Neoadjuvant Chemoradiation Therapy Is Beneficial for Clinical Stage T2 N0 Esophageal Cancer Patients Due to Inaccurate Preoperative Staging

Zhang, Jennifer Q.; Hooker, Craig M.; Brock, Malcolm V.; Shin, James; Lee, Sue; How, Remealle A; Franco, Noreli; Prevas, H; Hulbert, Alicia; Yang, Stephen C.

doi:10.1016/j.athoracsur.2011.10.061

Cited by 62 publications

(69 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, just 35 of the 59 patients receiving primary resection were correctly staged while 13 patients were over- und 11 patients were understaged. These findings are in line with other available studies analyzing the optimal treatment strategy in patients with cT2 tumors [5,6,7,8,9]. Indeed, Rice et al [5] showed in 61 cT2N0 esophageal cancer patients that just 13% of the study patients were staged correctly regarding the T category, while of the incorrectly staged patients 63% were over- and 37% were understaged.…”

Section: Discussionsupporting

confidence: 79%

“…The working group revealed that the patients treated with trimodality therapy had an excellent overall survival with a high rate of complete pathologic response, providing support for multimodality therapy in patients with cT2 tumors. Similar recommendations were proposed by Zhang et al [9]. Indeed, in their retrospective analysis including 69 patients with cT2N0 esophageal cancer, they failed to show that induction therapy did translate into a statistically significant improvement of survival; nevertheless, the authors still recommend neoadjuvant therapy to all cT2N0 patients before surgery due to a significant understaging in this study [9].…”

Section: Discussionmentioning

confidence: 49%

“…While early-stage cT1a lesions are best managed by endoscopic mucosal resection and locally advanced tumors (cT3/4Nx) mainly receive neoadjuvant therapy followed by surgical resection, the therapeutic approach in patients with clinically staged cT2 tumors remains highly controversial [5,6,7,8,9]. Indeed, these proposed therapeutic trends emphasize that the pretherapeutic correct determination of the clinical T category is of great importance for the appropriate therapy decision.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the authors recommended that patients with cT2N0 tumors should first undergo surgical resection and that clinically understaged patients should receive postoperative adjuvant therapy. In contrast, Zhang et al [9] performed a retrospective analysis of 69 patients with cT2N0 esophageal cancer, assessing whether this patient population should undergo neoadjuvant therapy. Even though the authors were not able to show that induction therapy did translate into a statistically significant improvement in survival, they recommend a neoadjuvant therapy to all cT2N0 patients due to significant understaging of the patients in this study.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, cT2 AEGs are not a common but a very interesting entity, of which available data about the optimal treatment strategy is very rare [5,6,7,8,9]. For example, Rice et al [5] evaluated the treatment algorithm for 61 cT2N0 esophageal cancer patients by determining errors in clinical staging and consequences of over- and undertreatment of incorrectly staged patients.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences

Vallböhmer

Sisic²,

Blank³

et al. 2014

Oncol Res Treat

View full text Add to dashboard Cite

Background: Multimodality treatment options in locally advanced adenocarcinomas of the esophagogastric junction (AEGs) have been established in the last years. However, the therapeutic approach in patients with clinically staged cT2 tumors remains controversial. The most important determinant is the accuracy of clinical staging. We aimed to evaluate the association of clinical and histopathological staging in patients with cT2 tumors in respect of possible therapeutic consequences. Patients and Methods: Between 2001 and 2011, 71 patients with AEG tumors were clinically staged as cT2 (cN0 = 48 (68%); cN+ = 23 (32%)) and underwent surgical resection. Results: A primary tumor resection was performed in 59 (83%) patients while 12 (17%) patients received neoadjuvant therapy. Primarily resected patients showed the following pT/pN categories: pT1: 13 (22%), pT2: 35 (59%), pT3: 11 (19%), pN0: 23 (39%), whereas the clinical/histopathological pN category included 55% of the patients. Neoadjuvantly treated patients showed the following pT/pN categories: ypT0: 3 (25%), ypT1: 3 (25%), ypT2: 6 (50%), ypN0: 6 (50%). The overall survival of primarily resected patients compared with patients undergoing neoadjuvant therapy was not significantly different. Conclusions: The accuracy of clinical staging in patients with cT2 tumors of the gastroesophageal junction is poor. As in primarily resected patients, over- and understaging balance each other; correct pretherapeutic staging occurs in just about 60% of the patients. Moreover, our study suggests that a radical surgical resection with adequate lymphadenectomy seems to be appropriate for cT2N0 and even in cT2N+ tumors, since down-categorizing and prognosis are not improved for neoadjuvantly treated patients. However, the data have to be interpreted with caution because of the small patient numbers.

show abstract

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences

Vallböhmer

Sisic²,

Blank³

et al. 2014

Oncol Res Treat

View full text Add to dashboard Cite

show abstract

Association Between Clinically Staged Node-Negative Esophageal Adenocarcinoma and Overall Survival Benefit From Neoadjuvant Chemoradiation

Gabriel

Attwood²,

et al. 2016

JAMA Surg

View full text Add to dashboard Cite

Importance While neoadjuvant chemoradiation for esophageal cancer improves oncologic outcomes for a broad group of patients with locally advanced and/or node-positive tumors, it is less clear which specific subset of patients derives most benefit in terms of overall survival (OS). Objective To determine whether neoadjuvant chemoradiation based on esophageal adenocarcinoma histology has similar oncologic outcomes for patients treated with surgery alone when stratified by clinical nodal status. Design, Setting, and Participants A retrospective analysis using the American College of Surgeons National Cancer Database from 1998 to 2006. Patients with esophageal adenocarcinoma histology and clinical stage T1bN1-N3 or T2-T4aN−/+M0 were divided into 2 treatment groups: (1) neoadjuvant chemoradiation followed by surgery and (2) surgery alone. Subset analysis within each treatment group was performed for clinically node-negative patients (cN−) vs node-positive patients (cN+) in conjunction with pathological nodal status. A propensity score–adjusted analysis, which included patient demographics, comorbidity status, and clinical T stage, was also performed. Main Outcome and measures The primary outcome was 3-year OS. Secondary outcomes included margin status, postoperative length of stay, unplanned readmission rate, and 30-day mortality. Results A total of 1309 patients were identified, of whom 539 received neoadjuvant chemoradiation followed by surgery and 770 received surgery alone. Of the 1309 patients, 41.2% (n = 539) received neoadjuvant chemoradiation and 47.2% (n = 618) were cN+. Median follow-up for the entire cohort was 73.3 months (interquartile range, 64.1-93.5 months). The 3-year OS was better for neoadjuvant chemoradiation followed by surgery compared with surgery alone (49% vs 38%, respectively; P < .001). Stratifying based on clinical nodal status, the propensity score–adjusted OS was significantly better for cN+ patients who received neoadjuvant chemoradiation (hazard ratio, 0.52; 95% CI, 0.42-0.66; P < .001). In contrast, there was no difference in OS for cN− patients based on treatment (hazard ratio, 0.84; 95% CI, 0.65-1.10; P = .22). Conclusions and Relevance Patients with cN+ esophageal adenocarcinoma benefit significantly from neoadjuvant chemoradiation. However, patients with cN− tumors treated with neoadjuvant chemoradiation plus surgery do not derive a significant OS benefit compared with surgery alone. This finding may have significant implications on the use of neoadjuvant chemoradiation in patients with cN− disease.

show abstract

Does Induction Therapy for T2N0 Esophageal Adenocarcinoma Patients Improve Survival?

Donohoe

Reynolds

2020

Difficult Decisions in Surgery: An Evidence-Based Approach

View full text Add to dashboard Cite

Neoadjuvant Chemoradiation Therapy Is Beneficial for Clinical Stage T2 N0 Esophageal Cancer Patients Due to Inaccurate Preoperative Staging

Cited by 62 publications

References 13 publications

Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences

Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences

Association Between Clinically Staged Node-Negative Esophageal Adenocarcinoma and Overall Survival Benefit From Neoadjuvant Chemoradiation

Does Induction Therapy for T2N0 Esophageal Adenocarcinoma Patients Improve Survival?

Contact Info

Product

Resources

About