Thomas Steffen1, Daniel Dietrich2, Annelies Schnider3, Christoph Kettelhack4, Olivier Huber5, Walter R Marti6, Markus Furrer7, Beat Gloor8, Marc Schiesser1, Sandra Thierstein2, Peter Brauchli2, Thomas Ruhstaller9. 1. Department of General, Visceral, Endocrine and Transplant Surgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland. 2. SAKK Coordinating Centre, Berne, Switzerland. 3. Department of Visceral, Thoracic and Vascular Surgery, City Hospital Triemli, Zurich, Switzerland. 4. Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland. 5. Department of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland. 6. Department of Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland. 7. Department of Surgery, Cantonal Hospital of Graubünden, Chur, Switzerland. 8. Department of Visceral Surgery and Medicine, Inselspital University Berne, Berne Switzerland. 9. Department of Oncology/Hematology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
Abstract
OBJECTIVE: The long-term follow up data of 2 prospective phase II trials is reported (NCT00072033, NCT00445861), which investigated neoadjuvant chemoradiation followed by surgery in patients with esophageal carcinoma. Postoperative complications as well as prognostic factors and patterns of relapse during long-term observation are shown. SUMMARY OF BACKGROUND DATA: Long-term follow-up is often missing in the complex setting of multimodal treatments of esophageal carcinoma; this leads to rather undifferentiated follow-up guidelines for this tumor entity. METHODS: In the first trial, patients received induction chemotherapy followed by chemoradiation and surgery. In the second trial, cetuximab was added to the same neoadjuvant treatment concomitant with induction chemotherapy and chemoradiation. RESULTS: Eighty-two patients underwent surgery; the median follow-up time was 6.8 and 6.4 years, respectively. Fifty-five percent were diagnosed with adenocarcinoma, 80% clinically node-positive, 68% receivedtransthoracic esophagectomy, and 32% transhiatal or transmediastinal resection. Five patients died postoperatively in-hospital due to complications (6%). The median overall survival was 4.3 years, and the median event-free survival was 2.7 years. Patients with adenocarcinoma rarely relapsed after a 3-year event-free survival. Whereas patients with residual tumor cells after neoadjuvant therapy primarily experienced relapse within the first 2 postoperative years, this in contrast to several patients with complete remission who also experienced late relapses 4 years after surgery. CONCLUSION: After curative surgery in a multimodal setting, the histological type and the response to neoadjuvant therapy predicted the time frame of relapse; this knowledge may influence further follow-up guidelines for esophageal carcinoma.
RCT Entities:
OBJECTIVE: The long-term follow up data of 2 prospective phase II trials is reported (NCT00072033, NCT00445861), which investigated neoadjuvant chemoradiation followed by surgery in patients with esophageal carcinoma. Postoperative complications as well as prognostic factors and patterns of relapse during long-term observation are shown. SUMMARY OF BACKGROUND DATA: Long-term follow-up is often missing in the complex setting of multimodal treatments of esophageal carcinoma; this leads to rather undifferentiated follow-up guidelines for this tumor entity. METHODS: In the first trial, patients received induction chemotherapy followed by chemoradiation and surgery. In the second trial, cetuximab was added to the same neoadjuvant treatment concomitant with induction chemotherapy and chemoradiation. RESULTS: Eighty-two patients underwent surgery; the median follow-up time was 6.8 and 6.4 years, respectively. Fifty-five percent were diagnosed with adenocarcinoma, 80% clinically node-positive, 68% received transthoracic esophagectomy, and 32% transhiatal or transmediastinal resection. Five patients died postoperatively in-hospital due to complications (6%). The median overall survival was 4.3 years, and the median event-free survival was 2.7 years. Patients with adenocarcinoma rarely relapsed after a 3-year event-free survival. Whereas patients with residual tumor cells after neoadjuvant therapy primarily experienced relapse within the first 2 postoperative years, this in contrast to several patients with complete remission who also experienced late relapses 4 years after surgery. CONCLUSION: After curative surgery in a multimodal setting, the histological type and the response to neoadjuvant therapy predicted the time frame of relapse; this knowledge may influence further follow-up guidelines for esophageal carcinoma.
Authors: Alicia S Borggreve; Lucas Goense; Peter S N van Rossum; Sophie E Heethuis; Richard van Hillegersberg; Jan J W Lagendijk; Marnix G E H Lam; Astrid L H M W van Lier; Stella Mook; Jelle P Ruurda; Marco van Vulpen; Francine E M Voncken; Berthe M P Aleman; Annemarieke Bartels-Rutten; Jingfei Ma; Penny Fang; Benjamin C Musall; Steven H Lin; Gert J Meijer Journal: Int J Radiat Oncol Biol Phys Date: 2020-01-25 Impact factor: 7.038
Authors: Joerg Lindenmann; Melanie Fediuk; Nicole Fink-Neuboeck; Christian Porubsky; Martin Pichler; Luka Brcic; Udo Anegg; Marija Balic; Nadia Dandachi; Alfred Maier; Maria Smolle; Josef Smolle; Freyja Maria Smolle-Juettner Journal: Cancers (Basel) Date: 2020-07-27 Impact factor: 6.639
Authors: Alicia S Borggreve; Sophie E Heethuis; Mick R Boekhoff; Lucas Goense; Peter S N van Rossum; Lodewijk A A Brosens; Astrid L H M W van Lier; Richard van Hillegersberg; Jan J W Lagendijk; Stella Mook; Jelle P Ruurda; Gert J Meijer Journal: Eur Radiol Date: 2019-12-10 Impact factor: 5.315