Is There a Role for Surgery for Patients with a Complete Clinical Response after Chemoradiation for Esophageal Cancer? An Intention-to-Treat Case-Control Study

Piessen, Guillaume; Messager, Mathieu; Mirabel, X.; Briez, Nicolas; Robb, William B.; Adenis, Antoine; Mariette, C.

doi:10.1097/sla.0000000000000228

Cited by 81 publications

(65 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The authors compared the outcomes of neoadjuvant CRT followed by surgery and definitive CRT in patients who achieved clinically complete remission (CR) after CRT. 56 Although this study was retrospective in nature, additional surgery significantly improved survival (median, 83 months vs. 31 months; 5-year, 58.9% vs. 33.4%, P ¼ 0.001) as well as DFS (median, 83 months vs. 31 months; 5-year DFS, 57.4% vs. 33.4%, P ¼ 0.001). In addition, all patients were clinically complete responders, but 34.6% of patients who underwent surgery had persistent esophageal tumors or node metastases on the esophagectomy specimens.…”

Section: Issues Related To Good Responders After Crtmentioning

confidence: 89%

“…First, the number of randomized trials is only two, which is insufficient to establish a definite conclusion, and one case-control study (conducted by Piessen et al 56 ) reported conflicting results. The authors compared the outcomes of neoadjuvant CRT followed by surgery and definitive CRT in patients who achieved clinically complete remission (CR) after CRT.…”

Section: Issues Related To Good Responders After Crtmentioning

confidence: 95%

See 1 more Smart Citation

WITHDRAWN: Multimodality treatment for locally advanced esophageal cancers

Jeong

Kim

2014

Gastrointestinal Intervention

View full text Add to dashboard Cite

a b s t r a c tFor several decades, there have been numerous efforts to improve poor outcomes of locally advanced esophageal cancer. Multimodality treatment with neoadjuvant chemoradiotherapy (CRT) followed by surgery has been accepted as a standard treatment for locally advanced, potentially resectable esophageal cancers in many institutions based on several recent randomized trials and meta-analysis. In addition, there has been some controversy about the role of additional surgery in patients who responded well to CRT. In this article, we reviewed the results of classic treatments, past and current multimodality treatments, and issues related to good responders after CRT.Esophageal cancer has been reported as the eighth most common cancer and the sixth most lethal cancer worldwide. 1 In 2008, an estimated 480,000 cases of esophageal cancer occurred, and 400,000 patients died of esophageal cancer worldwide. 2 The incidence and the predominant histologic type vary depending on the geographic location and the time trend. Southern and Eastern Africa and Eastern Asia have been known as high-risk areas of esophageal cancer, and most of esophageal cancers in these areas are squamous cell carcinomas (SCCs). 1-3 By contrast, incidence rates in the United States and several Western countries are low, and adenocarcinomas are dominant in these areas and have been increasing since the 1970s. [1][2][3] Historically, surgery has been the standard treatment for resectable esophageal cancers. Patients who had resectable esophageal cancer and underwent surgery showed the most favorable prognosis with 2-year overall survival (OS) rates ranging from 30% to 50% and 5-year survival rates ranging from 16% to 34%. 4-11 But in patients with unresectable cancers or with medically inoperable conditions, radiotherapy with or without chemotherapy has been performed, and the treatment outcomes of radiotherapy alone were extremely poor as 2-year OS rates ranged between 10% and 20%, and the 5-year OS rates were reported to be < 10%. [12][13][14][15] In patients who received radiotherapy with concurrent chemotherapy, the 2-and 5-year OS rates were reported as 25-40% and 9-27%, respectively, which were definitely higher than those of radiotherapy alone and equivalent to those of surgery. [16][17][18][19][20] To improve the poor outcomes of locally advanced esophageal cancer, many treatment modalities have been attempted such as addition of adjuvant radiotherapy and/or chemotherapy, neoadjuvant radiotherapy and/or chemotherapy, and definitive chemoradiotherapy (CRT) with various radiation doses and techniques. Although the standard treatment for locally advanced, potentially resectable esophageal cancers has not been definitively established yet, the most widely accepted multimodality treatment is neoadjuvant CRT followed by surgery in many institutions on the basis of the results in many retrospective and prospective studies. Moreover, several studies also reported that patients who responded well after CRT might achieve relatively good surviva...

show abstract

Section: Issues Related To Good Responders After Crtmentioning

confidence: 89%

Section: Issues Related To Good Responders After Crtmentioning

confidence: 95%

WITHDRAWN: Multimodality treatment for locally advanced esophageal cancers

Jeong

Kim

2014

Gastrointestinal Intervention

View full text Add to dashboard Cite

show abstract

“…In fact, a personal decision threshold can be chosen according to the willingness of risking a false-positive result. In the context of predicting pathCR in esophageal cancer, a false-positive finding could result in omission of surgery in a patient with residual disease, which is potentially hazardous (14,33), and therefore the decision threshold should be high (e.g., ;0.9). To evaluate the incremental value of a model including 18 F-FDG PET information, the net benefit (demonstrated on the y-axis) of the model should be higher than the model without that information.…”

Section: Discussionmentioning

confidence: 99%

The Incremental Value of Subjective and Quantitative Assessment of ¹⁸F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer

et al. 2016

View full text Add to dashboard Cite

A reliable prediction of a pathologic complete response (pathCR) to chemoradiotherapy before surgery for esophageal cancer would enable investigators to study the feasibility and outcome of an organ-preserving strategy after chemoradiotherapy. So far no clinical parameters or diagnostic studies are able to accurately predict which patients will achieve a pathCR. The aim of this study was to determine whether subjective and quantitative assessment of baseline and postchemoradiation 18 F-FDG PET can improve the accuracy of predicting pathCR to preoperative chemoradiotherapy in esophageal cancer beyond clinical predictors. Methods: This retrospective study was approved by the institutional review board, and the need for written informed consent was waived. Clinical parameters along with subjective and quantitative parameters from baseline and postchemoradiation 18 F-FDG PET were derived from 217 esophageal adenocarcinoma patients who underwent chemoradiotherapy followed by surgery. The associations between these parameters and pathCR were studied in univariable and multivariable logistic regression analysis. Four prediction models were constructed and internally validated using bootstrapping to study the incremental predictive values of subjective assessment of 18 F-FDG PET, conventional quantitative metabolic features, and comprehensive 18 F-FDG PET texture/geometry features, respectively. The clinical benefit of 18 F-FDG PET was determined using decision-curve analysis. Results: A pathCR was found in 59 (27%) patients. A clinical prediction model (corrected c-index, 0.67) was improved by adding 18 F-FDG PET-based subjective assessment of response (corrected c-index, 0.72). This latter model was slightly improved by the addition of 1 conventional quantitative metabolic feature only (i.e., postchemoradiation total lesion glycolysis; corrected c-index, 0.73), and even more by subsequently adding 4 comprehensive 18 F-FDG PET texture/geometry features (corrected c-index, 0.77). However, at a decision threshold of 0.9 or higher, representing a clinically relevant predictive value for pathCR at which one may be willing to omit surgery, there was no clear incremental value. Conclusion: Subjective and quantitative assessment of 18 F-FDG PET provides statistical incremental value for predicting pathCR after preoperative chemoradiotherapy in esophageal cancer. However, the discriminatory improvement beyond clinical predictors does not translate into a clinically relevant benefit that could change decision making.

show abstract

“…18 The pretherapeutic cTNM classification, performed before any stenting, was based on endoscopic ultrasound and/or CT scan in cases where tumor stenosis precluded full endoscopic ultrasound examination.…”

Section: Pretherapeutic Workupmentioning

confidence: 99%

Self-Expanding Covered Metallic Stent as a Bridge to Surgery in Esophageal Cancer: Impact on Oncologic Outcomes

Mariette¹,

Gronnier²,

Duhamel³

et al. 2015

Journal of the American College of Surgeons

Self Cite

View full text Add to dashboard Cite

Is There a Role for Surgery for Patients with a Complete Clinical Response after Chemoradiation for Esophageal Cancer? An Intention-to-Treat Case-Control Study

Cited by 81 publications

References 34 publications

WITHDRAWN: Multimodality treatment for locally advanced esophageal cancers

WITHDRAWN: Multimodality treatment for locally advanced esophageal cancers

The Incremental Value of Subjective and Quantitative Assessment of ¹⁸F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer

Self-Expanding Covered Metallic Stent as a Bridge to Surgery in Esophageal Cancer: Impact on Oncologic Outcomes

Contact Info

Product

Resources

About

Is There a Role for Surgery for Patients with a Complete Clinical Response after Chemoradiation for Esophageal Cancer? An Intention-to-Treat Case-Control Study

Cited by 81 publications

References 34 publications

WITHDRAWN: Multimodality treatment for locally advanced esophageal cancers

WITHDRAWN: Multimodality treatment for locally advanced esophageal cancers

The Incremental Value of Subjective and Quantitative Assessment of 18F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer

Self-Expanding Covered Metallic Stent as a Bridge to Surgery in Esophageal Cancer: Impact on Oncologic Outcomes

Contact Info

Product

Resources

About

The Incremental Value of Subjective and Quantitative Assessment of ¹⁸F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer