Association of clinical complete response (cCR) after preoperative chemoradiation and pathological complete response (pathCR) in patients with gastroesophageal cancer (GEC) and indispensability of trimodality therapy (TMT).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4086-4086 ◽  
Author(s):  
Naga K Sucharita Cheedella ◽  
Akihiro Suzuki ◽  
Arlene M Correa ◽  
Wayne Lewis Hofstetter ◽  
Reza J. Mehran ◽  
...  
Keyword(s):  
Pathological Complete Response ◽  
Complete Response ◽  
Endoscopic Biopsy ◽  
Preoperative Chemoradiation ◽  
High Rate ◽  
Gastroesophageal Cancer ◽  
Clinical Implementation ◽  
Trimodality Therapy ◽  
Level 1 ◽  
The Difference

4086 Background: TMT strategy has the highest level-1 evidence for treating localized GEC. High rates of cCR (defined as post-chemoradiation negative endoscopic biopsy and physiologic uptake on PET) are common and have questioned the benefit from surgery in patients with cCR after chemoradiation. We hypothesized that cCR would be associated with a high rate of pathCR than < cCR. Methods: The data were analyzed retrospectively in 563 patients who had esophagectomy for GEC in between 2002 and 2010 at UTMDACC. Among them, 284 had TMT and post-chemoradiation endoscopic biopsies and PET (before surgery). Multiple statistical methods were used. Results: Of these 284 TMT patients, 218 (77%) patients achieved a cCR. However, only 67 (31%) of 218 had a pathCR. The sensitivity of cCR for pathCR was 97.1 % (67/69) but the specificity was low, 29.8 % (64/215). Intriguingly, 66 patients who had < cCR, only 2 patients (3%) had a pathCR. The difference in the rate of pathCR between the cCR and < cCR groups was significant (P < 0.001). Conclusions: Our data show that cCR is frequent after chemoradiation but the pathCR rate is not high and it is associated with specificity that is too low for clinical implementation. Therefore, all TMT-eligible patients, irrespective of the achievement of cCR or < cCR must be encouraged to undergo surgery. Therapies that overcome chemoradiation resistance and could increase the pathCR rate are needed for esophageal preservation in select GEC patients. Supported by UTMDACC and generous donors. [Table: see text]

Outcome of trimodality-eligible esophagogastric cancer (EC) patients who declined surgery after preoperative chemoradiation.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 6-6 ◽  
Author(s):  
Takashi Taketa ◽  
Arlene M Correa ◽  
Akihiro Suzuki ◽  
Mariela Anabel Blum ◽  
Jeffrey Edwin Lee ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Performance Status ◽  
Preoperative Staging ◽  
Poor Performance ◽  
Complete Response ◽  
Endoscopic Biopsy ◽  
Preoperative Chemoradiation ◽  
Poor Performance Status ◽  
Trimodality Therapy ◽  
Esophagogastric Cancer

6 Background: Patients with localized EC eligible for resection at presentation should receive trimodality therapy (chemoradiation and surgery). However, surgical resection is not always performed in these patients because of poor performance status or reluctance in eligible patients to proceed with surgical resection after preoperative chemoradiation. Reports on the outcome of such patients are rare. Methods: Between 2002 and 2010, we identified 599 trimodality-eligible EC patients in our prospective database. All patients had extensive baseline staging, preoperative chemoradiation, and preoperative staging that included endoscopic biopsy and PET-CT. Of 599 patients, 32 patients declined surgery. Results: The median age was 70 years (range, 55-81), 29 patients (90.6%) were men and 30 (93.8%) were Caucasian. Majority had baseline stage II (44%) or III (38%) cancer. All 32 patients had an adenocarcinoma (moderate: 53.1%, poorly: 46.9%) and reached a clinical complete response (negative biopsy and PET in the physiologic range) post-chemoradiation. Four patients had salvage surgery and 3 are alive. Overall, 22 patients remain alive at a median follow up of 33.1 months (95% CI, 28.1-38.1). 3-year overall survival (OS) and relapse-free survival (RFS) were 65.1±10.4% and 37.5±10.3%. Median OS and RFS were 54.2 months (95% CI, 25.7-82.7), 30.4 months (95% CI, 16.3-44.5). Conclusions: Although the outcome of patients with EC who decline surgical resection after chemoradiation is reasonable, the lack of a validated approach to esophageal preservation dictates that trimodality therapy remains the standard of care in patients with potentially resectable EC.

Outcome of 58 trimodality-eligible esophagogastric cancer (EC) patients who achieved clinical complete response (cCR) after preoperative chemoradiation but then declined surgery.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4078-4078
Author(s):  
Takashi Taketa ◽  
Arlene M Correa ◽  
Akihiro Suzuki ◽  
Mariela A. Blum ◽  
Jeffrey H Lee ◽  
...  
Keyword(s):  
Preoperative Staging ◽  
Complete Response ◽  
Endoscopic Biopsy ◽  
Preoperative Chemoradiation ◽  
Cancer Center ◽  
Trimodality Therapy ◽  
Salvage Resection ◽  
Pet Ct ◽  
Esophagogastric Cancer ◽  
Prognosis Model

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.

The effect of MRI or PET fusion in radiotherapy treatment planning on the pathological complete response rate in rectal adenocarcinoma.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 523-523
Author(s):  
Zaker Hamid Rana ◽  
Robert Hong ◽  
Joon Han ◽  
Isaac Chen ◽  
Mohammed Nurhussien ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Treatment Planning ◽  
Response Rate ◽  
Pathological Complete Response ◽  
Complete Response Rate ◽  
Rectal Adenocarcinoma ◽  
Complete Response ◽  
Preoperative Chemoradiation ◽  
Pathological Response ◽  
Complete Pathological Response

523 Background: A pathological complete response rate of 10% to 30% has been noted to occur following preoperative chemoradiation with CT-based treatment planning in patients with rectal cancer. Fusion of the treatment planning CT with other imaging modalities like MRI or PET may help identify tumor location and improve tumor coverage. This retrospective study sought to evaluate the effect of adding MRI or PET imaging to CT-based treatment planning and its impact on pathological complete response rates in patients with rectal cancer. Methods: A retrospective analysis was performed on 39 patients, who received neoadjuvant chemoradiation for rectal adenocarcinoma from February 2009 to September 2013. Patients were divided into two groups. The first group was treated using CT-only based treatment 3D-Conformal or IMRT planning (n=9) and the second was treated using either PET or MRI fusion with the simulation CT scan (n=30). Patients were treated to a total of 5,040 cGy in 28 fractions. Pathological complete response rates (ypT0N0M0) were assessed using postoperative pathologic reports following resection. Results: 39 patients with a median age of 62 received preoperative chemoradiation with an interval to surgery ranging from 34-162 days and a median of 70 days. Patients treated with PET or MRI fusion treatment planning showed a complete pathological response rate at the primary site of 60% and a complete lymph node pathological response rate of 70.83% compared to 22.22% at the primary site and 66.66% at lymph node sites in patients with CT-only treatment planning. In patients treated using MRI or PET fusion, middle rectal cancer showed the best complete pathological response rate at 80%, followed by lower rectal cancer at 41.66%, and upper rectal cancer at 37.5%. Conclusions: Although the sample size was small, utilization of MRI or PET fusion resulted in a higher pathological complete response rate when compared to CT-only based treatment planning, especially in middle rectal cancers. Further studies are needed to accurately identify those patients with a complete pathologic response which may ultimately alter their treatment course.

A multicenter U.S. trial of neoadjuvant pemetrexed plus cisplatin (PC) followed by extrapleural pneumonectomy (EPP) and hemithoracic radiation (RT) for stage I-III malignant pleural mesothelioma (MPM)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7561-7561 ◽  
Author(s):  
L. M. Krug ◽  
H. Pass ◽  
V. W. Rusch ◽  
H. L. Kindler ◽  
D. Sugarbaker ◽  
...  
Keyword(s):  
Early Stage ◽  
Clinical Stage ◽  
Pathologic Complete Response ◽  
Early Time ◽  
Complete Response ◽  
High Rate ◽  
Vitamin Supplementation ◽  
Extrapleural Pneumonectomy ◽  
Eligibility Criteria ◽  
Trimodality Therapy

7561 Background: The optimal management for fit patients with early stage MPM remains controversial. One approach involves neoadjuvant chemotherapy followed by EPP and hemithoracic RT and prior trials using gemcitabine and cisplatin have been reported (Weder JCO 2004, Flores JTO 2006). We administered PC, followed by EPP and RT to further assess feasibility and survival of trimodality therapy in a larger, multicenter study. Methods: Eligibility criteria: Stage T1–3 N0–2, no prior surgical resection, adequate organ function (including predicted post-op FEV1 >35%) and PS 0–1. Pts received pemetrexed 500 mg/m2 plus cisplatin 75 mg/m2 with vitamin supplementation for 4 cycles. Pts without disease progression underwent EPP followed by RT (54 Gy). The primary endpoint was pathologic complete response (pCR) rate. Enrollment was completed in March, 2006. Results: 77 patients were enrolled and 72 are evaluable. Median age 63.5 (range 34–78), M:F = 51:21, Clinical stage I:II:III:IV = 5:31:33:1, epithelial:nonepithelial = 58:15, ECOG PS 0:1:2 = 28:42:2. 83% of patients completed all four cycles of PC. Grade 3/4 events related to chemotherapy included: neutropenia (4%), febrile neutropenia (3%), nausea (1%), vomiting (3%), pneumonia (6%), pulmonary embolism (1%), and chest pain (3%). Of 73 pts assessed for radiologic response, 3 CRs, 21 PRs, 36 SDs, 3 PDs, and 10 were unevaluable; (RR= 33% [95% CI, 0.22, 0.45]). Of 54 pts who underwent surgery, EPP completion rate was 87% (47/54); that is 47/77 (61%) by ITT. Pathologic stage I:II:III:IV:NE = 4:12:24:3:11. One pCR was confirmed. 35/39 completed RT. Preliminary TTP =13.1 mo (95% CI=9.6, 15.9; 48% censored) and median survival=16.6 mo (95% CI=13.9, 19.3; 55% censored;1-yr survival = 68%). Conclusions: This multicenter trial testing trimodality therapy in MPM showed that it is feasible with a high rate of chemotherapy delivery. One pCR was observed. Preliminary survival is below that reported by single institutions for patients undergoing EPP but with a high censorship rate at this early time point. Further analyses are necessary to identify a cohort of patients most likely to benefit. This study was sponsored by Eli Lilly & Company. No significant financial relationships to disclose.

scholarly journals Analysis of pathological complete response rates with paclitaxel-based regimens in trimodality therapy for esophageal cancer

2014 ◽  
Vol 28 (7) ◽  
pp. 619-625 ◽  
Author(s):  
D. H. Boggs ◽  
C. Tarabolous ◽  
C. G. Morris ◽  
A. Hanna ◽  
W. Burrows ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Pathological Complete Response ◽  
Response Rates ◽  
Complete Response ◽  
Trimodality Therapy

Various clinical outcomes in patients with esophageal or gastroesophageal junction (E-GEJ) adenocarcinoma undergoing trimodality therapy: Prognostic implications.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 120-120
Author(s):  
Akihiro Suzuki ◽  
Lianchun Xiao ◽  
Takashi Taketa ◽  
Kazuki Sudo ◽  
Mariela A. Blum ◽  
...  
Keyword(s):  
Pathological Complete Response ◽  
Gastroesophageal Junction ◽  
Complete Response ◽  
Trimodality Therapy ◽  
Poorly Differentiated Adenocarcinoma ◽  
Free Survival ◽  
Node Metastasis ◽  
Poorly Differentiated ◽  
Prognostic Implications

120 Background: Preoperative chemoradiation (trimodality therapy) has the strongest evidence in trimodality-eligible patients with E-GEJ adenocarcinoma. Pathological complete response (pathCR) and clinical complete response (clinCR) are favorable prognostic factors. We hypothesized that pathCR is associated with best prognosis. Methods: Patients with E-GEJ adenocarcinoma undergoing trimodality therapy were identified from the prospectively maintained databases at our institution. Multiple statistical methods were used. Results: For 314 esophageal cancer patients, the median follow-up time was 44.0 months (95% CI; 34.2-50.9). 107 of 314 patients died at this analysis. 80 patients (25.5%) had a pathCR. 160 patients (51.0%) had a clinCR prior to surgery but did not have pathCR. The remaining 74 (23.6%) had <pathCR and <clinCR. Median OS were: not achieved in pathCR patients, 82.8 months (95% CI; 63.9, NA) in clinCR patients and 27. 6 months (95% CI; 19.4, NA) <pathCR/<clinCR (p<0.001). The median recurrence-free survival (RFS) were: 79.6 months (95% CI; 37.4, NA) in pathCR patients, 67.4 months (95% CI; 31.8, NA) in clinCR patients and 13.5 months (95% CI; 10.4, 21.4) in <pathCR/<clinCR (p<0.001). In multivariate analysis, no lymph node metastasis (p<0.001), not poorly differentiated adenocarcinoma (p=0.002) and pathCR (p=0.02), and cCR (p<0.001) were independent prognosticators of OS and RFS. Conclusions: pathCR and clinCR are independent prognosticators (pathCR producing the best results) and may be helpful in devising new therapeutic and surveillance strategies.

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