Long-term outcomes following neoadjuvant chemoradiotherapy for esophageal cancer

Reynolds, John V., Muldoon, Cian, Hollywood, Donal, Ravi, Naraymasamy, Rowley, Suzanne, O'Byrne, Kenneth J., Kennedy, John, & Murphy, Thomas J. (2007) Long-term outcomes following neoadjuvant chemoradiotherapy for esophageal cancer. Annals of Surgery, 245(5), pp. 707-716.

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OBJECTIVE: We present and analyze long-term outcomes following multimodal therapy for esophageal cancer, in particular the relative impact of histomorphologic tumor regression and nodal status.

PATIENTS AND METHODS: A total of 243 patients [(adenocarcinoma (n = 170) and squamous cell carcinoma (n = 73)] treated with neoadjuvant chemoradiotherapy in the period 1990 to 2004 were followed prospectively with a median follow-up of 60 months. Pathologic stage and tumor regression grade (TRG) were documented, the site of first failure was recorded, and Kaplan-Meier survival curves were plotted.

RESULTS: Thirty patients (12%) did not undergo surgery due to disease progression or deteriorated performance status. Forty-one patients (19%) had a complete pathologic response (pCR), and there were 31(15%) stage I, 69 (32%) stage II, and 72 (34%) stage III cases. The overall median survival was 18 months, and the 5-year survival was 27%. The 5-year survival of patients achieving a pCR was 50% compared with 37% in non-pCR patients who were node-negative (P = 0.86). Histomorphologic tumor regression was not associated with pre-CRT cTN stage but was significantly (P < 0.05) associated with ypN stage. By multivariate analysis, ypN status (P = 0.002) was more predictive of overall survival than TRG (P = 0.06) or ypT stage (P = 0.39).

CONCLUSION: Achieving a node-negative status is the major determinant of outcome following neoadjuvant chemoradiotherapy. Histomorphologic tumor regression is less predictive of outcome than pathologic nodal status (ypN), and the need to include a primary site regression score in a new staging classification is unclear. © 2007 Lippincott Williams & Wilkins, Inc.

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95 citations in Scopus
81 citations in Web of Science®
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ID Code: 65376
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: cisplatin, fluorouracil, adult, aged, article, cancer chemotherapy, cancer growth, cancer radiotherapy, cancer staging, cancer surgery, cancer survival, disease association, esophageal adenocarcinoma, esophageal squamous cell carcinoma, esophagus carcinoma, female, human, major clinical study, male, multivariate analysis, priority journal, treatment outcome, tumor regression, Adenocarcinoma, Antineoplastic Agents, Carcinoma, Squamous Cell, Esophageal Neoplasms, Esophagectomy, Follow-Up Studies, Humans, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Prospective Studies, Radiotherapy, Adjuvant, Survival Rate
DOI: 10.1097/01.sla.0000254367.15810.38
ISSN: 0003-4932
Divisions: Current > Schools > School of Biomedical Sciences
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2007 Lippincott Williams & Wilkins
Deposited On: 13 Dec 2013 00:16
Last Modified: 11 Mar 2014 04:51

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