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Neoadjuvant chemotherapy may improve esophageal adenocarcinoma outcomes
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Response to preoperative neoadjuvant chemotherapy in the primary tumor and lymph nodes may extend DFS in patients with esophageal or gastroesophageal adenocarcinoma, according to results of a retrospective study.
Researchers reviewed data on 218 consecutive patients treated for adenocarcinoma of the esophagus or gastroesophageal junction at the University Hospital Southampton National Health Service Foundation Trust (UHSFT). The patients, treated between January 2005 and December 2011, underwent either surgical resection alone or surgery plus neoadjuvant chemotherapy.
Initial staging examinations consisted of endoscopic ultrasonography, high-resolution CT, integrated fluorodeoxyglucose PET/CT and staging laparoscopy.
Patients considered for neoadjuvant chemotherapy included those candidates for surgical resection with tumors staged T2N0M0 or above. These 136 patients underwent triplet neoadjuvant chemotherapy comprised of platinum, fluoropyrimidine and anthracycline.
The researchers evaluated patients’ response to neoadjuvant chemotherapy based on tumor regression grade; they also analyzed lymph node downstaging.
Patients were followed for 5 years after surgery. Radiologic findings were used to identify recurrence.
The researchers examined the association between tumor regression grade and lymph node downstaging with DFS and a complete range of clinicopathologic features.
The overall mortality rate was 1.8% (n=4). Of the patients who underwent neoadjuvant chemotherapy, 74.3% showed some indication of pathologic tumor regression (tumor regression grade 1-4), and 5.9% had a complete pathologic response. Downstaging of nodal disease (cN1 to ypN0) was seen in 44.1% of patients who underwent surgery plus neoadjuvant chemotherapy vs. 15.9% of those who underwent surgery alone (preoperatively overstaged: CN1 to pn0; P<.0001). Researchers observed a significant link between response to neoadjuvant chemotherapy and DFS. Mean DFS was 5.1 years (95% CI, 4.6-5.6) among those with tumor regression grade 1-2 vs. 2.8 years (95% CI, 2.2-3.3) for those with tumor regression grade 3-5.
Nodal downstaging provided a significant DFS benefit in patients with a poor primary tumor response to neoadjuvant chemotherapy. Among patients with tumor regression grade 3-5, median DFS was 5.53 years (95% CI, 3.558-7.531) for those with nodal downstaging vs. 1.11 years (95% CI, 0.961-1.267) among those without nodal downstaging.
“We propose that methods to assess the pathological response to neoadjuvant chemotherapy are refined so that both the response in the primary tumor and the regional lymph nodes is used to guide selection of tailored postoperative treatment strategies, guide biomarkers of response to chemotherapy, provide prognostic information and assess multimodal therapies,” the researchers wrote.
Disclosure: The researchers report support from a clinical research training fellowship from Cancer Research UK, as well as a clinician scientist fellowship from Medical Research Council UK.
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