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Delayed tumor resection associated with pathologic complete response in esophageal cancer
Delaying surgical resection by 85 to 98 days from completion of chemoradiotherapy was associated with an increased likelihood of pathologic complete response in patients with esophageal cancer, according to data published in JAMA Surgery.
Researchers reported no adverse effects as a result of delayed surgery.
“Contemporary treatment plans for patients with esophageal cancer suggest that esophagectomy be performed within 6 to 8 weeks of the completion of neoadjuvant therapy. However, studies of other solid tumors, such as pancreatic and rectal cancer, have found that longer time intervals between chemoradiotherapy and surgical procedures are associated with increased rates of pathologic complete response,” Kelly R. Haisley, MD, of the division of gastrointestinal and general surgery, department of surgery at Oregon Health and Science University, Portland, and colleagues wrote. “However, evaluations of this phenomenon in patients with esophageal cancer have produced mixed results.”
Researchers used a registry from an NCI–designated cancer center to review data of 234 patients (81.6% male; 97.4% white) with esophageal cancer who underwent neoadjuvant chemoradiotherapy from January 2000 to July 2015, followed by esophagectomy. Median age at operation was 64 years (range, 58-70), and 206 patients (88%) were diagnosed with adenocarcinoma.
Patients were categorized into one of five groups based on time from preoperative chemotherapy or radiation to surgical resection: 0 to 42 days, 43 to 56 days, 57 to 70 days, 71 to 84 days, 85 to 98 days and 99 or more days.
Sixty-five patients (27.9%) had a pathologic complete response. Most groups had response rates between 19.2% and 33.3%. The rate was higher among patients in the 85 to 98-day group (42.1%).
Although the odds of a pathologic complete response were higher among all groups compared with the 0 to 42-day group, results showed a significantly higher OR (5.46) in the 85 to 98-day group (95% CI, 1.16-25.68; P = .03).
“To optimize rates of pathologic complete response with the goal of improving survival in this disease, delaying surgical procedures until 85 to 98 days after the completion of neoadjuvant chemoradiotherapy may be a reasonable approach,” Haisley and colleagues wrote. “Validation of our observations in similar cohorts, ideally through a multi-institutional, prospective, randomized evaluation, is warranted to address the issues of bias.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.