Outcomes After Trimodality Therapy for Esophageal Cancer

Koshy, Matthew; Greenwald, Bruce D.; Hausner, P; Krasna, Mark J.; Horiba, Naomi; Battafarano, Richard J.; Burrows, W.; Suntharalingam, Mohan

doi:10.1097/coc.0b013e3181e841ce

Cited by 37 publications

(30 citation statements)

References 31 publications

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“…18 Our 2-year PAF rate was higher at 9%, which was likely related to the finding that a greater percentage of patients in the current study had adenocarcinoma (79% vs 68%), with the majority involving the GEJ. We found the highest rates of PAF (19%) among patients with adenocarcinoma of the GEJ who had ≥2 clinically involved lymph nodes at the time of diagnosis.…”

Section: Discussionmentioning

confidence: 49%

Patterns of recurrence after trimodality therapy for esophageal cancer

Dorth

Pura

Palta

et al. 2014

Cancer

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BACKGROUND Patterns of failure after neoadjuvant chemoradiotherapy and surgery for esophageal cancer are poorly defined. METHODS All patients in the current study were treated with trimodality therapy for nonmetastatic esophageal cancer from 1995 to 2009. Locoregional failure included lymph node failure (NF), anastomotic failure, or both. Abdominal paraaortic failure (PAF) was defined as disease recurrence at or below the superior mesenteric artery. RESULTS Among 155 patients, the primary tumor location was the upper/middle esophagus in 18%, the lower esophagus in 32%, and the gastroesophageal junction in 50% (adenocarcinoma in 79% and squamous cell carcinoma in 21%) of patients. Staging methods included endoscopic ultrasound (73%), computed tomography (46%), and positron emission tomography/computed tomography (54%). Approximately 40% of patients had American Joint Committee on Cancer stage II disease and 60% had stage III disease. The median follow-up was 1.3 years. The 2-year locoregional control, event-free survival, and overall survival rates were 86%, 36%, and 48%, respectively. The 2-year NF rate was 14%, the isolated NF rate was 3%, and the anastomotic failure rate was 6%. The 2-year PAF rate was 9% and the isolated PAF rate was 5%. PAF was found to be increased among patients with gastroesophageal junction tumors (12% vs 6%), especially for the subset with ≥2 clinically involved lymph nodes at the time of diagnosis (19% vs 4%). CONCLUSIONS Few patients experience isolated NF or PAF as their first disease recurrence. Therefore, it is unlikely that targeting additional regional lymph node basins with radiotherapy would significantly improve clinical outcomes.

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Section: Discussionmentioning

confidence: 49%

Patterns of recurrence after trimodality therapy for esophageal cancer

Dorth

Pura

Palta

et al. 2014

Cancer

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“…All PET/CT studies were acquired on the same scanner following an institutional standard protocol (10). All patients were treated with external-beam radiotherapy to the same total dose of 50.4 Gy with concurrent Cisplatin or Carboplatin chemotherapy (14). …”

Section: Methodsmentioning

confidence: 99%

Modeling Pathologic Response of Esophageal Cancer to Chemoradiation Therapy Using Spatial-Temporal 18F-FDG PET Features, Clinical Parameters, and Demographics

Zhang

Tan

Chen

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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105

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Purpose To construct predictive models using comprehensive tumor features for the evaluation of tumor response to neoadjuvant chemoradiotherapy (CRT) in patients with esophageal cancer. Methods and Materials This study included 20 patients who underwent trimodality therapy (CRT + surgery) and had 18F-FDG PET/CT scans both before and after CRT. Four groups of tumor features were examined: (1) conventional PET/CT response measures (SUVmax, tumor diameter, etc.); (2) clinical parameters (TNM stage, histology, etc.) and demographics; (3) spatial-temporal PET features, which characterize tumor SUV intensity distribution, spatial patterns, geometry, and associated changes resulting from CRT; and (4) all features combined. An optimal feature set was identified with recursive feature selection and cross-validations. Support vector machine (SVM) and logistic regression (LR) models were constructed for prediction of pathologic tumor response to CRT, using cross-validations to avoid model over-fitting. Prediction accuracy was assessed via area under the receiver operating characteristic curve (AUC), and precision was evaluated via confidence intervals (CIs) of AUC. Results When applied to the 4 groups of tumor features, the LR model achieved AUCs (95% CI) of 0.57 (0.10), 0.73 (0.07), 0.90 (0.06), and 0.90 (0.06). The SVM model achieved AUCs (95% CI) of 0.56 (0.07), 0.60 (0.06), 0.94 (0.02), and 1.00 (no misclassifications). Using spatial–temporal PET features combined with conventional PET/CT measures and clinical parameters, the SVM model achieved very high accuracy (AUC 1.00) and precision (no misclassifications), significantly better than using conventional PET/CT measures or clinical parameters and demographics alone. For groups with a large number of tumor features (groups 3 and 4), the SVM model achieved significantly higher accuracy than the LR model, Conclusions The SVM model using all features including spatial–temporal PET features accurately and precisely predicted pathologic tumor response to CRT in esophageal cancer.

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“…With a median interval of time from completion of radiation to surgery of 49 days, they reported no difference in patient outcomes based on the interval from radiation completion and surgery. Similarly, Koshy et al, found that with a median time lapse of 7 weeks between treatments, there was no significant effect on tumor response (20). …”

Section: Commentmentioning

confidence: 98%

Increased Time From Neoadjuvant Chemoradiation to Surgery Is Associated With Higher Pathologic Complete Response Rates in Esophageal Cancer

Shaikh

Ruth

Scott

et al. 2015

The Annals of Thoracic Surgery

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Background The interval between neoadjuvant chemoradiation treatment and surgery has been described as an important predictor of pathologic response to therapy in non-esophageal cancer sites. We retrospectively reviewed our experience with patients who underwent neoadjuvant chemoradiation and esophagectomy to better understand the impact of the timing of surgery on pathologic complete response rates in esophageal cancer. Methods Two hundred thirty one sequentially treated patients from 2000 to 2011 were identified for this study, 88 of these patients completed neoadjuvant chemoradiation followed by esophagectomy at our institution. The interval between completion of chemoradiation and surgery was calculated for each patient. The patients were categorized into quartiles and also 3-week interval groups. Treatment factors and surgical morbidity data including the estimated blood loss and length of operative stay were also assessed. Results Quartiles for the neoadjuvant chemoradiation to surgery interval were <45 days, 46-50 days, 51-63 days, and 64+ days. Corresponding pathologic complete response rates were 12.5%, 20.0%, 22.7% and 40.9% (p=0.03). Results for 3-week intervals were similar (p=0.02). There was no association between increasing time interval between the ending of neoadjuvant chemoradiation to surgery and length of stay longer than 2 weeks. Conclusions A longer interval between completion of neoadjuvant chemoradiation and surgery was associated with higher pathologic complete response rates without an impact on surgical morbidity.

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Outcomes After Trimodality Therapy for Esophageal Cancer

Cited by 37 publications

References 31 publications

Patterns of recurrence after trimodality therapy for esophageal cancer

Patterns of recurrence after trimodality therapy for esophageal cancer

Modeling Pathologic Response of Esophageal Cancer to Chemoradiation Therapy Using Spatial-Temporal 18F-FDG PET Features, Clinical Parameters, and Demographics

Increased Time From Neoadjuvant Chemoradiation to Surgery Is Associated With Higher Pathologic Complete Response Rates in Esophageal Cancer

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