Tumor Stage After Neoadjuvant Chemotherapy Determines Survival After Surgery for Adenocarcinoma of the Esophagus and Esophagogastric Junction

Davies, Andrew; Gossage, James; Zylstra, Janine; Mattsson, Fredrik; Lagergren, Jesper; Maisey, Nick; Smyth, Elizabeth; Cunningham, David; Allum, William; Mason, Robert C.

doi:10.1200/jco.2014.55.9070

Cited by 212 publications

(195 citation statements)

References 22 publications

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“…147 Some recent studies indicate that an increase in the time latencies between completed neoadjuvant therapy and surgery from currently 4-6 weeks to over 12 weeks may improve the tumour response to neoadjuvant therapy in OSCC and OAC, which may increase the rate of radical resection. 148,149 The optimal interval between neoadjuvant therapy and surgery in relation to survival is being assessed in an RCT (NCT02415101).…”

Section: Timing Of Surgery Following Neoadjuvant Therapymentioning

confidence: 99%

Oesophageal cancer

et al. 2017

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SummaryOesophageal cancer is a clinically challenging disease requiring a multidisciplinary approach.The extensive treatment may be associated with serious limitations in health-related quality of life and yet still a poor prognosis. Recent decades have witnessed a gradual improvement in prognosis in many countries. Endoscopic procedures have increasingly been used in the treatment of premalignant and early oesophageal tumours. Neoadjuvant therapy with chemotherapy or chemoradiotherapy has supplemented surgery as standard treatment of locally advanced oesophageal cancer. Surgery has become more standardised and centralised. There are several therapeutic alternatives for palliative treatment. This review aims to provide insights into the current clinical management, on-going controversies and future needs in oesophageal cancer.3

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Section: Timing Of Surgery Following Neoadjuvant Therapymentioning

confidence: 99%

Oesophageal cancer

et al. 2017

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“…However, these thresholds may not be optimal: PERCIST is neither tumor-nor contextspecific, whereas the MUNICON threshold was derived from just 40 patients; furthermore, SUV max provides no spatial information. More fundamentally, both assess only the primary tumor; the high rates of disease recurrence seen even in patients with pathologically responsive primary tumors suggests important unidentified factors, perhaps involving nodal or distant micrometastases-a recent report described tumor downstaging after NAC (a reduction from pretreatment clinical to posttreatment pathologic stage) to be strongly associated with survival (14).…”

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confidence: 99%

Predicting Pathologic Response of Esophageal Cancer to Neoadjuvant Chemotherapy: The Implications of Metabolic Nodal Response for Personalized Therapy

et al. 2016

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Only a minority of esophageal cancers demonstrates a pathologic tumor response (pTR) to neoadjuvant chemotherapy (NAC). 18 F-FDG PET/CT is often used for restaging after NAC and to assess response. Increasingly, it is used during therapy to identify unresponsive tumors and predict pTR, using avidity of the primary tumor alone. However, definitions of such metabolic tumor response (mTR) vary. We aimed to comprehensively reevaluate metabolic response assessment using accepted parameters, as well as novel concepts of metabolic nodal stage (mN) and metabolic nodal response (mNR).Methods: This was a single-center retrospective U.K. cohort study. All patients with esophageal cancer staged before NAC with PET/CT and after with CT or PET/CT and undergoing resection from 2006 to 2014 were identified. pTR was defined as Mandard tumor regression grade 1-3; imaging parameters included metrics of tumor avidity (SUV max/mean/peak ), composites of avidity and volume (including metabolic tumor volume), nodal SUV max , and our new concepts of mN stage and mNR. Results: Eighty-two (27.2%) of 301 patients demonstrated pTR. No pre-NAC PET parameters predicted pTR. In 220 patients restaged by PET/CT, the optimal tumor DSUV max threshold was a 77.8% reduction. This was as sensitive as the current PERCIST 30% reduction, but more specific with a higher negative predictive value (P , 0.001). DSUV max and Dlength independently predicted pTR, and composite avidity/spatial metrics outperformed avidity alone. Although both mTR and mNR were associated with pTR, in 82 patients with 18 F-FDG-avid nodes before NAC we observed mNR in 10 (12.2%) not demonstrating mTR. Conclusion: Current definitions of metabolic response are suboptimal and too simplistic. Composite avidity/volume measures improve prediction. mNR may further improve response assessment, by specifically assessing metastatic tumor subpopulations, likely responsible for disease relapse, and should be urgently assessed when considering aborting therapy on the basis of mTR alone.

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“…Patients with ypIII or ypIV had a significantly poorer survival. Some studies have demonstrated the prognostic value of postoperative pathological findings including ypTNM (27,28), while other proposed that both pretherapeutic factors also worked as prognostic factors (29,30). Among these prognostic factors, postoperative pathological findings attracted more attention.…”

Section: Discussionmentioning

confidence: 99%

Results of neoadjuvant therapy followed by esophagectomy for patients with locally advanced thoracic esophageal squamous cell carcinoma

Lin

et al. 2017

J. Thorac. Dis.

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Background: For patients diagnosed with locally advanced esophageal cancer, neoadjuvant therapy followed by surgery is the most common approach. However, randomized trials resulted in inconsistent conclusions. We conducted this retrospective study to evaluate the influence of neoadjuvant therapy on postoperative events and the influence on disease-free survival (DFS) and overall survival (OS). Methods:We retrospectively reviewed all of the patients underwent surgery following neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma (ESCC) during January 1st, 2013 and December 31st, 2015 in Fudan University Shanghai Cancer Center (FUSCC). Prognostic factors for DFS and OS were identified by univariate and multivariate analyses.Results: A total of fifty patients were included. Regarding postoperative morbidities, pneumonia and leakage occurred in 9 (18.0%) and 6 (12.0%) patients, respectively. For the whole patients, the 1-, 2-, 3-year DFS and OS rates were 57.0%, 48.0%, 42.0% and 86.0%, 73.0%, 62.0%, respectively. Lung metastasis and mediastinal node involvement were the most common relapse patterns. Univariate and multivariate analyses confirmed ypTNM stage as an independent prognostic factor for both DFS and OS; while leakage was an independent prognostic factor for DFS. Conclusions: Neoadjuvant therapy did not increase postoperative morbidities but did achieve favorable survival. The ypTNM stage was an independent prognostic factor for both DFS and OS. Long-term survival needs further investigation.

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Tumor Stage After Neoadjuvant Chemotherapy Determines Survival After Surgery for Adenocarcinoma of the Esophagus and Esophagogastric Junction

Cited by 212 publications

References 22 publications

Oesophageal cancer

Oesophageal cancer

Predicting Pathologic Response of Esophageal Cancer to Neoadjuvant Chemotherapy: The Implications of Metabolic Nodal Response for Personalized Therapy

Results of neoadjuvant therapy followed by esophagectomy for patients with locally advanced thoracic esophageal squamous cell carcinoma

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