BACKGROUND: Patients suffering from locally advanced esophageal carcinoma are generally treated using multimodal therapies. This prospective, non-randomized trial was performed to evaluate the survival benefit of neoadjuvant radiochemotherapy prior to surgery in comparison with surgery only. PATIENTS & METHODS: Histopathological outcomes and survival were compared between 61 patients who underwent neoadjuvant radiochemotherapy and 64 comparable control patients who had been under-staged. After neoadjuvant therapy, tumor regression was assessed using the method described by Mandard in 1994. Survival curves for the two groups were estimated using the Kaplan-Meier method, and compared with the log-rank test. RESULTS: Median and 3-year recurrence-free survival for the entire group were 26 months and 39.7%, respectively. The median and 3-year overall survival reached 34 months and 48.1%. Patients who showed complete response to neoadjuvant therapy had significantly improved survival (35 months) compared to patients with residual tumor cells (28 months), patients with tumors unresponsive to radiochemotherapy (22 months), or patients who received surgery only (control group, 29 months). Patients with nodal-negative carcinomas showed significantly longer survival after surgery only and after neoadjuvant therapy compared to patients with lymph node-positive cancers. CONCLUSIONS: Complete response after neoadjuvant radiochemotherapy is associated with significantly improved survival. Negative nodal status is a major determinant of outcomes following primary operation or neoadjuvant treatment.
BACKGROUND:Patients suffering from locally advanced esophageal carcinoma are generally treated using multimodal therapies. This prospective, non-randomized trial was performed to evaluate the survival benefit of neoadjuvant radiochemotherapy prior to surgery in comparison with surgery only. PATIENTS & METHODS: Histopathological outcomes and survival were compared between 61 patients who underwent neoadjuvant radiochemotherapy and 64 comparable control patients who had been under-staged. After neoadjuvant therapy, tumor regression was assessed using the method described by Mandard in 1994. Survival curves for the two groups were estimated using the Kaplan-Meier method, and compared with the log-rank test. RESULTS: Median and 3-year recurrence-free survival for the entire group were 26 months and 39.7%, respectively. The median and 3-year overall survival reached 34 months and 48.1%. Patients who showed complete response to neoadjuvant therapy had significantly improved survival (35 months) compared to patients with residual tumor cells (28 months), patients with tumors unresponsive to radiochemotherapy (22 months), or patients who received surgery only (control group, 29 months). Patients with nodal-negative carcinomas showed significantly longer survival after surgery only and after neoadjuvant therapy compared to patients with lymph node-positive cancers. CONCLUSIONS: Complete response after neoadjuvant radiochemotherapy is associated with significantly improved survival. Negative nodal status is a major determinant of outcomes following primary operation or neoadjuvant treatment.
Authors: Brendon M Stiles; Farooq Mirza; Anthony Coppolino; Jeffrey L Port; Paul C Lee; Subroto Paul; Nasser K Altorki Journal: Ann Thorac Surg Date: 2011-06-24 Impact factor: 4.330
Authors: Jaffer A Ajani; James S Barthel; David J Bentrem; Thomas A D'Amico; Prajnan Das; Crystal S Denlinger; Charles S Fuchs; Hans Gerdes; Robert E Glasgow; James A Hayman; Wayne L Hofstetter; David H Ilson; Rajesh N Keswani; Lawrence R Kleinberg; W Michael Korn; A Craig Lockhart; Mary F Mulcahy; Mark B Orringer; Raymond U Osarogiagbon; James A Posey; Aaron R Sasson; Walter J Scott; Stephen Shibata; Vivian E M Strong; Thomas K Varghese; Graham Warren; Mary Kay Washington; Christopher Willett; Cameron D Wright Journal: J Natl Compr Canc Netw Date: 2011-08-01 Impact factor: 11.908
Authors: Katrin M Sjoquist; Bryan H Burmeister; B Mark Smithers; John R Zalcberg; R John Simes; Andrew Barbour; Val Gebski Journal: Lancet Oncol Date: 2011-06-16 Impact factor: 41.316
Authors: Traves D Crabtree; Wael N Yacoub; Varun Puri; Riad Azar; Jennifer Bell Zoole; G Alexander Patterson; A Sasha Krupnick; Daniel Kreisel; Bryan F Meyers Journal: Ann Thorac Surg Date: 2011-03-24 Impact factor: 4.330
Authors: Grace L Smith; Benjamin D Smith; Thomas A Buchholz; Zhongxing Liao; Melenda Jeter; Stephen G Swisher; Wayne L Hofstetter; Jaffer A Ajani; Mary F McAleer; Ritsuko Komaki; James D Cox Journal: Int J Radiat Oncol Biol Phys Date: 2009-03-14 Impact factor: 7.038
Authors: Cameron D Wright; John C Kucharczuk; Sean M O'Brien; Joshua D Grab; Mark S Allen Journal: J Thorac Cardiovasc Surg Date: 2009-03 Impact factor: 5.209