Proposed Revision of the Esophageal Cancer Staging System to Accommodate Pathologic Response (pP) Following Preoperative Chemoradiation (CRT)

Swisher, Stephen G.; Hofstetter, Wayne L.; Wu, Tsung Teh; Correa, Arlene M.; Ajani, Jaffer A.; Komaki, Ritsuko; Chirieac, Lucian R.; Hunt, Kelly K.; Liao, Zhongxing; Phan, Alexandria T.; Rice, David C.; Vaporciyan, Ara A.; Walsh, Garrett L.; Roth, Jack A.; McMasters, Kelly M.; LoCicero, Joseph; Doherty, Gerard M.; Merchant, Nipun B.; Copeland, Edward M.; Greene, Frederick L.; Vogel, Stephen B.

doi:10.1097/01.sla.0000161983.82345.85

Cited by 146 publications

(128 citation statements)

References 19 publications

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“…However, several authors have criticised the TNM oesophageal staging system, claiming that it poorly stratifies what is a heterogeneous group of patients who have variable prognostic outcomes and undergo different treatment regimens [12][13][14][15][16][17][18][19][20][21][22][23]. The UICC has responded to these recommendations in its seventh edition of TNM staging, released in 2010, by modifying all three aspects of the scoring system.…”

Section: Introductionmentioning

confidence: 99%

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

Kayani

Zacharakis

Ahmed

et al. 2011

European Journal of Surgical Oncology (EJSO)

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Oesophageal cancer is the seventh most common cause of cancer-related death in the developed world and the incidence of oesophageal adenocarcinoma is now the fastest growing of any gastrointestinal cancer. Lymph node involvement is the single most important prognostic factor in oesophageal cancer. Imaging to determine the extent of lymph node involvement and plan treatment often requires a combination of modalities to avoid under-staging. The seventh edition of the staging system released by the International Union Against Cancer (IUCC) has stratified lymph node involvement according to the number of lymph nodes involved and redefined its groupings for location of metastatic lymph node involvement. This review discusses the prognostic and treatment implications of these modifications and explores micrometastatic lymph node involvement, capsular infiltration and lymph node ratio as possible additions to the staging system.

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Section: Introductionmentioning

confidence: 99%

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

Kayani

Zacharakis

Ahmed

et al. 2011

European Journal of Surgical Oncology (EJSO)

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“…A pCR occurs in approximately 15 -30% of cases, and 3-year survival rates of approximately 60% irrespective of the applied protocol, type of histology and tumour stage are achieved (Geh et al, 2001). A further subdivision of pathological response to neoadjuvant regimens, the tumour regression grade (TRG) (Mandard et al, 1994), may also identify patterns of incomplete response that may impact on treatment outcome, and the addition of the pathologic response to pTNM staging has been recently advocated (Swisher et al, 2005). Where a cohort of patients may benefit from neoadjuvant CRT, with pCR and TRG the surrogate markers, many patients will not be helped, and their prognosis may be worsened by delay in surgery and by the added risks of surgery in patients on multimodal protocols (Ancona et al, 2001;Fiorica et al, 2004).…”

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confidence: 99%

18FDG uptake during induction chemoradiation for oesophageal cancer fails to predict histomorphological tumour response

et al. 2006

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To determine whether [18 F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) could predict the pathological response in oesophageal cancer after only the first week of neoadjuvant chemoradiation. Thirty-two patients with localised oesophageal cancer had a pretreatment PET scan and a repeat after the first week of chemoradiation. The change in mean maximum standardised uptake value (SUV) and volume of metabolically active tissue (MTV) was compared with the tumour regression grade (TRG) in the final histology. Those who achieved a TRG of 1 and 2 were deemed responders and 3 -5 nonresponders. In the responders (28%), the SUV fell from 12.6 (76.3) to 8.1 (72.9) after 1 week of chemoradiation (P ¼ 0.070). In nonresponders (72%), the results were 9.7 (75.4) and 7.1 (73.8), respectively (P ¼ 0.003). The MTV in responders fell from 36.6 (722.7) to 22.3 (710.4) cm 3 (P ¼ 0.180), while in nonresponders, this fell from 35.9 (736.7) to 31.9 (752.7) cm 3 (P ¼ 0.405). There were no significant differences between responders and nonresponders. The hypothesis that early repeat FDG-PET scanning may predict histomorphologic response was not proven. This may reflect an inflammatory effect of radiation that obscures tumour-specific metabolic changes at this time. This assessment may have limited application in predicting response to multimodal regimens for oesophageal cancer.

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“…Applying this scoring system, patients with less than 10% residual tumor cells after neoadjuvant treatment are classifi ed as histopathological responders (score 1a, complete response and score 1b, less than 10% residual tumor cells). In other publications, only patients with complete tumor regression are classifi ed as histopathological responders [26,27]. In contrast, Shah et al [28] defi ned patients with less than 50% residual tumor cells as histopathological responders.…”

Section: Response Evaluationmentioning

confidence: 99%

“…It is generally accepted that responders have a signifi cantly improved survival compared to that in nonresponding patients [12]. Unfortunately, no standardized scores for clinical or histopathological response evaluation have been established so far, which makes studies hard to compare [5,22,27,28]. There is a need for the homogenization of clinical and histopathological response scores after induction chemotherapy.…”

Section: The New Credomentioning

confidence: 99%

The new credo: induction chemotherapy in locally advanced gastric cancer: consequences for surgical strategies

et al. 2008

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mens, possibly including biologically targeted drugs, could be considered in those with FDG-nonavid tumors. Key words Response guided neoadjuvant treatment · Locally advanced gastric cancer Induction chemotherapy in gastric cancerPrognosis in gastric cancer is highly dependent on tumor stage at presentation. Western patients with locally advanced tumors who do not receive perioperative treatment have a poor prognosis 20%-30% 5-year survival [1]. Improving results with extended surgery, as in Japan, has not been reproduced in the Western world [2][3][4]. The potential benefi ts of giving chemotherapy before surgery are the downsizing and downstaging of the primary tumor and lymph node metastases, treating micrometastases early in the course of treatment, increasing the rate of curative resections, and alleviating tumor-related symptoms. A new and important aspect is the possibility to test in vivo the chemosensitivity of the primary tumor. This might infl uence the administration and the regimen applied postoperatively in the adjuvant setting. The feasibility of neoadjuvant treatment in locally advanced gastric cancer has been proven by numerous phase II studies with different treatment regimens [5][6][7][8]. Compared with the prognosis in historical controls, the prognosis of the neoadjuvantly treated patients seemed to be improved and toxicity was moderate in most studies [6,9]. In the preoperative phase, acceptance, compliance, and tolerance of the patients was high and the complete dose could be given in nearly all patients.Recently, two randomized phase III studies with perioperative chemotherapy, showing a survival benefi t for patients with perioperative chemotherapy followed

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Proposed Revision of the Esophageal Cancer Staging System to Accommodate Pathologic Response (pP) Following Preoperative Chemoradiation (CRT)

Cited by 146 publications

References 19 publications

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

18FDG uptake during induction chemoradiation for oesophageal cancer fails to predict histomorphological tumour response

The new credo: induction chemotherapy in locally advanced gastric cancer: consequences for surgical strategies

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