Michael J McNamara1, David J Adelstein2, Daniela S Allende3, Joanna W Bodmann2, Denise I Ives2, Sudish C Murthy4, Daniel Raymond4, Siva Raja4, Cristina P Rodriguez5, Davendra Sohal2, Kevin L Stephans6, Gregory M M Videtic6, Lisa A Rybicki7. 1. Cleveland Clinic, Taussig Cancer Institute, Hematology and Oncology, 9500 Euclid Avenue, R35, Cleveland, OH, 44195, USA. mcnamam@ccf.org. 2. Cleveland Clinic, Taussig Cancer Institute, Hematology and Oncology, 9500 Euclid Avenue, R35, Cleveland, OH, 44195, USA. 3. Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, L25, Cleveland, OH, 44195, USA. 4. Cleveland Clinic, Heart and Vascular Institute, Thoracic and Cardiovascular Surgery, 9500 Euclid Avenue, J4-1, Cleveland, OH, 44195, USA. 5. Department of Medicine, Division of Medical Oncology, University of Washington, 825 Eastlake Ave E. MS G4-940, Seattle, WA, 98109, USA. 6. Cleveland Clinic, Taussig Cancer Institute, Radiation Oncology, 9500 Euclid Avenue, T28, Cleveland, OH, 44195, USA. 7. Cleveland Clinic, Quantitative Health Sciences, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Abstract
PURPOSE: Preoperative therapy is frequently employed in the management of esophageal adenocarcinoma. However, many patients are found to have advanced pathologic stage and have poor outcomes. A prognostic factor which identifies this patient population before surgery would be desirable, as alternative treatment strategies may be warranted. METHODS: Between 2/08 and 1/12, 60 evaluable patients with locally advanced esophageal adenocarcinoma enrolled in single-arm phase II trial of induction chemotherapy, surgery, and post-operative adjuvant chemo-radiotherapy (CRT). A clinical stage of T3, N1, or M1a (AJCC 6th) was required for eligibility. Induction chemotherapy with epirubicin 50 mg/m2 d1, oxaliplatin 130 mg/m2 d1, and fluorouracil 200 mg/m2/day continuous infusion for 3 weeks, was given every 21 days for 3 cycles and was followed by surgical resection. Adjuvant CRT consisted of 50-55 Gy @ 1.8-2.0 Gy/day and 2 cycles of cisplatin (20 mg/m2/day) and fluorouracil (1000 mg/m2/day) given as 96-h infusions during weeks 1 and 4 of radiotherapy. Dysphagia was assessed at baseline and after induction chemotherapy. RESULTS: Persistent dysphagia was associated with worse distant metastatic control [HR 3.48 (1.43-8.43), p = 0.006], recurrence free survival [HR 3.04 (1.34-6.92), p = 0.008], and overall survival [HR 3.31 (1.43-7.66), p = 0.005]. Persistent dysphagia was associated with more advanced pathologic T descriptor (pT) (p = 0.048) and N descriptor (pN) (p = 0.002), a greater median number of involved lymph nodes (3 v 1, p = 0.003), and greater residual tumor viability (p = 0.05). No patients with persistent dysphagia had pT0-T2 or pN0 disease. CONCLUSIONS: Persistent dysphagia after induction chemotherapy is associated with more advanced pathologic stage and inferior outcomes.
PURPOSE: Preoperative therapy is frequently employed in the management of esophageal adenocarcinoma. However, many patients are found to have advanced pathologic stage and have poor outcomes. A prognostic factor which identifies this patient population before surgery would be desirable, as alternative treatment strategies may be warranted. METHODS: Between 2/08 and 1/12, 60 evaluable patients with locally advanced esophageal adenocarcinoma enrolled in single-arm phase II trial of induction chemotherapy, surgery, and post-operative adjuvant chemo-radiotherapy (CRT). A clinical stage of T3, N1, or M1a (AJCC 6th) was required for eligibility. Induction chemotherapy with epirubicin 50 mg/m2 d1, oxaliplatin 130 mg/m2 d1, and fluorouracil 200 mg/m2/day continuous infusion for 3 weeks, was given every 21 days for 3 cycles and was followed by surgical resection. Adjuvant CRT consisted of 50-55 Gy @ 1.8-2.0 Gy/day and 2 cycles of cisplatin (20 mg/m2/day) and fluorouracil (1000 mg/m2/day) given as 96-h infusions during weeks 1 and 4 of radiotherapy. Dysphagia was assessed at baseline and after induction chemotherapy. RESULTS: Persistent dysphagia was associated with worse distant metastatic control [HR 3.48 (1.43-8.43), p = 0.006], recurrence free survival [HR 3.04 (1.34-6.92), p = 0.008], and overall survival [HR 3.31 (1.43-7.66), p = 0.005]. Persistent dysphagia was associated with more advanced pathologic T descriptor (pT) (p = 0.048) and N descriptor (pN) (p = 0.002), a greater median number of involved lymph nodes (3 v 1, p = 0.003), and greater residual tumor viability (p = 0.05). No patients with persistent dysphagia had pT0-T2 or pN0 disease. CONCLUSIONS: Persistent dysphagia after induction chemotherapy is associated with more advanced pathologic stage and inferior outcomes.
Authors: Xifeng Wu; Jian Gu; Tsung-Teh Wu; Stephen G Swisher; Zhongxin Liao; Arlene M Correa; Jun Liu; Carol J Etzel; Christopher I Amos; Maosheng Huang; Silvia S Chiang; Luke Milas; Walter N Hittelman; Jaffer A Ajani Journal: J Clin Oncol Date: 2006-06-19 Impact factor: 44.544
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: G Zuccaro; T W Rice; J Goldblum; S V Medendorp; M Becker; R Pimentel; L Gitlin; D J Adelstein Journal: Am J Gastroenterol Date: 1999-04 Impact factor: 10.864
Authors: Andrew R Davies; James A Gossage; Janine Zylstra; Fredrik Mattsson; Jesper Lagergren; Nick Maisey; Elizabeth C Smyth; David Cunningham; William H Allum; Robert C Mason Journal: J Clin Oncol Date: 2014-09-20 Impact factor: 44.544