Influence of tumor response and treatment schedule on the distribution of tumor recurrence in esophageal cancer patients treated with neoadjuvant chemoradiotherapy.

Abstract

113 Background: Knowledge of pathologic complete tumor response (pCR) and the used neoadjuvant chemoradiotherapy (nCRT) schedule on the distribution of recurrent disease is important in the treatment of esophageal cancer (EC) patients. We assessed the effect of both pCR and different nCRT schedules on the pattern of first tumor recurrences in EC. Methods: The study was performed in two different centers in patients with T1N+/T2-4aN0-3/M0 EC. Patients were treated with nCRT according to the CROSS (carboplatin/paclitaxel/41.4Gy : n=134) and Cis/5FU schedule (Cisplatin/5-fluorouracil/45-50.4Gy : n=88) followed by surgery. First we determined the effect of pCR on tumor recurrence distribution (local, distant or combined) and site-specific recurrences in the CROSS group. After propensity matching on clinical T-stage, clinical N-stage and histology (n=63), we determined the effect of both nCRT schedules on the distribution of tumor recurrence and site specific recurrences. Results: The median follow-up after pCR (n=24) was significant longer ( P=0.001) than in non-complete responders (pNCR); 45.5 (IQR 20.3-69.5) and 20.0 months (12.0-42.3), respectively. The pattern of recurrence also differed significantly ( P=0.001), with 0 (0.0%) and 7 (6.4%) locoregional, 5 (20.8%) and 36 (32.7%) distant, and 0 (0.0%) and 21 (19.1%) local and distant recurrence between the pCR and pNCR group, respectively. Patients with a pCR had significant less local and distant recurrences. With equal median time to recurrence, the distribution of metastases in the matched groups differed only in the numbers of lung metastases ( P=0.029), with 15 (23.8%) and 6 (9.5%), respectively. Conclusions: Patients with a pCR have less local and distant recurrences. With equal time to first recurrence, the nCRT schedule itself had only a minor influence on the distribution of recurrences.

Patterns and risk of recurrence in patients with esophageal cancer with a pathologic complete response after chemoradiotherapy followed by surgery

“…1,11 Despite these outcomes, other studies have reported that 21% to 39% of patients with a pCR still have recurrence. [8][9][10] In our study, 61 patients with pCR experienced recurrence of disease. To date, few studies have assessed whether clinical and pathologic characteristics may predict recurrence in this patient population.…”

“…1,6 The degree of response to chemoradiotherapy is a strong predictor of both OS and DFS, and several studies have demonstrated that patients with a pCR have better OS and DFS and lower rates of recurrence in comparison with patients with residual disease contained in the surgical specimen despite complete resection. [7][8][9] In particular, for patients with pCR, 5-year OS and DFS have been reported to be approximately 50% regardless of histology. [10][11][12][13] Despite these positive results, 21% to 39% of patients who achieve pCR do have recurrence, predominantly within 2 years post-treatment.…”

“…[10][11][12][13] Despite these positive results, 21% to 39% of patients who achieve pCR do have recurrence, predominantly within 2 years post-treatment. [8][9][10] Whether such patients with early recurrences truly had no evidence of residual disease after CRT-S certainly remains a valid question, because misclassification of minimal residual disease is possible. However, if they were correctly designated as having a pCR, then underlying clinical characteristics and tumor biology that predispose to recurrence are worth exploring to better risk stratify patients.…”

Prognostic Impact of Postoperative Lymph Node Metastases After Neoadjuvant Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of Esophagus

“…However, recurrence rate after pCR remains an issue. Although the recurrence rate is quite low compared to that of non-pCR patients, 28 >20% of patients still relapse after trimodal treatment 29,30 . We experienced a recurrence rate of 13.9%.…”

Prognostic Impact of Lymph Node Localization in Node-Positive Esophageal Cancer

“…Despite the improvement in multimodal treatment during the past several years, the prognosis of esophageal cancer remains poor [2][3][4][5][21][22][23][24]. One of the main reasons is the high frequency of tumor recurrence following curative-intended surgery [5,25].…”