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Gao X, Overtoom HCG, Eyck BM, Huang SH, Nieboer D, van der Sluis PC, Lagarde SM, Wijnhoven BPL, Chao YK, van Lanschot JJB. Pathological response to neoadjuvant chemoradiotherapy for oesophageal squamous cell carcinoma in Eastern versus Western countries: meta-analysis. Br J Surg 2024; 111:znae083. [PMID: 38721902 DOI: 10.1093/bjs/znae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/23/2024] [Accepted: 03/05/2024] [Indexed: 05/15/2024]
Abstract
OBJECTIVE Locally advanced oesophageal squamous cell carcinoma can be treated with neoadjuvant chemoradiotherapy or chemotherapy followed by oesophagectomy. Discrepancies in pathological response rates have been reported between studies from Eastern versus Western countries. The aim of this study was to compare the pathological response to neoadjuvant chemoradiotherapy in Eastern versus Western countries. METHODS Databases were searched until November 2022 for studies reporting pCR rates after neoadjuvant chemoradiotherapy for oesophageal squamous cell carcinoma. Multi-level meta-analyses were performed to pool pCR rates separately for cohorts from studies performed in centres in the Sinosphere (East) or in Europe and the Anglosphere (West). RESULTS For neoadjuvant chemoradiotherapy, 51 Eastern cohorts (5636 patients) and 20 Western cohorts (3039 patients) were included. Studies from Eastern countries included more men, younger patients, more proximal tumours, and more cT4 and cN+ disease. Patients in the West were more often treated with high-dose radiotherapy, whereas patients in the East were more often treated with a platinum + fluoropyrimidine regimen. The pooled pCR rate after neoadjuvant chemoradiotherapy was 31.7% (95% c.i. 29.5% to 34.1%) in Eastern cohorts versus 40.4% (95% c.i. 35.0% to 45.9%) in Western cohorts (fixed-effect P = 0.003). For cohorts with similar cTNM stages, pooled pCR rates for the East and the West were 32.5% and 41.9% respectively (fixed-effect P = 0.003). CONCLUSION The pathological response to neoadjuvant chemoradiotherapy is less favourable in patients treated in Eastern countries compared with Western countries. Despite efforts to investigate accounting factors, the discrepancy in pCR rate cannot be entirely explained by differences in patient, tumour, or treatment characteristics.
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Affiliation(s)
- Xing Gao
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Hidde C G Overtoom
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Ben M Eyck
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Shi-Han Huang
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Daan Nieboer
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Sjoerd M Lagarde
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
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Vaidya P, Cohen EE. Facts and Hopes in Neoadjuvant Immunotherapy: Current Approvals and Emerging Evidence. Clin Cancer Res 2024; 30:1232-1239. [PMID: 37955563 PMCID: PMC10984792 DOI: 10.1158/1078-0432.ccr-23-0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/27/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
In 2021 and 2022, two immune checkpoint inhibitors received FDA approval in the neoadjuvant setting for the treatment of early-stage triple negative breast cancer (TNBC) and non-small cell lung cancer (NSCLC). Several more studies have since indicated the benefits, and challenges, of administering neoadjuvant immunotherapy prior to definitive surgery in the gastrointestinal, head and neck, and cutaneous realms. In addition, numerous ongoing phase II and phase III trials are investigating outcomes of neoadjuvant immune treatment in early-stage disease. As such, it is anticipated that more immune checkpoint inhibitors will receive approval for various neoadjuvant indications in the next several years. Medical oncologists, surgeons, and other providers in a multidisciplinary cancer care team will be presented with alternate treatment paradigms and clinical decisions regarding upfront surgery versus neoadjuvant treatment. Here, we describe the current evidence supporting use of immune checkpoint inhibitors for neoadjuvant treatment, ongoing studies, and clinical considerations of this treatment approach.
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Affiliation(s)
- Poorva Vaidya
- Dept of Internal Medicine, Division of Hematology-Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Ezra E.W. Cohen
- Dept of Internal Medicine, Division of Hematology-Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA
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Yuan MX, Cai QG, Zhang ZY, Zhou JZ, Lan CY, Lin JB. Application of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in curative surgery for esophageal cancer: A meta-analysis. World J Gastrointest Oncol 2024; 16:214-233. [PMID: 38292844 PMCID: PMC10824113 DOI: 10.4251/wjgo.v16.i1.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/20/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The effectiveness of neoadjuvant therapy in esophageal cancer (EC) treatment is still a subject of debate. AIM To compare the clinical efficacy and toxic side effects between neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT) for locally advanced EC (LAEC). METHODS A comprehensive search was conducted using multiple databases, including PubMed, EMBASE, MEDLINE, Science Direct, The Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Journal Database, and Chinese Biomedical Literature Database Article. Studies up to December 2022 comparing nCRT and nCT in patients with EC were selected. RESULTS The analysis revealed significant differences between nCRT and nCT in terms of disease-free survival. The results indicated that nCRT provided better outcomes in terms of the 3-year overall survival rate (OSR) [odds ratio (OR) = 0.95], complete response rate (OR = 3.15), and R0 clearance rate (CR) (OR = 2.25). However, nCT demonstrated a better 5-year OSR (OR = 1.02) than nCRT. Moreover, when compared to nCRT, nCT showed reduced risks of cardiac complications (OR = 1.15) and pulmonary complications (OR = 1.30). CONCLUSION Overall, both nCRT and nCT were effective in terms of survival outcomes for LAEC. However, nCT exhibited better performance in terms of postoperative complications.
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Affiliation(s)
- Mao-Xiu Yuan
- The Graduate School, Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Thoracic Surgery, Affiliated Hospital of Jinggangshan University, Ji’an 343000, Jiangxi Province, China
| | - Qi-Gui Cai
- Department of Thoracic Surgery, Affiliated Hospital of Jinggangshan University, Ji’an 343000, Jiangxi Province, China
| | - Zhen-Yang Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, Fujian Province, China
| | - Jian-Zhong Zhou
- Department of Thoracic Surgery, Affiliated Hospital of Jinggangshan University, Ji’an 343000, Jiangxi Province, China
| | - Cai-Yun Lan
- Department of Thoracic Surgery, Affiliated Hospital of Jinggangshan University, Ji’an 343000, Jiangxi Province, China
| | - Jiang-Bo Lin
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, Fujian Province, China
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Zeng H, Zhang F, Sun Y, Li S, Zhang W. Treatment options for neoadjuvant strategies of esophageal squamous cell carcinoma (Review). Mol Clin Oncol 2024; 20:4. [PMID: 38223404 PMCID: PMC10784769 DOI: 10.3892/mco.2023.2702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/26/2023] [Indexed: 01/16/2024] Open
Abstract
Compared with postoperative adjuvant therapy, neoadjuvant therapy has more potential advantages, such as decreasing tumor stage, killing micrometastatic cells. Because of these advantages, neoadjuvant therapy is recommended for numerous types of tumor, such as breast, lung and rectal cancer. To determine the role of neoadjuvant therapy on overall survival and adverse for patients with resectable esophageal carcinoma. we summarized clinical studies on 7 types of neoadjuvant therapies in this review. Currently, patients with esophageal cancer (EC) in China mainly receive postoperative treatment with <30% of patients receiving neoadjuvant therapy. One reason for the limited use of neoadjuvant therapy in China is inaccurate staging based on imaging and neoadjuvant treatment may increase difficulties in surgery. After neoadjuvant therapy, there may be tissue edema, blurry surgical field of view and unclear tissue gaps, resulting in greater difficulty in surgical procedures. However, oncologists are interested in neoadjuvant treatment, especially neoadjuvant immunotherapy to treat EC. Concurrent chemoradiotherapy for esophageal squamous cell carcinoma (ESCC) is the most common neoadjuvant treatment regimen and increases the pathological complete response (pCR) and 5- and 10-year survival rates. Preoperative induction chemotherapy and sequential concurrent chemoradiotherapy are currently the most widely treatments used in clinical practice in China. However, this treatment strategy does not yield long-term survival. The pCR rate of neoadjuvant immunotherapy is greater than that of concurrent chemoradiotherapy but, to the best of our knowledge, no evidence of long-term survival benefit has been found in phase I and II clinical trials. Neoadjuvant treatment should be considered for patients with locally advanced ESCC.
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Affiliation(s)
- Hai Zeng
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China
| | - Fan Zhang
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China
| | - Yujiao Sun
- Department of Clinical Medicine, Medical School of Yangtze University, Jingzhou, Hubei 434000, P.R. China
| | - Shuang Li
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China
| | - Weijia Zhang
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China
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Loc NVV, Vuong NL, Trung LV, Trung TT. Effect of Time to Minimally Invasive Esophagectomy After Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma. J Gastrointest Cancer 2023; 54:1240-1251. [PMID: 36723785 PMCID: PMC9890412 DOI: 10.1007/s12029-023-00915-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) with docetaxel, cisplatin, and 5-fluorouracil/capecitabine (DCF/DCX) followed by esophagectomy has been the recommended treatment for esophageal squamous cell carcinoma (ESCC). However, the optimal interval from NAC to surgery has not yet been established. This study evaluated the impact of time to surgery (TTS) in the treatment of ESCC. METHODS Between August 2018 and September 2021, 97 patients who underwent radical esophagectomy following 3-6 cycles of NAC with DCF/DCX for ESCC at a single hospital were analyzed. TTS was categorized into three groups: 16-41 days (group 1; 33 patients), 42-55 days (group 2; 29 patients), and 56-135 days (group 3; 35 patients). Survival outcomes included overall survival (OS) and progression-free survival (PFS). RESULTS Mean age was 59.6 ± 6.8 years, and 95 patients were male. One patient had grade-III anemia, 12 had grade-II anemia, and four had grade-II neutropenia; all other NAC-related toxicities were as grade I. Regarding pathologic tumor response, 18.6% achieved complete response, 71.1% achieved partial response, and 10.3% had stable disease. Forty-eight patients (49.5%) had a postoperative complication, but only six (6.2%) with grade IIIa and two (2.1%) with grade IVa according to the Clavien-Dindo classification. Median follow-up time was 24 months. Groups 1 and 3 had worse OS (HR [95% CI]: 3.36 [1.16-11.7] and 1.83 [0.55-6.10]) and worse PFS (HR [95% CI]: 3.27 [1.25-8.53] and 1.61 [0.58-4.45]) compared to group 2. CONCLUSION We suggest the optimal TTS after NAC is 6-8 weeks. However, this finding must be confirmed by prospective trials.
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Affiliation(s)
- Nguyen Vo Vinh Loc
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
- Digestive Surgery Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
| | - Lam Viet Trung
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
- Digestive Surgery Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tran Thien Trung
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
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Su F, Yang X, Yin J, Shen Y, Tan L. Validity of Using Pathological Response as a Surrogate for Overall Survival in Neoadjuvant Studies for Esophageal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 2023; 30:7461-7471. [PMID: 37400616 DOI: 10.1245/s10434-023-13778-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/04/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Pathological response is a critical factor in predicting long-term survival of patients with esophageal cancer after preoperative therapy. However, the validity of using pathological response as a surrogate for overall survival (OS) for esophageal cancer has not yet been established. In this study, a literature-based meta-analysis was conducted to evaluate pathological response as a proxy endpoint for survival in esophageal cancer. METHODS Three databases were systematically searched to identify relevant studies investigating neoadjuvant treatment for esophageal cancer. The correlation between pathological complete response (pCR) and OS were assessed using a weighted multiple regression analysis at the trial level, and the coefficient of determination (R2) was calculated. The research design and histological subtypes were considered in the performance of subgroup analysis. RESULTS In this meta-analysis, a total of 40 trials, comprising 43 comparisons and 55,344 patients were qualified. The surrogacy between pCR and OS was moderate (R2 = 0.238 in direct comparison, R2 = 0.500 for pCR reciprocals, R2 = 0.541 in log settings). pCR could not serve as an ideal surrogate endpoint in randomized controlled trials (RCTs) (R2 = 0.511 in direct comparison, R2 = 0.460 for pCR reciprocals, R2 = 0.523 in log settings). A strong correlation was observed in studies comparing neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy (R2 = 0.595 in direct comparison, R2 = 0.840 for pCR reciprocals, R2 = 0.800 in log settings). CONCLUSIONS A lack of surrogacy of pathological response for long-term survival at trial level is established in this study. Hence, caution should be exercised when using pCR as the primary endpoint in neoadjuvant studies for esophageal cancer.
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Affiliation(s)
- Feng Su
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Xinyu Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Jun Yin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China.
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
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Maramara T, Shridhar R, Blinn P, Huston J, Meredith K. Timing After Neoadjuvant Therapy Predicts Mortality in Patients Undergoing Esophagectomy: a Propensity Score-Matched Analysis. J Gastrointest Surg 2023; 27:2342-2351. [PMID: 37848687 DOI: 10.1007/s11605-023-05851-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Currently most surgeons allow 6-12 weeks after neoadjuvant therapy prior to recommending esophagectomy. Given that complete pathologic response correlates to improved survival, some have advocated a longer interval should be entertained to increase the pathologic response. The impact of an expanded neoadjuvant therapy-surgery timing is not currently well understood. METHODS Utilizing the National Cancer Database, we identified patients with esophageal cancer who underwent neoadjuvant therapy followed by esophagectomy. Patients were divided into 3-time intervals: < 6 weeks, 6-12 weeks, and > 3 months. RESULTS We identified 9256 patients who received neoadjuvant therapy followed by esophagectomy. There were 7858 (84.9%) males and 1398 (15.1%) females with a median age of 62. The median lymph nodes harvested decreased as timing increased (p < 0.001) and mean lymph nodes positive decreased as timing increased, p = 0.01. The complete response rate also increased as timing increased, p < 0.001. However, this improvement in pathologic complete response did not translate into an increase in median survival. Ninety-day mortality increased as the timing from neoadjuvant therapy increased: 6.4%, 7.9%, and 10.2%, respectively, p = 0.002. CONCLUSION Our data demonstrates that patients who have a prolonged neoadjuvant therapy- esophagectomy interval will have a substantial increase in 90-day mortality. While there was an increase in pathologic complete response rates, this did not translate into an improvement in survival. The current recommendations of a neoadjuvant therapy-surgery timing of 6-12 weeks should remain.
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Affiliation(s)
- Taylor Maramara
- College of Medicine, Florida State University, 1950 Arlington Street, Suite 101, Sarasota, FL, USA
| | | | - Paige Blinn
- College of Medicine, Florida State University, 1950 Arlington Street, Suite 101, Sarasota, FL, USA
| | - Jamie Huston
- Sarasota Memorial Hospital System, Sarasota Memorial Cancer Institute, Sarasota, FL, USA
| | - Kenneth Meredith
- College of Medicine, Florida State University, 1950 Arlington Street, Suite 101, Sarasota, FL, USA.
- Sarasota Memorial Hospital System, Sarasota Memorial Cancer Institute, Sarasota, FL, USA.
- Brian D. Jellison Cancer Institute, Sarasota, FL, USA.
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Guo Y, Xu M, Lou Y, Yuan Y, Wu Y, Zhang L, Xin Y, Zhou F. Survival and complications after neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy for esophageal squamous cell cancer: A meta-analysis. PLoS One 2022; 17:e0271242. [PMID: 35930539 PMCID: PMC9355212 DOI: 10.1371/journal.pone.0271242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
To compare the survival and complications of neoadjuvant chemoradiation (NCRT) versus neoadjuvant chemotherapy (NCT) for esophageal squamous cell carcinoma (ESCC).
Methods
We conducted a systematic literature search of the PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, Wanfang Data, CBM, and VIP databases from inception to November 2021. Meta-analyses were performed using RevMan (version 5.3) and Stata version 15.0.
Results
A total of 18 studies were included, which involved 3137 patients, The results of the metaanalysis showed that the pathological complete remission rate (odds ratio [OR] = 5.21, 95% confidence interval [CI]: 2.85–9.50, p<0.00001) and complete tumor resection rate (OR = 2.31, 95% CI: 1.57–3.41, p<0.0001) in the NCRT group were significantly better than those in the NCT group. Our meta-analysis results showed that 1-, 3-, and 5-year survival rates (1-year overall survival [OS]: OR = 1.51, 95% CI: 1.11–2.05, p = 0.009; 3-year OS: OR = 1.73, 95% CI: 1.36–2.21, p<0.0001; 5-year OS: OR = 1.61, 95% CI: 1.30–1.99, p<0.00001) in the NCRT group were significantly higher than those in the NCT group. NCRT can lead a significant survival benefit compared with NCT and there was no significant difference between the two neoadjuvant treatments in terms of postoperative complications.
Conclusion
The use of NCRT in the treatment of patients with ESCC patients showed significant advantages in terms of survival and safety relative to the use of NCT.
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Affiliation(s)
- Yaru Guo
- Department of Radiation, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- First Clinical College, Xuzhou Medical University, Xuzhou, China
| | - Mingna Xu
- Department of Radiation, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- First Clinical College, Xuzhou Medical University, Xuzhou, China
| | - Yufei Lou
- Department of Radiation, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- First Clinical College, Xuzhou Medical University, Xuzhou, China
| | - Yan Yuan
- Department of Radiation, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- First Clinical College, Xuzhou Medical University, Xuzhou, China
| | - Yuling Wu
- Department of Radiation, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- First Clinical College, Xuzhou Medical University, Xuzhou, China
| | - Longzhen Zhang
- Department of Radiation, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yong Xin
- Department of Radiation, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- First Clinical College, Xuzhou Medical University, Xuzhou, China
- * E-mail: (YX); (FZ)
| | - Fengjuan Zhou
- First Clinical College, Xuzhou Medical University, Xuzhou, China
- Department of Radiation, the Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- * E-mail: (YX); (FZ)
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Qian D, Chen X, Shang X, Wang Y, Tang P, Han D, Jiang H, Chen C, Zhao G, Zhou D, Cao F, Er P, Zhang W, Li X, Zhang T, Zhang B, Guan Y, Wang J, Yuan Z, Yu Z, Wang P, Pang Q. Definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy followed by surgery in patients with locally advanced esophageal squamous cell carcinoma who achieved clinical complete response when induction chemoradiation finished: A phase II random. Radiother Oncol 2022; 174:1-7. [PMID: 35764191 DOI: 10.1016/j.radonc.2022.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND PURPOSE More than 40% of patients with esophageal squamous cell carcinoma (ESCC) exhibit pathological complete responses (pCR) after neoadjuvant chemoradiotherapy (nCRT), and theoretically, these patients may be cured by CRT and omit surgery. This prospectively randomized pilot study compared definitive chemoradiotherapy (dCRT) with nCRT in patients with locally advanced ESCC who achieved clinical complete responses (cCRs) to nCRT. MATERIALS AND METHODS Single center, randomized, open phase 2 study of 256 patients with locally advanced ESCC enrolled between April 2016 and November 2018. Immediately when nCRT finished, patients enrolled underwent response evaluations within 1 week. Patients with cCR were randomly allocated to undergo surgery (arm A) or complete CRT up to the definitive radiation dose (arm B). The primary end point was 3-year disease-free survival (DFS). RESULTS Finally, 71 patients were randomly assigned to the nCRT (n = 36) and dCRT (n = 35) arms. The median observation time was 35.7 months. The 3-year DFS rate was 56.43% in arm A versus 54.73% in arm B (hazard ratio [HR] = 0.862, 95% confidence interval [CI] = 0.452 to 1.645, P = 0.652). The 3-year overall survival (OS) rates in arms A and B were 69.5% and 62.3% (HR = 0.824, 95% CI = 403-1.688, P = 0.597), respectively. CONCLUSIONS According to our treatment response evaluation criteria, survival of the patients with cCR after nCRT was not significant different between nCRT group and dCRT group. An optimized response evaluation strategy soon after nCRT may guide next therapy decisions for patients with locally advanced ESCC.
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Affiliation(s)
- Dong Qian
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China; Department of Radiation Oncology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, PR China
| | - Xi Chen
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xiaobin Shang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yuwen Wang
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Peng Tang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Dong Han
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Hongjing Jiang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Chuangui Chen
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Gang Zhao
- Department of pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Dejun Zhou
- Department of endoscopy diagnosis and therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Fuliang Cao
- Department of endoscopy diagnosis and therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Puchun Er
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Wencheng Zhang
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xiaoxia Li
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Tian Zhang
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Baozhong Zhang
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Yong Guan
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jun Wang
- Department of radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiyong Yuan
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
| | - Ping Wang
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.
| | - Qingsong Pang
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.
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10
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Alves IPF, Tercioti Junior V, Coelho Neto JDS, Ferrer JAP, Carvalheira JBC, Pereira EB, Lopes LR, Andreollo NA. NEOADJUVANT CHEMORADIOTHERAPY FOLLOWED BY TRANSHITAL ESOPHAGECTOMY IN LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA: IMPACT OF PATHOLOGICAL COMPLETE RESPONSE. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 34:e1621. [PMID: 35019133 PMCID: PMC8735162 DOI: 10.1590/0102-672020210002e1621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multimodal therapy with neoadjuvant chemoradiotherapy, followed by esophagectomy has offered better survival results, compared to isolated esophagectomy, in advanced esophageal cancer. In addition, patients who have a complete pathological response to neoadjuvant treatment presented greater overall survival and longer disease-free survival compared to those with incomplete response. AIM To compare the results of overall survival and disease-free survival among patients with complete and incomplete response, submitted to neoadjuvant chemoradiotherapy, with two therapeutic regimens, followed by transhiatal esophagectomy. METHODS Retrospective study, approved by the Research Ethics Committee, analyzing the medical records of 56 patients with squamous cell carcinoma of the esophagus, divided into two groups, submitted to radiotherapy (5040 cGY) and chemotherapy (5-Fluorouracil + Cisplatin versus Paclitaxel + Carboplatin) neoadjuvants and subsequently to surgical treatment, in the period from 2005 to 2012, patients. RESULTS The groups did not differ significantly in terms of gender, race, age, postoperative complications, disease-free survival and overall survival. The 5-year survival rate of patients with incomplete and complete response was 18.92% and 42.10%, respectively (p> 0.05). However, patients who received Paclitaxel + Carboplatin, had better complete pathological responses to neoadjuvant, compared to 5-Fluorouracil + Cisplatin (47.37% versus 21.62% - p = 0.0473, p <0.05). CONCLUSIONS There was no statistical difference in overall survival and disease-free survival for patients who had a complete pathological response to neoadjuvant. Patients submitted to the therapeutic regimen with Paclitaxel and Carboplastin, showed a significant difference with better complete pathological response and disease progression. New parameters are indicated to clarify the real value in survival, from the complete pathological response to neoadjuvant, in esophageal cancer.
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Affiliation(s)
| | | | | | | | | | - Eduardo Baldon Pereira
- Radiotherapy Division, University Hospital, School of Medical Sciences, State University Campinas - Unicamp, Campinas, Sao Paulo, Brazil
| | - Luiz Roberto Lopes
- Digestive Diseases Surgical Unit, Department of Surgery and Gastrocentro
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11
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Han J, Wang Z, Liu C. Survival and complications after neoadjuvant chemotherapy or chemoradiotherapy for esophageal cancer: a meta-analysis. Future Oncol 2021; 17:2257-2274. [PMID: 33739165 DOI: 10.2217/fon-2021-0021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objectives: To identify the effective approach between neoadjuvant chemotherapy (NCT) and chemoradiotherapy (NCRT) by comparing patient survival and complications. Methods: A systematic literature search of articles published between January 1980 and October 2020 was conducted. Data were extracted and analyzed with STATA 12.0. Results: Five randomized trials and 15 retrospective studies, including 4529 patients (NCT: 2035; NCRT: 2494), were enrolled. Compared with NCT, NCRT provided a higher 3-year survival benefit, higher R0 resection and pathological complete response rates and lower local recurrence and distant metastasis rates, but no increase in 5-year survival. Perioperative mortality and cardiovascular complications were more common in patients with adenocarcinoma. Conclusions: Further studies should concentrate on identifying the optimal neoadjuvant approach and suitable beneficiaries.
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Affiliation(s)
- Jinmin Han
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China.,Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Zhongtang Wang
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Chengxin Liu
- Shandong University, Cheeloo College of Medicine, Jinan, 250012, China.,Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China.,Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Jinan, 250117, China
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12
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Murakami T, Shoji Y, Nishi T, Chang SC, Jachimowicz RD, Hoshimoto S, Ono S, Shiloh Y, Takeuchi H, Kitagawa Y, Hoon DSB, Bustos MA. Regulation of MRE11A by UBQLN4 leads to cisplatin resistance in patients with esophageal squamous cell carcinoma. Mol Oncol 2021; 15:1069-1087. [PMID: 33605536 PMCID: PMC8024730 DOI: 10.1002/1878-0261.12929] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/20/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023] Open
Abstract
Resistance to standard cisplatin‐based chemotherapies leads to worse survival outcomes for patients with esophageal squamous cell carcinoma (ESCC). Therefore, there is an urgent need to understand the aberrant mechanisms driving resistance in ESCC tumors. We hypothesized that ubiquilin‐4 (UBQLN4), a protein that targets ubiquitinated proteins to the proteasome, regulates the expression of Meiotic Recombination 11 Homolog A (MRE11A), a critical component of the MRN complex and DNA damage repair pathways. Initially, immunohistochemistry analysis was conducted in specimens from patients with ESCC (n = 120). In endoscopic core ESCC biopsies taken from 61 patients who underwent neoadjuvant chemotherapy (NAC) (5‐fluorouracil and cisplatin), low MRE11A and high UBQLN4 protein levels were associated with reduced pathological response to NAC (P < 0.001 and P < 0.001, respectively). Multivariable analysis of surgically resected ESCC tissues from 59 patients revealed low MRE11A and high UBLQN4 expression as independent factors that can predict shorter overall survival [P = 0.01, hazard ratio (HR) = 5.11, 95% confidence interval (CI), 1.45–18.03; P = 0.02, HR = 3.74, 95% CI, 1.19–11.76, respectively]. Suppression of MRE11A expression was associated with cisplatin resistance in ESCC cell lines. Additionally, MRE11A was found to be ubiquitinated after cisplatin treatment. We observed an amplification of UBQLN4 gene copy numbers and an increase in UBQLN4 protein levels in ESCC tissues. Binding of UBQLN4 to ubiquitinated‐MRE11A increased MRE11A degradation, thereby regulating MRE11A protein levels following DNA damage and promoting cisplatin resistance. In summary, MRE11A and UBQLN4 protein levels can serve as predictors for NAC response and as prognostic markers in ESCC patients.
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Affiliation(s)
- Tomohiro Murakami
- Department of Translational Molecular Medicine, Division of Molecular Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.,Department of Surgery, Hamamatsu University School of Medicine, Japan
| | - Yoshiaki Shoji
- Department of Translational Molecular Medicine, Division of Molecular Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.,Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Tomohiko Nishi
- Department of Translational Molecular Medicine, Division of Molecular Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.,Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Shu-Ching Chang
- Medical Data Research Center Providence Health and Services at Providence Saint Joseph's Health, Portland, OR, USA
| | - Ron D Jachimowicz
- Clinic I of Internal Medicine, University Hospital Cologne, Germany.,Max Planck Institute for Biology of Ageing, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Ageing-Associated Diseases, University of Cologne, Germany
| | - Sojun Hoshimoto
- Department of Translational Molecular Medicine, Division of Molecular Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.,Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Shigeshi Ono
- Department of Translational Molecular Medicine, Division of Molecular Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.,Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Yosef Shiloh
- David and Inez Myers Laboratory for Cancer Genetics, Sackler School of Medicine, Tel Aviv University, Israel
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Dave S B Hoon
- Department of Translational Molecular Medicine, Division of Molecular Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Matias A Bustos
- Department of Translational Molecular Medicine, Division of Molecular Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
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Figueroa-Giralt M, Valenzuela C, Torrealba A, Csendes A, Braghetto I, Lanzarini E, Musleh M, Korn O, Valladares H, CortÉs S. LYMPHOPARIETAL INDEX IN ESOPHAGEAL CANCER IS STRONGER THAN TNM STAGING IN LONG-TERM SURVIVAL PROGNOSIS IN A LATIN-AMERICAN COUNTRY. ACTA ACUST UNITED AC 2021; 33:e1547. [PMID: 33470377 PMCID: PMC7812684 DOI: 10.1590/0102-672020200003e1547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/02/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND The identification of prognostic factors of esophageal cancer has allowed to predict the evolution of patients. AIM Assess different prognostic factors of long-term survival of esophageal cancer and evaluate a new prognostic factor of long-term survival called lymphoparietal index (N+/T). METHOD Prospective study of the Universidad de Chile Clinical Hospital, between January 2004 and December 2013. Included all esophageal cancer surgeries with curative intent and cervical anastomosis. Exclusion criteria included: stage 4 cancers, R1 resections, palliative procedures and emergency surgeries. RESULTS Fifty-eight patients were included, 62.1% were men, the average age was 63.3 years. A total of 48.3% were squamous, 88% were advanced cancers, the average lymph node harvest was 17.1. Post-operative surgical morbidity was 75%, with a 17.2% of reoperations and 3.4% of mortality. The average overall survival was 41.3 months, the 3-year survival was 31%. Multivariate analysis of the prognostic factors showed that significant variables were anterior mediastinal ascent (p=0.01, OR: 6.7 [1.43-31.6]), anastomotic fistula (p=0.03, OR: 0.21 [0.05-0.87]), N classification (p=0.02, OR: 3.8 [1.16-12.73]), TNM stage (p=0.04, OR: 2.8 [1.01-9.26]), and lymphoparietal index (p=0.04, RR: 3.9 [1.01-15.17]. The ROC curves of lymphoparietal index, N classification and TNM stage have areas under the curve of 0.71, 0.63 and 0.64 respectively, with significant statistical difference (p=0.01). CONCLUSION The independent prognostic factors of long-term survival in esophageal cancer are anterior mediastinal ascent, anastomotic fistula, N classification, TNM stage and lymphoparietal index. In esophageal cancer the new lymphoparietal index is stronger than TNM stage in long-term survival prognosis.
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Affiliation(s)
| | - Catalina Valenzuela
- Department of Surgery, Universidad de Chile Clinical Hospital, Santiago, Chile
| | - Andrés Torrealba
- Department of Surgery, Universidad de Chile Clinical Hospital, Santiago, Chile
| | - Attila Csendes
- Department of Surgery, Universidad de Chile Clinical Hospital, Santiago, Chile
| | - Italo Braghetto
- Department of Surgery, Universidad de Chile Clinical Hospital, Santiago, Chile
| | - Enrique Lanzarini
- Department of Surgery, Universidad de Chile Clinical Hospital, Santiago, Chile
| | - Maher Musleh
- Department of Surgery, Universidad de Chile Clinical Hospital, Santiago, Chile
| | - Owen Korn
- Department of Surgery, Universidad de Chile Clinical Hospital, Santiago, Chile
| | - Hector Valladares
- Department of Surgery, Universidad de Chile Clinical Hospital, Santiago, Chile
| | - Solange CortÉs
- Department of Surgery, Universidad de Chile Clinical Hospital, Santiago, Chile
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14
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Rumiato E, Boldrin E, Malacrida S, Battaglia G, Sileni VC, Ruol A, Amadori A, Saggioro D. Identification of host variants associated with overall survival of esophageal cancer patients receiving platinum-based therapy. Pharmacogenomics 2020; 21:393-402. [PMID: 32285752 DOI: 10.2217/pgs-2019-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Clinical features of esophageal cancer (EC) patients have poor prognostic power. Thus, it is paramount to discover biomarkers that can allow a more accurate survival prediction. Methods: To detect genetic variants associated with survival, DNA from 120 patients treated with cisplatin-based neoadjuvant therapy were genotyped using drug metabolism enzymes and transporters array. Results: We identified two variants: the rs2038067 in PPARD (p = 0.0004) and the rs683369 (F160L) in SLC22A1 (p = 0.001). Their prognostic power was greater than that of clinical stage alone (p = 0.017) and comparable to that of response to neoadjuvant therapy (p = 0.71). Interestingly, the prognostic accuracy of response models increased significantly when genetic variables were included (p = 0.003). Conclusion: Our data, though preliminary, strengthen the potential utility of germline variants for a better-tailored management of EC patients.
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Affiliation(s)
- Enrica Rumiato
- Immunology & Molecular Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Elisa Boldrin
- Immunology & Molecular Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Sandro Malacrida
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Giorgio Battaglia
- Endoscopy Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | | | - Alberto Ruol
- Department of Surgical Sciences, Oncology & Gastroenterology, University of Padova, Padova, Italy
| | - Alberto Amadori
- Immunology & Molecular Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.,Department of Surgical Sciences, Oncology & Gastroenterology, University of Padova, Padova, Italy
| | - Daniela Saggioro
- Immunology & Molecular Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
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15
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Macedo FI, Mesquita-Neto JW, Kelly KN, Azab B, Yakoub D, Merchant NB, Livingstone AS, Franceschi D. Utility of Radiation After Neoadjuvant Chemotherapy for Surgically Resectable Esophageal Cancer. Ann Surg Oncol 2019; 27:662-670. [PMID: 31788752 DOI: 10.1245/s10434-019-07788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) ± radiation (NRT) is the "gold standard" approach for locally advanced esophageal cancer (EC). However, the benefits of RT on overall survival (OS) in patients with resectable EC undergoing neoadjuvant therapy followed by esophagectomy remain controversial. METHODS The National Cancer Data Base was queried for patients with nonmetastatic EC between 2004 and 2014. Kaplan-Meier, log-rank, and Cox multivariable regression analysis were performed to analyze OS. Logistic regression analyzed factors associated with 90-day mortality, lymph node involvement, and complete pathological response (pCR). RESULTS A total of 12,238 EC patients who underwent neoadjuvant therapy [neoadjuvant chemoradiation (NACR), 92.1% and NAC, 7.9%] followed by esophagectomy were included. OS was similar in patients undergoing NAC ± RT (35.9 vs. 37.6 mo, respectively, p = 0.393). pCR rate was 18.1% (19.2%, NACR vs. 6.3%, NAC, p < 0.001). NRT was an independent predictor for increased pCR (HR 2.593, p < 0.001). Patients with pCR had increased survival compared with those without pCR (62.3 vs. 34.4 mo, p < 0.001); however, no difference was found between NACR and NAC (61.7 mo vs. median not reached, p = 0.745) in pCR patients. In non-pCR patients, NAC had improved OS compared with NACR (37.3 vs. 30.8 mo, p = 0.002). NRT was associated with worse 90-day mortality (8.2% vs. 7.7%, HR1.872, p = 0.036) In Cox regression, NRT was an independent predictor of worse OS (HR 1.561, p < 0.001). CONCLUSIONS Neoadjuvant RT is associated with improved pCR rates; however, it had deleterious effects in short- and long-term survival. Also, patients who did not achieve pCR had worse OS after neoadjuvant RT.
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Affiliation(s)
- Francis I Macedo
- Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, FL, USA.
| | | | - Kristin N Kelly
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Basem Azab
- Sentara Careplex Hospital, Sentara Healthcare System, Hampton, VA, USA
| | - Danny Yakoub
- Department of Surgery, University of Tennessee School of Medicine, Memphis, TN, USA
| | - Nipun B Merchant
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alan S Livingstone
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dido Franceschi
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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16
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Liu C, Hu Q, Hu K, Su H, Shi F, Kong L, Zhu H, Yu J. Increased CD8+CD28+ T cells independently predict better early response to stereotactic ablative radiotherapy in patients with lung metastases from non-small cell lung cancer. J Transl Med 2019; 17:120. [PMID: 30971280 PMCID: PMC6458628 DOI: 10.1186/s12967-019-1872-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/04/2019] [Indexed: 12/25/2022] Open
Abstract
Background Stereotactic ablative radiotherapy (SABR) shows a remarkable local control of non-small cell lung cancer (NSCLC) metastases, partially as a result of host immune status. However, the predictors of immune cells for tumor response after SABR are unknown. To that effect, we investigated the ability of pre-SABR immune cells in peripheral blood to predict early tumor response to SABR in patients with lung metastases from NSCLC. Methods This study included 70 patients with lung metastases from NSCLC who were undergoing SABR. We evaluated the early tumor response 1 month and 6 months after SABR in these patients following RECIST 1.1 guidelines. Pre-SABR peripheral CD8+ T cell count, CD8+CD28+ T-cell count, CD8+CD28− T-cell count, CD4+ T-cell count, and Treg-cell count were measured using flow cytometry. Results Increased CD8+CD28+ T-cell counts (14.43 ± 0.65 vs. 10.21 ± 0.66; P = 0.001) and CD4/Treg ratio (16.96 ± 1.76 vs. 11.91 ± 0.74; P = 0.011) were noted in 1-month responsive patients, compared with non-responsive patients. In univariate logistic analyses, high CD8+CD28+ T-cell counts (OR 0.12, 95% CI 0.03–0.48; P = 0.003), CD4/Treg ratio (OR 0.24, 95% CI 0.06–0.90; P = 0.035), and BED10 (OR 0.91, 95% CI 0.84–0.99; P = 0.032) predicted a 1-month tumor response to SABR. According to multivariate logistic analyses, the CD8+CD28+ T-cell count predicted a 1-month tumor response to SABR (OR 0.19, 95% CI 0.04–0.90; P = 0.037) independently. Furthermore, we confirmed the independent predictive value of the CD8+CD28+ T-cell count in predicting tumor response to SABR in 41 patients 6 months after treatment (OR 0.08, 95% CI 0.01–0.85; P = 0.039). Conclusions A pre-SABR CD8+CD28+ T-cell count could predict early tumor response to SABR in patients with lung metastases from NSCLC. Larger, independently prospective analyses are warranted to verify our findings. Electronic supplementary material The online version of this article (10.1186/s12967-019-1872-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chao Liu
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.,Department of Radiation Oncology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, 100071, China
| | - Qinyong Hu
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Kai Hu
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Huichao Su
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Fang Shi
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Li Kong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.
| | - Jinming Yu
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060, China. .,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.
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17
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Neoadjuvant chemoradiotherapy or chemotherapy for gastroesophageal junction adenocarcinoma: A systematic review and meta-analysis. Gastric Cancer 2019; 22:245-254. [PMID: 30483986 DOI: 10.1007/s10120-018-0901-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 11/20/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The preferred neoadjuvant treatment for gastroesophageal junction (GEJ) adenocarcinoma is still matter of debate. We conducted a meta-analysis to assess the different impact of neoadjuvant combined chemotherapy and radiotherapy (CTRT) versus chemotherapy (CT) alone. METHODS A comprehensive search was performed in EMBASE, PubMed, and Cochrane Library databases from inception to 30th June 2018. Studies comparing survival of patients who underwent CTRT or CT alone before surgery for GEJ adenocarcinoma were included. Hazard ratio (HR) for overall survival (OS) was extracted, and a random-effects model was used for pooled analysis. Median OS, 5-year OS, complete pathologic response (pCR), locoregional and distant failure rates were also calculated. RESULTS 22 studies including 18,260 patients were considered for the final analysis. The pooled results demonstrated that combined CTRT do not significantly reduce the risk of death (HR 0.95, 95% CI 0.84-1.07; P = 0.41) but has a positive impact on the risk of relapse (HR 0.85, 95% CI 0.75-0.97; P = 0.01) compared to CT alone. Addition of RT to CT alone significantly increased the odds of pCR by 2.8 (95% CI 2.27-3.47; P < 0.001) and reduced the risk of locoregional failure (OR 0.6, 95% CI 0.39-0.91; P = 0.01) but not the risk of distant metastases (OR 0.81, 95% CI 0.59-1.11; P = 0.19). CONCLUSIONS In this systematic review and meta-analysis comparing neoadjuvant CTRT with CT for adenocarcinoma of GEJ, we found no difference in terms of median OS, despite a higher pCR rate and a reduced risk of locoregional recurrences for the combined approach. Further studies, preferably large randomized clinical trials, are needed to confirm these results.
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18
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Song KJ, Arndt AT. Is a Novel Nomogram Better Than TNM Staging at Predicting Survival in Siewert Type 2 Adenocarcinoma? Ann Surg Oncol 2019; 26:1182-1183. [PMID: 30771117 DOI: 10.1245/s10434-019-07242-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Kimberly J Song
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, USA.
| | - Andrew T Arndt
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA
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19
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Sawas T, Killcoyne S, Iyer PG, Wang KK, Smyrk TC, Kisiel JB, Qin Y, Ahlquist DA, Rustgi AK, Costa RJ, Gerstung M, Fitzgerald RC, Katzka DA. Identification of Prognostic Phenotypes of Esophageal Adenocarcinoma in 2 Independent Cohorts. Gastroenterology 2018; 155:1720-1728.e4. [PMID: 30165050 PMCID: PMC6298575 DOI: 10.1053/j.gastro.2018.08.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/06/2018] [Accepted: 08/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Most patients with esophageal adenocarcinoma (EAC) present with de novo tumors. Although this could be due to inadequate screening strategies, the precise reason for this observation is not clear. We compared survival of patients with prevalent EAC with and without synchronous Barrett esophagus (BE) with intestinal metaplasia (IM) at the time of EAC diagnosis. METHODS Clinical data were studied using Cox proportional hazards regression to evaluate the effect of synchronous BE-IM on EAC survival independent of age, sex, TNM stage, and tumor location. We analyzed data from a cohort of patients with EAC from the Mayo Clinic (n=411; 203 with BE and IM) and a multicenter cohort from the United Kingdom (n=1417; 638 with BE and IM). RESULTS In the Mayo cohort, BE with IM had a reduced risk of death compared to patients without BE and IM (hazard ratio [HR] 0.44; 95% CI, 0.34-0.57; P<.001). In a multivariable analysis, BE with IM was associated with longer survival independent of patient age or sex, tumor stage or location, and BE length (adjusted HR, 0.66; 95% CI, 0.5-0.88; P=.005). In the United Kingdom cohort, patients BE and IM had a reduced risk of death compared with those without (HR, 0.59; 95% CI, 0.5-0.69; P<.001), with continued significance in multivariable analysis that included patient age and sex and tumor stage and tumor location (adjusted HR, 0.77; 95% CI, 0.64-0.93; P=.006). CONCLUSION Two types of EAC can be characterized based on the presence or absence of BE. These findings could increase our understanding the etiology of EAC, and be used in management and prognosis of patients.
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Affiliation(s)
- Tarek Sawas
- Divisions of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Sarah Killcoyne
- Medical Research Council Cancer Unit, Hutchison/Medical Research Council Research Centre, University of Cambridge, Cambridge, United Kingdom; European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, United Kingdom
| | - Prasad G Iyer
- Divisions of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Kenneth K Wang
- Divisions of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Thomas C Smyrk
- Division of Pathology, Mayo Clinic, Rochester, Minnesota
| | - John B Kisiel
- Divisions of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Yi Qin
- Divisions of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - David A Ahlquist
- Divisions of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Anil K Rustgi
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rui J Costa
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, United Kingdom
| | - Moritz Gerstung
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, United Kingdom
| | - Rebecca C Fitzgerald
- Medical Research Council Cancer Unit, Hutchison/Medical Research Council Research Centre, University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
| | - David A Katzka
- Divisions of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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20
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Ohnuma H, Sato Y, Hayasaka N, Matsuno T, Fujita C, Sato M, Osuga T, Hirakawa M, Miyanishi K, Sagawa T, Fujikawa K, Ohi M, Okagawa Y, Tsuji Y, Hirayama M, Ito T, Nobuoka T, Takemasa I, Kobune M, Kato J. Neoadjuvant chemotherapy with docetaxel, nedaplatin, and fluorouracil for resectable esophageal cancer: A phase II study. Cancer Sci 2018; 109:3554-3563. [PMID: 30137686 PMCID: PMC6215867 DOI: 10.1111/cas.13772] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 12/12/2022] Open
Abstract
Cisplatin plus 5-fluorouracil is regarded as standard neoadjuvant chemotherapy for esophageal squamous cell carcinoma (ESCC) in Japan, but the prognosis remains poor. We have previously described how definitive chemoradiotherapy with docetaxel, nedaplatin, and 5-fluorouracil (DNF) led to a very high response rate and promising survival times. We therefore undertook a phase II trial to evaluate the feasibility and efficacy of neoadjuvant DNF. The study included patients with clinical stage Ib-III ESCC. Chemotherapy consisted of i.v. docetaxel (30 mg/m2 ) and nedaplatin (50 mg/m2 ) on days 1 and 8, and a continuous infusion of 5-fluorouracil (400 mg/m2 /day) on days 1-5 and 8-12, every 3 weeks. After three courses of chemotherapy, esophagectomy was carried out. The primary end-point was the completion rate of the protocol treatment. Twenty-eight patients were enrolled (cStage Ib/II/III, 2/3/23) and all received at least two cycles of chemotherapy. Twenty-five patients underwent surgery, all of whom achieved an R0 resection, leading to a completion rate of 89.3%. The overall response rate was 87.0%. A pathological complete response was confirmed in eight (32.0%) cases. Grade 3/4 adverse events included leukopenia (32.1%), neutropenia (39.3%), febrile neutropenia (10.7%), thrombocytopenia (10.7%), and diarrhea (14.3%), but were manageable. Treatment-related deaths and major surgical complications did not occur. Estimated 2-year progression-free and overall survival rates were 70.4% and 77.2%, respectively. Thus, DNF therapy was well tolerated and deemed feasible, with a strong tumor response in a neoadjuvant setting for ESCC. This trial is registered with the University Hospital Medical Information Network (UMIN ID: 000014305).
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Affiliation(s)
- Hiroyuki Ohnuma
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Yasushi Sato
- Department of Community Medicine for Gastroenterology and OncologyTokushima University Graduate School of Biomedical SciencesTokushimaJapan
| | - Naotaka Hayasaka
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Teppei Matsuno
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Chisa Fujita
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Masanori Sato
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Takahiro Osuga
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Masahiro Hirakawa
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Koji Miyanishi
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
| | - Tamotsu Sagawa
- Department of GastroenterologyHokkaido Cancer CenterSapporoJapan
| | - Koshi Fujikawa
- Department of GastroenterologyHokkaido Cancer CenterSapporoJapan
| | - Motoh Ohi
- Division of GastroenterologySapporo Kyoritsu Gorinbashi HospitalSapporoJapan
| | - Yutaka Okagawa
- Department of GastroenterologyTonan HospitalSapporoJapan
| | - Yasushi Tsuji
- Department of Medical OncologyTonan HospitalSapporoJapan
| | | | - Tatsuya Ito
- Department of SurgerySurgical Oncology and ScienceSapporo Medical University School of MedicineSapporoJapan
| | - Takayuki Nobuoka
- Department of SurgerySurgical Oncology and ScienceSapporo Medical University School of MedicineSapporoJapan
| | - Ichiro Takemasa
- Department of SurgerySurgical Oncology and ScienceSapporo Medical University School of MedicineSapporoJapan
| | - Masayoshi Kobune
- Department of HematologySapporo Medical University School of MedicineSapporoJapan
| | - Junji Kato
- Department of Medical OncologySapporo Medical University School of MedicineSapporoJapan
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21
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Li F, Ding N, Zhao Y, Yuan L, Mao Y. The current optimal multimodality treatments for oesophageal squamous-cell carcinoma: A systematic review and meta-analysis. Int J Surg 2018; 60:88-100. [PMID: 30389537 DOI: 10.1016/j.ijsu.2018.10.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Multimodality treatments including definitive chemoradiotherapy (dCRT) and neoadjuvant chemoradiotherapy (nCRT) or chemotherapy (nCT) followed by surgery (S) are frequently used to improve prognosis in locally advanced oesophageal squamous-cell carcinoma (LAESCC), while the optimal multimodality regimen has yet to be defined; therefore, this systematic review and meta-analysis aimed to find out the current best multimodality regimen for LAESCC. METHODS We conducted a systematic search of PubMed, Embase, Ovid and Cochrane Library databases for studies comparing nCRT + S with nCT + S or dCRT. The primary outcome was overall survival. The secondary outcomes were the rates of R0 resection, pathologic complete response (pCR), tumor-free lymph nodes (pN0) and postoperative recurrence. RESULTS Five studies comparing nCRT + S with nCT + S and fourteen studies comparing nCRT + S with dCRT were finally included. Meta-analysis showed that nCRT + S had higher rates of R0 resection (OR 1.84, 95% CI 1.03-3.29), pCR (OR: 2.90 95% CI 1.37-6.14) and pN0 (OR: 2.55 95% CI 1.54-4.24) with a significant survival advantage (HR 0.72; 95% CI 0.52-0.99) when compared with nCT + S in LAESCC. When nCRT + S was compared with dCRT, nCRT + S yielded a significant survival benefit (HR 0.65; 95% CI 0.56-0.76) and had a significantly lower rate of local recurrence (OR: 0.35 95% CI 0.22-0.57). CONCLUSION Current evidence suggests that CRT + S may be the optimal potential curative treatment mode for patients with LAESCC as long as they are suitable for this multimodality regimen.
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Affiliation(s)
- Feng Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ningning Ding
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yue Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ligong Yuan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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22
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Soror T, Kho G, Zhao KL, Ismail M, Badakhshi H. Impact of pathological complete response following neoadjuvant chemoradiotherapy in esophageal cancer. J Thorac Dis 2018; 10:4069-4076. [PMID: 30174850 DOI: 10.21037/jtd.2018.06.85] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Neoadjuvant radiochemotherapy (nRCT) followed by surgery has become the gold standard treatment in patients with locally advanced esophageal cancer. The pathological response is an important predictor in such patients. This work represents a single-center analysis investigating the impact of pathological complete response (pCR) on treatment outcome. Methods All patients treated with nRCT followed by surgery between January 2005 and December 2015 were reviewed. The patients were categorized into two groups according to the pathological response following nRCT: pCR group and non-pCR group. Results Fifty-six patients with invasive cancer, 23 patients (41.1%) achieved pCR and 33 patients had non-pCR (58.9%) following nRCT. The average age was 62 years (±9.1), and most patients were males (83.9%). Histological types included squamous cell carcinoma (75%) and adenocarcinoma (25%). The total radiation dose was 45 Gy in 76.8% of the patients and 50.4 Gy in 23.2%. The median overall survival (OS) of the entire group was 3.5±1.2 years, and the 5-year OS rate was 38.2%, while the median disease-free survival (DFS) was 2.1±0.4 years and the 5-year DFS rate was 33.1%. The patients who achieved pCR had significantly higher 5-year OS and 5-year DFS rates: 47.2% and 48% compared to 27.3% and 21% for the non-pCR patients respectively (P=0.04, 0.03). The median time of local recurrence was 3.8±0.4 years in pCR group and 1.8±0.2 years in non-pCR group (P=0.01), while the median time of distant metastases in pCR group was 1.2±0.5 years and 1.1±0.2 years in non-pCR group (P=0.6). Conclusions Complete pathological response predicts significantly higher rates of OS and DFS in patients with locally advanced esophageal cancer treated with nRCT followed by surgery.
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Affiliation(s)
- Tamer Soror
- Department of Clinical Radiation Oncology, Ernst von Bergmann Medical Center, Academic Teaching Hospital of Humboldt University Berlin (Charité), Berlin, Germany.,Radiation Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Gerlinda Kho
- Department of Clinical Radiation Oncology, Ernst von Bergmann Medical Center, Academic Teaching Hospital of Humboldt University Berlin (Charité), Berlin, Germany
| | - Kuai-Le Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Mahmoud Ismail
- Department of Surgery, Competence Center of Thoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Harun Badakhshi
- Department of Clinical Radiation Oncology, Ernst von Bergmann Medical Center, Academic Teaching Hospital of Humboldt University Berlin (Charité), Berlin, Germany
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23
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Kappel-Latif S, Zacherl J, Hejna M, Westerhoff M, Tamandl D, Ba-Ssalamah A, Mittlböck M, Wolf B, Wrba F, Kührer I, Pluschnig U, Schoppmann SF, Függer R, Zwrtek R, Glaser K, Karner J, Längle F, Wenzl E, Roka R, Öfner D, Tschmelitsch J, Hold M, Keil F, Gnant M, Kandioler D. • Pancho trial (p53-adapted neoadjuvant chemotherapy for resectable esophageal cancer) completed-mutation rate of the marker higher than expected. Eur Surg 2018; 50:160-166. [PMID: 30559831 PMCID: PMC6290852 DOI: 10.1007/s10353-018-0527-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 02/07/2023]
Abstract
Background In operable esophageal cancer patients, neoadjuvant therapy benefits only those who respond to the treatment. The • Pancho trial represents the first prospective randomized trial evaluating the relevance of the mark53 status for predicting the effect of two different neoadjuvant chemotherapies. Method Biomarker analysis was conducted using the mark53 analysis. Calculation of patient number needed was based on a 60% rate of marker positivity, deduced from the results of a phase II pilot study. Results From 2007–2012, the • Pancho trial recruited 235 patients with operable esophageal cancer in Austria. A total of 181 patients were eligible and could be subjected to mark53 analysis and randomization. After randomizing 74 patients, the overall TP53 mutation rate was 79%. However, due to the high prevalence of marker positivity, the number of projected patients was increased to 181 patients in order to ensure a sufficient number of marker-negative patients. After completion of the trial, the overall TP53 mutation rate was 77.9%. Conclusion Due to high medical need, the recruitment for the academic trial was excellent. Mark53 analysis clearly detected more mutations in the TP53 gene as compared to the cancer-specific p53 literature. Final analysis examining the interaction between the mark53 status and the effect of chemotherapies applied in the • Pancho trial is now awaited.
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Affiliation(s)
- Sonja Kappel-Latif
- 1Division of General Surgery, Department of Surgery, Research Laboratories, Medical University of Vienna, Vienna, Austria
| | - Johannes Zacherl
- 2Division of General Surgery, Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Michael Hejna
- 3Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Maria Westerhoff
- 4Department of Pathology, University of Michigan, Ann Arbor, MI USA
| | - Dietmar Tamandl
- 5Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ahmed Ba-Ssalamah
- 5Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martina Mittlböck
- 6Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Brigitte Wolf
- 1Division of General Surgery, Department of Surgery, Research Laboratories, Medical University of Vienna, Vienna, Austria
| | - Friedrich Wrba
- 7Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Irene Kührer
- 2Division of General Surgery, Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ursula Pluschnig
- 3Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sebastian F Schoppmann
- 2Division of General Surgery, Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Reinhold Függer
- 8Department of Surgery, Elisabethinen Hospital Linz, Linz, Austria
| | - Ronald Zwrtek
- Department of Surgery, Landesklinikum Mistelbach, Mistelbach, Austria
| | - Karl Glaser
- 10Department of General‑, Visceral- and Tumor Surgery, Wilhelminenspital, Vienna, Austria
| | - Josef Karner
- 11Department of Surgery, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Friedrich Längle
- Department of Surgery, Landesklinikum Wr. Neustadt, Wr. Neustadt, Austria
| | - Etienne Wenzl
- 13Department of General‑, Visceral- and Thoracic Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Rudolf Roka
- 14Department of Surgery I, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Dietmar Öfner
- 15Department of Visceral- , Transplant- and Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Jörg Tschmelitsch
- Department of Surgery, Hospital Barmherzige Brüder St. Veit/Glan, St. Veit/Glan, Austria
| | - Michael Hold
- 17Department of Surgery and Vascular Surgery, Hanusch Hospital, Vienna, Austria
| | - Felix Keil
- Department of Hematology and Oncology, Landeskrankenhaus Leoben, Leoben, Austria
| | - Michael Gnant
- 2Division of General Surgery, Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Daniela Kandioler
- 2Division of General Surgery, Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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