Long-term Outcomes Following Neoadjuvant Chemoradiotherapy for Esophageal Cancer

Reynolds, John V.; Muldoon, Cian; Hollywood, Donal; Ravi, Narayanasamy; Rowley, S.; O'Byrne, K. T.; Kennedy, J. S.; Murphy, Thomas J.

doi:10.1097/01.sla.0000254367.15810.38

Cited by 147 publications

(155 citation statements)

References 38 publications

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“…It is commonly accepted that patients who achieve a pathological complete response after neoadjuvant chemoradiotherapy for locally advanced oesophageal cancers have an improved prognosis (10)(11)(12)(13). Moreover, several studies found the extent of residual tumour after neoadjuvant chemoradiotherapy to be an important prognostic factor (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Pre- and post-therapy nodal status equally affects survival of patients with oesophageal squamous cell carcinoma receiving preoperative chemoradiation

et al. 2010

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Abstract. Patients with deeply invading (T3-T4) oesophageal cancers usually receive chemoradiotherapy with or without surgery. However, the prognostic significance of pre-therapy and post-therapy lymph node (LN) status remains unclear. We studied 195 patients who received chemoradiotherapy for deeply invading oesophageal cancers (T3-4, N0-1, M0). Of these, 105 patients underwent surgery while 90 were treated by chemoradiotherapy alone. Of the 105 surgically treated patients, overall survival was significantly better in cN0 patients than in cN1 (3-year survival rate, 65.3 vs. 25.8%, P=0.0014). This difference was similarly observed in 90 patients who received chemoradiotherapy alone. Patient survival differed significantly among patients with no positive LN, 1 positive LN and 2-4 positive LN (3-year survival rate, 57.1 vs. 40.5 vs. 17.6%, P<0.0001). However, there was no significant difference in survival between patients with 2-4 positive LN and ≥5 positive LN. Multivariate analysis identified pre-therapy LN status and the number of involved LNs as the most important independent prognostic factors prior to histopathological tumour regression. In conclusion, pretherapy LN status and the number of post-therapy involved LNs equally affect survival of patients who receive neoadjuvant chemoradiotherapy. Control of systemic metastasis is required, based on pre-and post-therapy LN status.

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Section: Introductionmentioning

confidence: 99%

Pre- and post-therapy nodal status equally affects survival of patients with oesophageal squamous cell carcinoma receiving preoperative chemoradiation

et al. 2010

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“…Patients with biopsyproven cancer of the oesophagus or an oesophago-gastric junction with localised disease determined by computerised tomography of the neck, thorax and abdomen, and whole-body 18 FDG-PET scans, and considered resectable by the primary surgeon, were eligible. The inclusion criteria for multimodal therapy, approved by the institutional review board, are as follows: age o77 years; satisfactory performance status (ASA 1 or 2; Karnofsky 490%) and medical fitness for surgery; no previous chemotherapy or radiation therapy; a leukocyte count greater than 3500 per cubic millimetre, a platelet count above 100 000 per cubic millimetre; and serum creatinine less than 124 mmol per litre (Reynolds et al, 2007).…”

Section: Patientsmentioning

confidence: 99%

“…The multimodality regimen was as previously described, with radiation (40 -44 Gy per 15 -22 fractions) over 3 weeks, and concurrent chemotherapy with 5-fluorouracil (15 mg kg À1 ) on days 1 -5 and with cisplatin (75 mg m À2 ) on day 7; chemotherapy was repeated on week 6 (Reynolds et al, 2007). All patients underwent a thoracotomy as a part of their surgical management, either combined with an abdominal and neck exploration (three-stage) for mid-and upper-oesophageal cancers, or for cancer arising in the long-segment Barrett's oesophagus, or with an abdominal exploration (two-stage) for most lower third and junctional tumours, or combined with a total gastrectomy for junctional tumours with significant gastric extension.…”

Section: Patientsmentioning

confidence: 99%

“…The patient population is homogeneous, with an average age above 60 years and a duration of surgery between 4 and 7 h. The magnitude of surgical trauma is relatively uniform with respect to altered physiology, immune function and metabolism, with a marked pro-inflammatory cytokine response and a well-defined high risk of clinical complications (Enzinger and Mayer, 2003). Finally, neoadjuvant chemotherapy and radiation therapy may be associated with increased operative risks, and whether this relates to an altered pro-coagulant or immune response is unknown (Bosset et al, 1997;Reynolds et al, 2007).…”

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confidence: 99%

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Long-term activation of the pro-coagulant response after neoadjuvant chemoradiation and major cancer surgery

et al. 2009

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BACKGROUND: The association between cancer, major surgery and venous thromboembolism (VTE) is well established. Multimodal therapy is increasingly being used as standard treatment for localised gastrointestinal cancer. The aim of this study was to examine the markers of pro-coagulation response and VTE risk in an exemplar multimodal model of pre-operative combination chemotherapy and radiation therapy, followed by complex cancer surgery. METHODS: Consecutive patients (n ¼ 36) with localised oesophageal cancer were studied at baseline after the first and second cycles of chemoradiation, and on post-operative days 1 -28, and at 3, 6 and 9 months. Factors regulating the pro-and anti-coagulant response, as well as pro-inflammatory markers including NFkB activation in peripheral blood mononuclear cells, were examined. All patients received enoxaparin 40 mg s.c. postoperatively up to discharge, and underwent pulmonary CT-pulmonary angiography and venography on day 10 postoperatively. RESULTS: Four (11%) non-fatal thromboembolic events were documented, all after hospital discharge. Neoadjuvant therapy before surgery activated factor VIII (FVIII) and pro-inflammatory NFkB, and increased D-dimers, pro-thrombin fragment 1 þ 2 (F1 þ 2) and the thrombin-anti-thrombin complex (TAT). Surgery significantly (Po0.05) increased pro-thrombin time (PT), activated partial thromboplastin time, fibrinogen, D-dimers, TAT, F1 þ 2 and FVIII up to 6 months. CONCLUSION: These data highlight the linked pro-coagulant and immunoinflammatory pathways in the multimodal management of oesophageal cancer, and suggest that the duration of current standard thromboprophylaxis regimens warrants further study.

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“…Alguns trabalhos avaliando o tratamento neo-adjuvante foram publicados com resultados controversos especialmente em relação à possível melhora da sobrevida as custas de maiores complicações peri-operatórias 1,2,4,8,11,14,15,16,17,18,19,21,22,28,35,36,38,40 .…”

Section: Discussionunclassified

Terapêutica neo-adjuvante aumenta as complicações pós-operatórias da esofagectomia?

Tercioti

Lopes

Coelho-Neto

et al. 2010

ABCD, arq. bras. cir. dig.

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RESUMO -Racional -O câncer de esôfago é o oitavo tipo de câncer mais incidente na população no mundo, sendo que no Brasil são estimados 10.630 novos casos para o ano de 2010. Na terapêutica curativa, a esofagectomia destaca-se nas suas mais diversas modalidades de tratamento. Objetivo -Avaliar por meio de um estudo retrospectivo não-randomizado as complicações peri-operatórias dos pacientes submetidos à esofagectomia por carcinoma epidermóide do esôfago, com ou sem terapêutica neoadjuvante.

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Long-term Outcomes Following Neoadjuvant Chemoradiotherapy for Esophageal Cancer

Cited by 147 publications

References 38 publications

Pre- and post-therapy nodal status equally affects survival of patients with oesophageal squamous cell carcinoma receiving preoperative chemoradiation

Pre- and post-therapy nodal status equally affects survival of patients with oesophageal squamous cell carcinoma receiving preoperative chemoradiation

Long-term activation of the pro-coagulant response after neoadjuvant chemoradiation and major cancer surgery

Terapêutica neo-adjuvante aumenta as complicações pós-operatórias da esofagectomia?

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