BACKGROUND: The purposes of this study were to determine the frequency of downstaging of T or N after neoadjuvant chemotherapy and radical resection in patients with carcinoma of the esophagus, and to evaluate the effect of tumor downstaging on survival. METHODS: A cohort of patients who underwent neoadjuvant chemotherapy followed by radical surgical resection for carcinoma of the esophagus was identified from a large, prospectively maintained, single-institution database of esophageal cancer patients. Patients were included if they had an accurate pretreatment clinical stage determined by the authors. Data collected included demographic data, the type of staging regimen, the chemotherapy agents used, clinical and pathologic data and stages, and survival data. Downstaging of T or N was determined by comparing the pretreatment, clinical stage to the postresection, pathologic stage. Downstaging was then evaluated in the context of survival. RESULTS: Seventy-seven patients were identified who had an accurate clinical stage assigned and underwent neoadjuvant chemotherapy followed by radical resection. Patients were clinically staged before treatment using computed tomography, positron emission tomography, and endoscopic ultrasonography. Thirty-seven patients (48%) experienced downstaging of T or N, and this group of patients had a 5-year overall actuarial survival of 63%, compared with 23% for those who were not downstaged (p = 0.002). Three patients had a complete pathologic response to neoadjuvant chemotherapy (3.9%). CONCLUSIONS: Patients who experience downstaging of T or N after neoadjuvant chemotherapy and radical surgical resection for esophageal carcinoma have a significantly higher survival rate compared with those who do not experience downstaging. This enhanced survival is comparable to survival rates reported in complete pathologic responders after neoadjuvant chemoradiation.
BACKGROUND: The purposes of this study were to determine the frequency of downstaging of T or N after neoadjuvant chemotherapy and radical resection in patients with carcinoma of the esophagus, and to evaluate the effect of tumor downstaging on survival. METHODS: A cohort of patients who underwent neoadjuvant chemotherapy followed by radical surgical resection for carcinoma of the esophagus was identified from a large, prospectively maintained, single-institution database of esophageal cancerpatients. Patients were included if they had an accurate pretreatment clinical stage determined by the authors. Data collected included demographic data, the type of staging regimen, the chemotherapy agents used, clinical and pathologic data and stages, and survival data. Downstaging of T or N was determined by comparing the pretreatment, clinical stage to the postresection, pathologic stage. Downstaging was then evaluated in the context of survival. RESULTS: Seventy-seven patients were identified who had an accurate clinical stage assigned and underwent neoadjuvant chemotherapy followed by radical resection. Patients were clinically staged before treatment using computed tomography, positron emission tomography, and endoscopic ultrasonography. Thirty-seven patients (48%) experienced downstaging of T or N, and this group of patients had a 5-year overall actuarial survival of 63%, compared with 23% for those who were not downstaged (p = 0.002). Three patients had a complete pathologic response to neoadjuvant chemotherapy (3.9%). CONCLUSIONS:Patients who experience downstaging of T or N after neoadjuvant chemotherapy and radical surgical resection for esophageal carcinoma have a significantly higher survival rate compared with those who do not experience downstaging. This enhanced survival is comparable to survival rates reported in complete pathologic responders after neoadjuvant chemoradiation.
Authors: Arta Monir Monjazeb; Greg Riedlinger; Mebea Aklilu; Kim R Geisinger; Girish Mishra; Scott Isom; Paige Clark; Edward A Levine; A William Blackstock Journal: J Clin Oncol Date: 2010-09-27 Impact factor: 44.544
Authors: Bernhard J Leibl; Stephanie Vitz; Wolfgang Schäfer; Martin Alfrink; Andreas Gschwendtner; Gerhard G Grabenbauer Journal: Strahlenther Onkol Date: 2011-03-24 Impact factor: 3.621
Authors: Keven S Y Ji; Samantha M Thomas; Sanziana A Roman; Brian Czito; Kevin L Anderson; Jessica Frakes; Mohamed A Adam; Julie A Sosa; Timothy J Robinson Journal: J Gastrointest Surg Date: 2018-10-29 Impact factor: 3.452
Authors: Fergus Noble; Luke Nolan; Adrian C Bateman; James P Byrne; Jamie J Kelly; Ian S Bailey; Donna M Sharland; Charlotte N Rees; Timothy J Iveson; Tim J Underwood; Andrew R Bateman Journal: World J Gastroenterol Date: 2013-12-28 Impact factor: 5.742