Y-K Chao1, Y Chang2, C-J Yeh3, H-K Chang4, C-K Tseng5, W-Y Chuang3. 1. Division of Thoracic Surgery, Chang Gung University, Taoyuan, Taiwan. 2. Department of Surgery, Chang Gung University, Taoyuan, Taiwan. 3. Department of Pathology, Chang Gung University, Taoyuan, Taiwan. 4. Division of Haematology/Oncology, Chang Gung University, Taoyuan, Taiwan. 5. Department of Radiation Oncology, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan.
Abstract
BACKGROUND: A 'surgery as needed' strategy has been proposed for patients with oesophageal cancer who truly achieve a pathological complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT). However, the ability to detect residual disease remains problematic. This study investigated the anatomical locations and pathological characteristics of residual cancer in patients with oesophageal squamous cell carcinoma (SCC) who achieved a near pCR following nCRT. METHODS: Patients with oesophageal SCC who achieved a near pCR after nCRT were eligible. Near pCR was defined as residual cancer in the resection specimen representing less than 10 per cent of the apparent original tumour area. RESULTS: Detailed histopathological reassessment of 76 consecutive patients (mean age 54·4 years) with a near pCR was undertaken. Some 32 patients (42 per cent) with a near pCR had no detectable mucosal lesions. Residual tumour was identified most frequently in the submucosal layer (54, 71 per cent), followed by the mucosa (44, 58 per cent), muscle layer (36, 47 per cent) and adventitia (22, 29 per cent) (P < 0·001). Among patients without ypT1a disease, increasing depth of tumour invasion correlated negatively with the likelihood of mucosal involvement. Of patients with ypT3 disease, 16 of 22 had no detectable cancer located in the mucosa, compared with six of 29 with ypT1b disease (P < 0·001). CONCLUSION: Better tools for predicting pCR are required before considering a 'surgery as needed' approach in the management of oesophageal cancer.
BACKGROUND: A 'surgery as needed' strategy has been proposed for patients with oesophageal cancer who truly achieve a pathological complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT). However, the ability to detect residual disease remains problematic. This study investigated the anatomical locations and pathological characteristics of residual cancer in patients with oesophageal squamous cell carcinoma (SCC) who achieved a near pCR following nCRT. METHODS:Patients with oesophageal SCC who achieved a near pCR after nCRT were eligible. Near pCR was defined as residual cancer in the resection specimen representing less than 10 per cent of the apparent original tumour area. RESULTS: Detailed histopathological reassessment of 76 consecutive patients (mean age 54·4 years) with a near pCR was undertaken. Some 32 patients (42 per cent) with a near pCR had no detectable mucosal lesions. Residual tumour was identified most frequently in the submucosal layer (54, 71 per cent), followed by the mucosa (44, 58 per cent), muscle layer (36, 47 per cent) and adventitia (22, 29 per cent) (P < 0·001). Among patients without ypT1a disease, increasing depth of tumour invasion correlated negatively with the likelihood of mucosal involvement. Of patients with ypT3 disease, 16 of 22 had no detectable cancer located in the mucosa, compared with six of 29 with ypT1b disease (P < 0·001). CONCLUSION: Better tools for predicting pCR are required before considering a 'surgery as needed' approach in the management of oesophageal cancer.
Authors: Chantal M den Bakker; Justin K Smit; Anna M E Bruynzeel; Nicole C T van Grieken; Freek Daams; Sarah Derks; Miguel A Cuesta; John T M Plukker; Donald L van der Peet Journal: J Thorac Dis Date: 2017-07 Impact factor: 2.895
Authors: S E Vollenbrock; F E M Voncken; J M van Dieren; D M J Lambregts; M Maas; G J Meijer; L Goense; S Mook; K J Hartemink; P Snaebjornsson; L C Ter Beek; M Verheij; B M P Aleman; R G H Beets-Tan; A Bartels-Rutten Journal: Br J Surg Date: 2019-02-25 Impact factor: 6.939