A meta-analysis of randomized controlled trials that compared neoadjuvant chemotherapy and surgery to surgery alone for resectable esophageal cancer

Urschel, John D.; Vasan, Hari; Blewett, C. J.

doi:10.1016/s0002-9610(02)00795-x

Cited by 195 publications

(114 citation statements)

References 26 publications

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“…Several metaanalyses have demonstrated a statistically significant benefit for neoadjuvant chemotherapy [40][41][42]. The EORTC 40954 trial, which primarily included patients with AEG junction, contributed to the evidence for neoadjuvant chemotherapy [37].…”

Section: Surgerymentioning

confidence: 99%

International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus

et al. 2014

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Background Clinical guidelines are essential in implementing and maintaining nationwide stage-specific diagnostic and therapeutic standards. In 2011, the first German expert consensus guideline defined the evidence for diagnosis and treatment of early and locally advanced esophagogastric cancers. Here, we compare this guideline with other national guidelines as well as current literature.Methods The German S3-guideline used an approved development process with de novo literature research, international guideline adaptation, or good clinical practice. Other recent evidence-based national guidelines and current references were compared with German recommendations.

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Section: Surgerymentioning

confidence: 99%

International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus

et al. 2014

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“…Both confer important survival benefits (3); however, up to 60% of tumors show either minimal or no pathologic response (pTR) to NAC (4,5), and a similarly poor response is seen in 30%-40% after NACR (6). For these patients such, in retrospect, futile therapy delays surgery, potentially allowing disease progression and a worse prognosis (7).…”

mentioning

confidence: 99%

Predicting Pathologic Response of Esophageal Cancer to Neoadjuvant Chemotherapy: The Implications of Metabolic Nodal Response for Personalized Therapy

et al. 2016

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Only a minority of esophageal cancers demonstrates a pathologic tumor response (pTR) to neoadjuvant chemotherapy (NAC). 18 F-FDG PET/CT is often used for restaging after NAC and to assess response. Increasingly, it is used during therapy to identify unresponsive tumors and predict pTR, using avidity of the primary tumor alone. However, definitions of such metabolic tumor response (mTR) vary. We aimed to comprehensively reevaluate metabolic response assessment using accepted parameters, as well as novel concepts of metabolic nodal stage (mN) and metabolic nodal response (mNR).Methods: This was a single-center retrospective U.K. cohort study. All patients with esophageal cancer staged before NAC with PET/CT and after with CT or PET/CT and undergoing resection from 2006 to 2014 were identified. pTR was defined as Mandard tumor regression grade 1-3; imaging parameters included metrics of tumor avidity (SUV max/mean/peak ), composites of avidity and volume (including metabolic tumor volume), nodal SUV max , and our new concepts of mN stage and mNR. Results: Eighty-two (27.2%) of 301 patients demonstrated pTR. No pre-NAC PET parameters predicted pTR. In 220 patients restaged by PET/CT, the optimal tumor DSUV max threshold was a 77.8% reduction. This was as sensitive as the current PERCIST 30% reduction, but more specific with a higher negative predictive value (P , 0.001). DSUV max and Dlength independently predicted pTR, and composite avidity/spatial metrics outperformed avidity alone. Although both mTR and mNR were associated with pTR, in 82 patients with 18 F-FDG-avid nodes before NAC we observed mNR in 10 (12.2%) not demonstrating mTR. Conclusion: Current definitions of metabolic response are suboptimal and too simplistic. Composite avidity/volume measures improve prediction. mNR may further improve response assessment, by specifically assessing metastatic tumor subpopulations, likely responsible for disease relapse, and should be urgently assessed when considering aborting therapy on the basis of mTR alone.

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“…The significance was more evident in adenocarcinomas by subgroup analyses by histology (mortality hazard=0.78, CI=0.64-0.95, p=0.014) (Gebski et al, 2007). Fortunately, treatment morbidity and mortality did not differ between NAC and surgery alone Urschel et al, 2002). However, the positive NAC effects on survival (Gebski et al, 2007) seem to be influenced by one MRC study (Medical Research Council Oesophageal Cancer Working Group 2002) with the largest sample size (n=802), while most of the included RCTs in this meta-analysis in which the number of recruited patients was less than 100 showed no or marginal benefit for NAC.…”

Section: Neoadjuvant Settingmentioning

confidence: 86%

Multimodal Therapies for Upper Gastrointestinal Cancers – Past, Now, and Future

Shimoyama¹

2011

Current Cancer Treatment - Novel Beyond Conventional Approaches

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A meta-analysis of randomized controlled trials that compared neoadjuvant chemotherapy and surgery to surgery alone for resectable esophageal cancer

Cited by 195 publications

References 26 publications

International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus

International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus

Predicting Pathologic Response of Esophageal Cancer to Neoadjuvant Chemotherapy: The Implications of Metabolic Nodal Response for Personalized Therapy

Multimodal Therapies for Upper Gastrointestinal Cancers – Past, Now, and Future

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