Tumor response to induction chemoradiation: Influence on survival after esophagectomy

Jessica S. Donington, Daniel L. Miller, Mark S. Allen, Claude Deschamps, Francis C. Nichols, Peter C. Pairolero

Research output: Contribution to journalArticlepeer-review

73 Scopus citations

Abstract

Objective: Preoperative chemoradiation is becoming standard of care for locally advanced esophageal cancer. The objective of this study was to determine if the degree of pathologic response to preoperative chemoradiation could predict survival and recurrence after resection in patients with adenocarcinoma of the distal esophagus. Methods: Between January 1998 and December 2001, 366 patients underwent esophagectomy for adenocarcinoma of the esophagus; 108 (30%) had induction chemoradiation prior to surgery. The records of these 108 patients were reviewed. Results: Histologic examination of the resected specimens documented complete pathologic response (CR) in 24 patients (22%) and residual tumor (RT) in 84 (78%). Operative mortality was 3.7%. Follow-up was complete in all patients and ranged from 1 to 46 months (median, 11 months). Three-year survival for patients with CR was 64% as compared to 34% for patients with RT (P=0.17). Median survival for patients with CR has not yet been reached; however, median survival for patients with RT was 19 months. Three-year cancer free survival for patients with CR was 57% compared to 30% for patients with RT (P=0.03). While median survival free of recurrence for patients with CR has not yet been reached, median survival free of recurrence for patients with RT was 9 months. Conclusion: Complete pathologic response to induction chemoradiation is associated with improved early overall and disease-free survival following esophagectomy for adenocarcinoma of the distal esophagus. Because recurrent cancer still develops in many of these patients, even after complete pathologic response, the search for the optimal treatment continues.

Original languageEnglish (US)
Pages (from-to)631-637
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume24
Issue number4
DOIs
StatePublished - Oct 1 2003
Externally publishedYes

Keywords

  • Esophageal cancer
  • Esophagectomy
  • Neoadjuvant chemoradiation
  • Pathology

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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