to be trimodality-elgible and must have received preoperative chemoradiation and completed preoperative staging that included a repeat endoscopic biopsy and PET-CT prior to surgery among other routine tests. Results: Of 621 trimodality-eligible patients identified, 58 patients declined surgery after completing chemoradiation. All patients had a cCR. The median age was 69 (range, 47-85). Male (84.5%) and Caucasian (91.4%) were dominant. Baseline stage was II (44.8%) or III (51.7%) and histology was adenocarcinoma (67.2%) or squamous cell carcinoma (29.3%). 40 patients remain alive at a median follow up of 50.4 months (95% CI, 38.6-62.1). 5-year OS and relapse-free survival were 56.7±9.0% and 32.9±7.7%. Of 12 patients with local recurrence during surveillance, 11 had salvage resection. Conclusions: Although, the outcome of EC patients with cCR who declined surgery appears reasonable, in the absence of a validated prediction/prognosis model, only trimodality therapy must be encouraged for trimodality-eligible patients. Supported by UT M. D. Anderson Cancer Center grants and generous donors.