Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer

Hagen, Pieter van; Hulshof, Maarten C.C.M.; Lanschot, J. Jan B. van; Steyerberg, Ewout W.; Henegouwen, Mark I. van Berge; Wijnhoven, Bas P. L.; Richel, Dick J.; Nieuwenhuijzen, G.; Hospers, Geke A.P.; Bonenkamp, Johannes J.; Cuesta, Miguel A.; Blaisse, Reinoud J B; Busch, Olivier R.; Kate, Fiebo J.W. ten; Creemers, Geert-Jan; Punt, Cja; Plukker, John Theodorus; Verheul, H.; Bilgen, Ernst Jan Spillenaar; Dekken, Herman van; Sangen, M.J.C. van der; Rozema, Tom; Biermann, Katharina; Beukema, Jannet C.; Piet, Anna H.M.; Rij, Caroline M. van; Reinders, Janny G.; Tilanus, H. W.; Gaast, Ate van der

doi:10.1056/nejmoa1112088

Cited by 4,518 publications

(4,133 citation statements)

References 22 publications

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“…The introduction of neoadjuvant treatment has increased the survival of patients undergoing surgery for oesophageal cancer1, 2, 3. Despite this, 5‐year survival rates following resection rarely exceed 50 per cent, and recurrence rates are still disappointingly high.…”

Section: Introductionmentioning

confidence: 99%

Impact of incremental circumferential resection margin distance on overall survival and recurrence in oesophageal adenocarcinoma

Knight

Zylstra²,

Wulaningsih

et al. 2018

BJS Open

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BackgroundPrevious analyses of the oesophageal circumferential resection margin (CRM) have focused on the prognostic validity of two different definitions of a positive CRM, that of the College of American Pathologists (tumour at margin) and that of the Royal College of Pathologists (tumour within 1 mm). This study aimed to analyse the validity of these definitions and explore the risk of recurrence and survival with incremental tumour distances from the CRM.MethodsThis cohort study included patients who underwent resection for adenocarcinoma of the oesophagus between 2000 and 2014. Kaplan–Meier and Cox regression analyses were performed to determine the hazard ratio (HR) with 95 per cent confidence intervals for recurrence and mortality in CRM increments: tumour at the cut margin, extending to within 0·1–0·9, 1·0–1·9, 2·0–4·9 mm, and 5·0 mm or more from the margin.ResultsA total of 444 patients were included in the study. Kaplan–Meier and unadjusted analyses showed a significant incremental improvement in overall survival (P < 0·001) and recurrence (P for trend < 0·001) rates with increasing distance from the CRM. Tumour distance of 2·0 mm or more remained a significant predictor of survival on multivariable analysis (HR for risk of death 0·66, 95 per cent c.i. 0·44 to 1·00). Multivariable analysis of overall survival demonstrated a significant difference between a positive and negative CRM with the Royal College of Pathologists' definition (HR 1·37, 1·01 to 1·85), but not with the College of American Pathologists' definition (HR 1·22, 0·90 to 1·65).ConclusionThis study demonstrated an incremental improvement in survival and recurrence rates with increasing tumour distance from the CRM.

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Section: Introductionmentioning

confidence: 99%

Impact of incremental circumferential resection margin distance on overall survival and recurrence in oesophageal adenocarcinoma

Knight

Zylstra²,

Wulaningsih

et al. 2018

BJS Open

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“…Systemic recurrence remains the most common cause of death following oesophageal resection and, as a result, most patients are offered oncological therapies in combination with surgery, in the hope of reducing this risk7. Neoadjuvant chemotherapy (NAC) and neoadjuvant chemoradiotherapy (NACRT) have both been shown to improve survival compared with surgery alone7, 8, 9. Although both may have a local downstaging effect on the primary tumour, this is widely acknowledged to be more pronounced following NACRT8.…”

Section: Introductionmentioning

confidence: 99%

“…Neoadjuvant chemotherapy (NAC) and neoadjuvant chemoradiotherapy (NACRT) have both been shown to improve survival compared with surgery alone7, 8, 9. Although both may have a local downstaging effect on the primary tumour, this is widely acknowledged to be more pronounced following NACRT8. Debate still exists regarding whether this local benefit of NACRT is at the cost of reduced systemic efficacy compared with NAC 9 .…”

Section: Introductionmentioning

confidence: 99%

Patterns of recurrence in oesophageal cancer following oesophagectomy in the era of neoadjuvant chemotherapy

Knight

Zylstra²,

Hemelrijck

et al. 2017

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BackgroundTumour recurrence following oesophagectomy for oesophageal cancer is common despite neoadjuvant treatment. Understanding patterns of recurrence and risk factors associated with locoregional and systemic recurrence might influence future treatment strategies.MethodsThis was a cohort study involving patients undergoing resection for adenocarcinoma or squamous cell carcinoma of the oesophagus between 2000 and 2014. Clinicopathological factors associated with locoregional and systemic recurrence were analysed using multivariable logistic regression to determine odds ratios (ORs) and 95 per cent confidence intervals.ResultsSome 698 patients were identified. Lymphovascular invasion (OR 2·09, 95 per cent c.i. 1·18 to 3·71) and preoperative stenting (OR 3·70, 1·34 to 10·23) were independent risk factors for isolated locoregional recurrence. Pathological nodal disease in patients with pT1–2 (pN1: OR 2·72, 1·35 to 5·48; pN2–3: OR 5·00, 2·35 to 10·66) or pT3–4 (pN1: OR 3·03, 1·51 to 6·07; pN2–3: OR 5·75, 3·15 to 10·49) disease predisposed to systemic recurrence. Poor or no response to chemotherapy was also an independent risk factor for isolated systemic recurrence (OR 1·85, 1·05 to 3·26). A positive resection margin (R1 resection) was not associated with a significantly increased risk of isolated locoregional recurrence (OR 1·37, 0·81 to 2·33).ConclusionThese findings confirm that oesophageal adenocarcinoma is frequently a systemic disease. Understanding the key predictors of local and systemic recurrence may facilitate the tailoring of oncological therapies to the individual patient.

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“…In the West, neoadjuvant chemoradiotherapy has become the standard treatment after being shown to be superior to chemotherapy alone when carrying out two‐field lymph node dissection for adenocarcinoma 10. The role of adjuvant therapy for squamous cell carcinoma of the esophagus for patients who receive three‐field lymph node dissection has been explored in several multi‐institutional randomized control trials in Japan.…”

Section: Esophageal Surgerymentioning

confidence: 99%

Gastroenterological surgery in Japan: The past, the present and the future

Colvin

Mizushima

Eguchi

et al. 2017

Annals of Gastroent Surgery

138

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In the last two centuries, there has been remarkable progress in the field of gastroenterological surgery, including the curative resection of cancers, replacement of failed organs through transplantation, increased safety of undergoing major surgeries and decreased operative morbidity through developments in minimal access surgery. Japan has very much been at the forefront of these advances, as is evident from the present review, from advancing the surgical management of gastric cancer to the pioneering work in live‐donor transplantation. This review also highlights many instances where surgical management of the same pathologies has evolved differently between Japan and the West. It is encouraging that many procedures established in Japan are eventually taken up by the West, often after rigorous assessment affirming the quality and applicability of such techniques. In Japan, many of the crucial issues in gastroenterological surgery are increasingly addressed through large multi‐institutional prospective control trials, ensuring that Japanese surgeons continue to contribute to the advances in gastroenterological surgery.

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Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer

Cited by 4,518 publications

References 22 publications

Impact of incremental circumferential resection margin distance on overall survival and recurrence in oesophageal adenocarcinoma

Impact of incremental circumferential resection margin distance on overall survival and recurrence in oesophageal adenocarcinoma

Patterns of recurrence in oesophageal cancer following oesophagectomy in the era of neoadjuvant chemotherapy

Gastroenterological surgery in Japan: The past, the present and the future

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