Accuracy of clinical staging with EUS for early stage esophageal cancer: Are we denying patients beneficial neoadjuvant chemo-radiation?

163 Background: Esophagectomy alone has been considered the standard of care for early stage esophageal cancer (EC) while neoadjuvant therapy is now standard for locally advanced disease. The choice of treatment therefore hinges on accurate locoregional staging by endoscopic ultrasound (EUS). Our objective is to evaluate the accuracy of EUS performed in a high-volume tertiary cancer center in clinical stage T1N0 (cT1N0) and T2N0 (cT2N0) esophageal cancer patients undergoing esophagectomy without neoadjuvant therapy. Methods: A retrospective review of the esophageal cancer database at a single institution was performed. Patients with cT1N0 and cT2N0 esophageal cancer based on EUS undergoing esophagectomy without neoadjuvant treatment were evaluated. Patient demographics, tumor characteristics, and treatment were reviewed. Surgical pathology was compared to EUS staging. Results: Between 2000 and 2015, 139 patients were identified. There were 25 (18%) female and 114 (82%) male patients. The tumor location included the middle 1/3 of the esophagus in 11 (8%) and lower 1/3 and gastroesophageal junction in 128 (92%) patients. Eighty-one percent of patients had adenocarcinoma, 9% had squamous cell carcinoma, 9% had Barrett’s dysplasia, and 1% had mixed histology. Clinical staging were as follows: 110 (79%) patients had cT1N0 and 29 (21%) patients had cT2N0 tumors. For the entire cohort, preoperative EUS matched the final surgical pathology in 76/139 patients for an accuracy rate of 53%. Twenty-nine patients (21%) were under-staged by EUS; of those, 19 (14%) had unrecognized nodal disease. This included 12/109 (11%) of cT1N0 and 7/29 (24%) of cT2N0 patients. Conclusions: The accuracy of preoperative EUS staging in early esophageal cancer remains sub-optimal. Interestingly, a significant proportion (24%) of cT2N0 EC patients were found to have positive lymph nodes on surgical pathology, and perhaps these patients could have benefitted from neoadjuvant therapy. In light of these findings, the current management of cT2N0 esophageal cancer should be reconsidered.

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The Ideal Approach for Treatment of cT1N+ and cT2Nany Esophageal Cancer.: A NCDB Analysis

10.21203/rs.3.rs-130883/v2 ◽

2021 ◽

Author(s):

Binhao Huang ◽

Ernest G. Chan ◽

Arjun Pennathur ◽

James D. Luketich ◽

Jie Zhang

Keyword(s):

Esophageal Cancer ◽

Adjuvant Therapy ◽

Neoadjuvant Therapy ◽

Cox Regression ◽

Locally Advanced ◽

Clinical Staging ◽

Ideal Approach ◽

Additional Chemotherapy ◽

Locally Advanced Esophageal Cancer ◽

The Ideal

Abstract Background Neoadjuvant therapy followed by surgery is recommended for locally advanced esophageal cancer. With the inaccuracies of clinical staging particularly for cT1N+ and cT2Nany tumors, some have proposed consideration of surgery followed by adjuvant treatment. Our objective is to evaluate the efficacy of neoadjuvant therapy vs surgery followed by adjuvant therapy, and to identify the ideal sequence of treatment in patients with cT1N+ and cT2Nany tumors.Methods We performed an analysis utilizing the National Cancer Database (2006-2015) identifying all patients with cT1N+ and cT2Nany esophageal cancer undergoing esophagectomy and additional chemotherapy or radiotherapy. The treatment was stratified as: neoadjuvant therapy (NT), adjuvant therapy (AT) and combination therapy of neoadjuvant and adjuvant (CT) groups and outcomes were analyzed.Results We identified 2795 patients with 81.9% (n=2289) receiving NT, 10.2% (n=285) AT, and 7.9% (n=221) CT. There were no significant differences noted in survival among AT, NT, and CT group in cT1N+(P=0.376), cT2N-(P=0.436), cT2N+(P=0.261) esophageal cancer by multivariate analysis using Cox regression model. This relationship held true in both squamous cell carcinoma and adenocarcinoma. Conclusion In clinical T1N+, T2Nany patients, there was no evident superiority of NT over AT. Surgery followed by adjuvant therapy can be considered to be an alternative option in these patients. Further prospective studies are needed to validate these findings.

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Efficacy and safety of camrelizumab combined with FOLFOX as neoadjuvant therapy for patients with resectable locally advanced gastric and gastroesophageal junction adenocarcinoma who received D2 radical gastrectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16549 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16549-e16549

Author(s):

Yuzhou Zhao ◽

Guangsen Han ◽

Jing Zhuang ◽

Zhimeng Li ◽

Gangcheng Wang ◽

...

Keyword(s):

Lymph Node ◽

Neoadjuvant Therapy ◽

Gastroesophageal Junction ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

R0 Resection ◽

Lymph Node Yield ◽

D2 Lymph Node Dissection ◽

Gastroesophageal Junction Adenocarcinoma ◽

The Mean

e16549 Background: Neoadjuvant chemotherapy for patients with locally advanced gastric and gastroesophageal junction adenocarcinoma (GC/GEJC) can improve the overall survival without increasing operation risk. Nowadays, immunotherapy has become a new promising neoadjuvant treatment. Therefore, we intended to evaluate the safety and efficacy of camrelizumab (anti-PD-1 antibody) combined with FOLFOX as the neoadjuvant therapy for patients with locally advanced GC/GEJC who received D2 radical gastrectomy. Methods: Patients who were diagnosed as resectable locally advanced GC/GEJC received the neoadjuvant treatment of camrelizumab and FOLFOX every 2 weeks for 4 cycles. Imaging evaluation was performed in 2-4 weeks after neoadjuvant therapy. Patients who had no progression disease (PD) were recruited. Eligible patients underwent gastrectomy with D2 lymph node dissection through laparotomy or laparoscopic surgery. The primary end points were safety and R0 resection rate. Results: From July 24 2019 to January 31 2020, 15 patients were recruited. The mean age was 57 years. A total of 10(67%) were males and 5(33%) were females. According to AJCC 8th, cT3 and cT4 were confirmed in 7(47%) patients and 8(53%) patients, N1 and N2 in 7(47%) patients and 8(53%) patients, respectively. During operation, intraperitoneal metastases were found in 2 patients. Of the 13 surgeries, only 2 were laparoscopic and the others were laparotomy. The surgical procedures included Roux-en-Y (9, 69.2%), Billroth II (1, 7.7%) and jejunum interposition (3, 23.1%). Thirteen patients underwent gastrectomy with D2 lymph node dissection and all of them were confirmed R0 resection by postoperative pathology results. The mean lymph node yield was 44.1±13.2 nodes, positive lymph node yield was 1.8±2.8 nodes. Duration time of surgery was 186.5±45.5 minutes, mean blood loss was 219.2±109 ml during the operation. Mean hospital stays were 13.2±2.4 days. Only 1 patient experienced grade 3 pneumonia. Neither serious intraoperative complications nor immune-related adverse events both prior and post operation were observed. There was no treatment-related death. Conclusions: Camrelizumab combined with FLOFOX as neoadjuvant treatment for patients with locally advanced GC/GEJC showed acceptable toxicity and promising efficacy with low complications and mortality. Clinical trial information: NCT03939962 .

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Efficacy and safety of camrelizumab combined with FLOT versus FLOT alone as neoadjuvant therapy in patients with resectable locally advanced gastric and gastroesophageal junction adenocarcinoma who received D2 radical gastrectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e16020 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e16020-e16020

Author(s):

Ning Liu ◽

Zimin Liu ◽

Yanbing Zhou ◽

Zhaojian Niu ◽

Haitao Jiang ◽

...

Keyword(s):

Neoadjuvant Therapy ◽

Intraoperative Complications ◽

Gastroesophageal Junction ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Tumour Regression ◽

R0 Resection ◽

Resection Rate ◽

Tumour Regression Grade ◽

Ecog Ps

e16020 Background: Docetaxel-based neoadjuvant chemotherapy has been suggested to be beneficial in patients with locally advanced gastric and gastro-oesophageal junction cancer (GC/GEJC). And immunotherapy also show promising treatment efficacy for advanced GC/GEJC. Here we compared the safety and efficacy of camrelizumab combined with chemotherapy versus chemotherapy alone as the neoadjuvant therapy for patients with resectable locally advanced GC/GEJC. Methods: Eligible patients diagnosed as resectable locally advanced GC/GEJC were randomized to receive neoadjuvant treatment, in arm A, the patients received FLOT alone (docetaxel 50 mg/m²; oxaliplatin 85 mg/m²; leucovorin 200 mg/m²; 5-FU 2600 mg/m², every 2 weeks), in arm B, the patients received FLOT combined with camrelizumab(camrelizumab 200mg intravenously every 3 weeks). Eligible patients underwent gastrectomy with D2 lymph node dissection. The primary end point of this trial was pCR rate and R0 resection rate, and the secondary end points were ORR,PFS, OS and safety profile. Results: From January 15 2020 to January 15 2021, 24 patients were recruited (11 patients in arm A and 13 patients in arm B). 19 patients had completed planned neoadjuvant treatment for 4 cycles (9 pts in the arm A, 10 ptsin the arm B). Two patients in the arm A were waiting for gastrectomy. This analysis was based on the 17 pts. In the arm A, the median age was 61 years (47-72 years) and a total of 5 males and 4 females, ECOG PS 0 (n = 1), ECOG PS 1 (n = 8). In the arm B, the median age was 63 years (57-71 years) and a total of 9 males and 1 females, all patients with ECOG PS 1. The R0 resection rate was high in arm B compared with arm A (10/10,100% vs. 5/7, 71.4%). No pCR were observed in the two arms. Tumour regression grade were as follows:TRG1 [arm A 0% (0/7), arm B 10% (1/10)], TRG2 [arm A 43% (3/7), arm B 60% (6/10)], TRG3 [arm A 29% (2/7), arm B 30% (3/10)].There was a significantly higher proportion of patients achieved a postoperative ypN0 in the arm B than arm A(60% vs 0%), which had preoperative clinical stage cT3-4N+M0. Postoperative pathologic staging was as follows: ypT1 [arm A 14% (1/7); armB 30% (3/10)]. ypT2 [armA 0% (0/7); armB 30% (3/10)]. ypT3 [arm A 29% (2/7); arm B 20% (2/10)]. ypT4 [armA 29% (2/7); armB 20% (2/10)]. Neither serious intraoperative complications nor immune-related adverse events were observed during perioperation. Treatment-related AEs neutropenia and leukopenia were manageable and there was no treatment-related death. Conclusions: Camrelizumab combined with FLOT showed promising efficacy as neoadjuvant treatment for patients with locally advanced gastric or GEJ adenocarcinoma, with low complications and acceptable toxicity. Clinical trial information: ChiCTR2000030610.

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A Dilemma in Staging of Esophageal Cancer: How Should We Stage ypT0 N2 M0 Esophageal Cancer after Neoadjuvant Therapy?

Case Reports in Pathology ◽

10.1155/2015/158626 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Sebahattin Celik ◽

Remzi Erten ◽

Abdulsamed Batur ◽

Burak Suvak

Keyword(s):

Esophageal Cancer ◽

Lymph Nodes ◽

Neoadjuvant Therapy ◽

Cell Cancer ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Complete Response ◽

Resection Margins ◽

Pathology Report ◽

Esophageal Mucosa

Background. Since neoadjuvant treatment in esophageal cancer began to become popular, a complete pathological response at the primary tumour site has been commonly reported. An issue of conflict is whether complete response in the esophageal lumen means that the esophagus is completely tumour-free. Another important issue is whether lymph nodes that are retrieved from pathologically complete response cases are also tumour-free or not. There is a gap in the esophageal cancer staging system for ypT0 N2 M0 tumours that have received neoadjuvant therapy. Here, we will discuss the problem about staging of esophageal cancer associated with neoadjuvant therapy.Case. A female aged 40 years complaining of dysphagia was diagnosed as having locally advanced thoracic esophageal cancer. Neoadjuvant therapy decision was taken by oncology committee. Six weeks after neoadjuvant therapy, with a curative intention, minimal invasive surgery was performed. The pathology report was as follows. “There were no neoplastic cells in the suspected area of the esophageal mucosa upon examination with all staining. There was no cancer at resection margins. Four metastatic lymph nodes were infiltrated with squamous cell cancer.”Conclusion. Despite the growing use of neoadjuvant treatment in locally advanced esophageal cancer in world, we do not have a protocol for the evaluation of these patients’ pathology reports. We believe that new studies and new ideas are needed to resolve this dilemma associated with neoadjuvant therapy.

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Chances, risks and limitations of neoadjuvant therapy in surgical oncology

Innovative Surgical Sciences ◽

10.1515/iss-2016-0004 ◽

2016 ◽

Vol 1 (1) ◽

pp. 3-11 ◽

Cited By ~ 1

Author(s):

Florian Lordick ◽

Ines Gockel

Keyword(s):

Neoadjuvant Therapy ◽

Systemic Disease ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Neoadjuvant Chemoradiotherapy ◽

Rare Event ◽

Surgical Oncology ◽

Clinical Staging ◽

Tumor Control ◽

Tumor Types

AbstractOver the last decades, neoadjuvant treatment has been established as a standard of care for a variety of tumor types in visceral oncology. Neoadjuvant treatment is recommended in locally advanced esophageal and gastric cancer as well as in rectal cancer. In borderline resectable pancreatic cancer, neoadjuvant therapy is an emerging treatment concept, whereas in resectable colorectal liver metastases, neoadjuvant treatment is often used, although the evidence for improvement of survival outcomes is rather weak. What makes neoadjuvant treatment attractive from a surgical oncology viewpoint is its ability to shrink tumors to a smaller size and to increase the chances for complete resection with clear surgical margins, which is a prerequisite for cure. Studies suggest that local tumor control is increased in some visceral tumor types, especially with neoadjuvant chemoradiotherapy. In some other studies, a better control of systemic disease has contributed to significantly improved survival rates. Additionally, delaying surgery offers the chance to bring the patient into a better general condition for major surgery, but it also confers the risk of progression. Although it is a relatively rare event, cancers may progress locally during neoadjuvant treatment or distant metastases may occur, jeopardizing a curative surgical treatment approach. Although this is seen as risk of neoadjuvant treatment, it can also be seen as a chance to select only those patients for surgery who have a better control of systemic disease. Some studies showed increased perioperative morbidity in patients who underwent neoadjuvant treatment, which is another potential disadvantage. Optimal multidisciplinary teamwork is key to controlling that risk. Meanwhile, the neoadjuvant treatment period is also used as a “window of opportunity” for studying the activity of novel drugs and for investigating predictive and prognostic biomarkers of chemoradiotherapy and radiochemotherapy. Although the benefits of neoadjuvant treatment have been clearly established, the risk of overtreatment of cancers with an unfavorable prognosis remains an issue. All indications for neoadjuvant treatment are based on clinical staging. Even if staging is done meticulously, making use of all recommended diagnostic modalities, the risk of overstaging and understaging remains considerable and may lead to false indications for neoadjuvant treatment. Finally, despite all developments and emerging concepts in medical oncology, many cancers remain resistant to the currently available drugs and radiation. This may in part be due to specific molecular resistance mechanisms that are marginally understood thus far. Neoadjuvant treatment has been one of the major advances in multidisciplinary oncology in the last decades, requiring a dedicated treatment team and an optimal infrastructure for complex oncology care. This article discusses the goals and novel directions as well as limitations in neoadjuvant treatment of visceral cancers.

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Recent Progress in the Neoadjuvant Treatment Strategy for Locally Advanced Esophageal Cancer

Cancers ◽

10.3390/cancers13205162 ◽

2021 ◽

Vol 13 (20) ◽

pp. 5162

Author(s):

Sicong Hou ◽

Ziyin Pan ◽

Xin Hao ◽

Qinglei Hang ◽

Yanbing Ding

Keyword(s):

Esophageal Cancer ◽

Neoadjuvant Therapy ◽

Randomized Clinical Trials ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Neoadjuvant Chemoradiotherapy ◽

Preoperative Chemoradiotherapy ◽

Research Progress ◽

Preoperative Radiation ◽

Treatment Protocols

Neoadjuvant therapies, primarily chemotherapy and chemoradiotherapy, are able to improve the overall survival (OS) in patients with locally advanced resectable esophageal cancer (EC) based on the results of several randomized clinical trials. The advantage of neoadjuvant therapy is chiefly attributed to the decreased risk of local–regional recurrence and distant metastasis. Thus, it has been recommended as standard treatment for patients with resectable EC. However, several fundamental problems remain. First, the combination of neoadjuvant chemotherapy (nCT), neoadjuvant chemoradiotherapy (nCRT), and surgery for EC patients with different histological types remains controversial. Furthermore, to reduce the toxicity of preoperative chemotherapy and the risk of complications caused by preoperative radiation therapy, the treatment protocols of nCT and nCRT still need to be investigated and optimized by prospective trials. Moreover, for patients with complete clinical response following neoadjuvant therapy, it is worth ascertaining whether a “watch and wait” surveillance plus surgery-as-needed policy is more favorable, as well as, in addition to preoperative chemoradiotherapy, whether immunotherapy, especially when combined with the traditional neoadjuvant therapy regimens, brings new prospects for EC treatment. In this review, we summarize the recent insights into the research progress and existing problems of neoadjuvant therapy for locally advanced resectable EC.

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The ideal approach for treatment of cT1N+ and cT2Nany esophageal cancer.: a NCDB analysis

BMC Cancer ◽

10.1186/s12885-021-08896-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Binhao Huang ◽

Ernest G. Chan ◽

Arjun Pennathur ◽

James D. Luketich ◽

Jie Zhang

Keyword(s):

Esophageal Cancer ◽

Adjuvant Therapy ◽

Neoadjuvant Therapy ◽

Cox Regression ◽

Locally Advanced ◽

Clinical Staging ◽

National Cancer Database ◽

Ideal Approach ◽

Locally Advanced Esophageal Cancer ◽

The Ideal

Abstract Background Neoadjuvant therapy followed by surgery is recommended for locally advanced esophageal cancer. With the inaccuracies of clinical staging particularly for cT1N+ and cT2Nany tumors, some have proposed consideration of surgery followed by adjuvant treatment. Our objective is to evaluate the efficacy of neoadjuvant therapy vs surgery followed by adjuvant therapy, and to identify the ideal sequence of treatment in patients with cT1N+ and cT2Nany tumors. Methods We performed an analysis utilizing the National Cancer Database (2006-2015) identifying all patients with cT1N+ and cT2Nany esophageal cancer undergoing esophagectomy. The treatment was stratified as: neoadjuvant therapy (NT), adjuvant therapy (AT) and combination therapy of neoadjuvant and adjuvant (CT) groups and outcomes were analyzed. Results We identified 2795 patients with 81.9% (n=2289) receiving NT, 10.2% (n=285) AT, and 7.9% (n=221) CT. There were no significant differences noted in survival among AT, NT, and CT group in cT1N+(P=0.376), cT2N-(P=0.436), cT2N+(P=0.261) esophageal cancer by multivariate analysis using Cox regression model. This relationship held true in both squamous cell carcinoma and adenocarcinoma. Conclusion In clinical T1N+, T2Nany patients, there was no evident superiority of NT over AT. Surgery followed by adjuvant therapy can be considered to be an alternative option in these patients. Further prospective studies are needed to validate these findings.

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Long-term outcomes of clinical and pathological-staged T3 N3 esophageal cancer

Diseases of the Esophagus ◽

10.1093/dote/doz109 ◽

2020 ◽

Vol 33 (8) ◽

Cited By ~ 2

Author(s):

S K Kamarajah ◽

N Newton ◽

M Navidi ◽

S Wahed ◽

A Immanuel ◽

...

Keyword(s):

Esophageal Cancer ◽

Neoadjuvant Therapy ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Stage Migration ◽

Term Survival ◽

Carcinoma Of The Esophagus ◽

Dismal Prognosis ◽

The Impact

Summary Locally advanced esophageal cancer is associated with poor long-term survival. Pre- and post-treatment stages may differ because of neoadjuvant therapy and inaccuracies in staging. The aim of this study was to determine the outcomes of patients staged with clinical T3 N3 and pathological T3 N3 carcinoma of the esophagus and determine differences between the groups. Consecutive patients from a single unit between 2010 and 2018 were included with either clinical (cT3 N3) or pathological (pT3 N3) esophageal cancer. Outcomes were compared between patients that underwent esophagectomy with or without neoadjuvant treatment and those patients staged cT3 N3 treated non-surgically (NSR). Patients were staged using the TNM 8. This study included 156 patients, 63 patients were staged cT3 N3 initially and had NSR treatment, only three of these had radical treatment. Of the remaining 93 patients who underwent esophagectomy, 34 were initially staged as cT3 N3, 54 were found to be pT3 N3 having been staged earlier initially, and five were unchanged before and after treatment. Median overall survival (OS) for surgical cT3 N3 patients was significantly longer than pT3 N3 and NSR (median: NR vs 19 vs 8 months, P < 0.001). Twenty-seven patients with cT3 N3 had lower staging following treatment, while three had a higher stage. T3 N3 disease carries a poor prognosis. Within this cohort, cT3 N3 disease treated surgically has a high 5-year OS suggesting possible over-staging and stage migration due to neoadjuvant therapy. Those not having surgery, have a dismal prognosis. The impact of neoadjuvant treatment cannot be predicted and, current staging modalities may be inaccurate. Clinical stage should be used with caution when counseling patients regarding management and prognosis.

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PS01.239: MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER IN PATIENTS WITH AIDS: AN ENTITY ON THE RISE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.239 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 117-118

Author(s):

Bruno Lorenzi ◽

Neda Farhangmehr ◽

Temisanren Akitikori ◽

Kanatheepan Shanmuganathan ◽

Oluwasunmisola Soile ◽

...

Keyword(s):

Esophageal Cancer ◽

General Population ◽

Minimally Invasive ◽

Conflicts Of Interest ◽

Gastroesophageal Junction ◽

Locally Advanced ◽

World Health ◽

Clinical Staging ◽

Hiv Patients ◽

Antiretroviral Medications

Abstract Background Recently it was reported by World Health Organization that over 36 million people are living with HIV globally; for the first time ever life expectancy in people with HIV exceeds the average. This is mainly due to the development of highly active antiretroviral medication that have turned AIDS from a life threatening disease to a chronic condition. HIV patients are as prone as the general population to developing esophageal cancer. We aim to describe our experience and factors for consideration whilst treating HIV patients with esophageal cancer. Methods In 2017, 77 cases were surgically treated for esophageal and gastroesophageal junction cancer in our tertiary referral centre. n = 2 (2.5%) were HIV positive. Their disease, demographic and surgical characteristics were analyzed and the outcomes are presented. Results A 62 and 65-year-old HIV male patients had 2-stage esophagectomy for gastro-esophageal junction adenocarcinoma. They both had similarities with locally advanced tumours and late presentation with dysphagia and > 10% total body weight loss. Clinical staging revealed T3N2M0 tumours in both cases. Viral load was low (< 40 copies/mL) and both had neoadjuvant chemotherapy as first line of treatment. Both had a 2-stage esophagectomy; one had laparoscopic-assisted and the other had totally minimally invasive. Histological staging was ypT3N1 and ypT3N3 respectively. Antiretroviral medications were in both started enterally on day 1; in the first case via a triple-lumen nasojejunal feeding tube and in the second via a single-lumen nasogastric tube. No feeding jejunostomies were placed. No immediate post-operative complications were noted. Length of stay was 14 and 8 days respectively. Conclusion AIDS patients with esophageal cancer can present late, with advanced tumors, as dysphagia is common due to fungal esophagitis and tends to be underestimated. Where indicated, this cohort of patients should receive full multimodality treatment, like the general population, as results are no different. Multidisciplinary approach with involvement of an HIV specialist doctor from the beginning of treatment planning is of paramount importance as optimization prior to surgery is commonly necessary. Antiretroviral medications are needed immediately post-operatively in all cases and a clear plan for enteral route administration should be in place. Disclosure All authors have declared no conflicts of interest.

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The Ideal Approach for Treatment of cT1N+ and cT2Nany Esophageal Cancer.: A NCDB Analysis

10.21203/rs.3.rs-130883/v1 ◽

2020 ◽

Author(s):

Binhao Huang ◽

Ernest G. Chan ◽

Arjun Pennathur ◽

James D. Luketich ◽

Jie Zhang

Keyword(s):

Esophageal Cancer ◽

Adjuvant Therapy ◽

Neoadjuvant Therapy ◽

Cox Regression ◽

Locally Advanced ◽

Clinical Staging ◽

Ideal Approach ◽

Additional Chemotherapy ◽

Locally Advanced Esophageal Cancer ◽

The Ideal

Abstract BackgroundNeoadjuvant therapy followed by surgery is recommended for locally advanced esophageal cancer. With the inaccuracies of clinical staging particularly for cT1N+ and cT2Nany tumors, some have proposed consideration of surgery followed by adjuvant treatment. Our objective is to evaluate the efficacy of neoadjuvant therapy vs surgery followed by adjuvant therapy, and to identify the ideal sequence of treatment in patients with cT1N+ and cT2Nany tumors.MethodsWe performed an analysis utilizing the National Cancer Database (2006-2015) identifying all patients with cT1N+ and cT2Nany esophageal cancer undergoing esophagectomy and additional chemotherapy or radiotherapy. The treatment was stratified as: neoadjuvant therapy (NT), adjuvant therapy (AT) and combination therapy of neoadjuvant and adjuvant (CT) groups and outcomes were analyzed.ResultsWe identified 2795 patients with 81.9% (n=2289) receiving NT, 10.2% (n=285) AT, and 7.9% (n=221) CT. There were no significant differences noted in survival among AT, NT, and CT group in cT1N+(P=0.376), cT2N-(P=0.436), cT2N+(P=0.261) esophageal cancer by multivariate analysis using Cox regression model. This relationship held true in both squamous cell carcinoma and adenocarcinoma. ConclusionIn clinical T1N+, T2Nany patients, there was no evident superiority of NT over AT. Surgery followed by adjuvant therapy can be considered to be an alternative option in these patients. Further prospective studies are needed to validate these findings.

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