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Pathologic Nonresponders after Neoadjuvant Chemoradiation for Esophageal Cancer Demonstrate no Survival Benefit Compared with Patients Treated with Primary Esophagectomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemoradiation (NCRT) has become the preferred treatment for patients with locally advanced esophageal cancer. Survival often is correlated to degree of pathologic response; however, outcomes in patients who are found to be pathologic nonresponders (pNR) remain uninvestigated. This study was designed to evaluate survival in pNR to NCRT compared with patients treated with primary esophagectomy (PE).

Methods

Using our comprehensive esophageal cancer database, we identified patients treated with NCRT and deemed pNR along with patients who proceeded to PE. Clinical and pathologic data were compared using Fisher’s exact and χ2, whereas Kaplan–Meier estimates were used for survival analysis.

Results

We identified 63 patients treated with NCRT and were found to have a pNR, and 81 patients who underwent PE. Disease-free (DFS) and overall survival (OS) were significantly decreased in the pNR group compared with those treated with PE (10 vs. 50 months (0–152), P < 0.001 and 13 vs. 50 months (0–152), P < 0.001, respectively). For patients with stage II disease, DFS and OS were similarly decreased in pathologic nonresponders (13 vs. 62 months (0–120), P < 0.001 and 31 vs. 62 months (0–120), P = 0.024, respectively). There were no differences in DFS or OS for patients with stage III disease (10 vs. 14 months (0–152), P = 0.29 and 10 vs. 19 months (0–152), P = 0.16, respectively).

Conclusions

Pathologic nonresponders to NCRT for esophageal cancer receive no benefit in DFS or OS compared with patients treated with PE. For patients with stage II disease, DFS and OS are, in fact, significantly decreased in the pNR.

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Authors and Affiliations

  1. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA

    George W. Dittrick MD, Jill M Weber MPH, Khaldoun Almhanna MD, Richard C. Karl MD & Kenneth L. Meredith MD

  2. Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Ravi Shridhar MD, Sarah Hoffe MD & James Barthel MD

  3. Department of Surgery, New York Presbyterian Veterans Administration, New York, NY, USA

    Marcovalerio Melis MD

  4. Department of Surgery, Medical College of Georgia, Augusta, GA, USA

    James McLoughlin

  5. Section Head of Esophagogastric Oncology, H. Lee Moffitt Cancer and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA

    Kenneth L. Meredith MD

Authors
  1. George W. Dittrick MD
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  2. Jill M Weber MPH
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  3. Ravi Shridhar MD
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  4. Sarah Hoffe MD
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  7. James Barthel MD
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  8. James McLoughlin
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  10. Kenneth L. Meredith MD
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Correspondence to Kenneth L. Meredith MD.

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Dittrick, G.W., Weber, J.M., Shridhar, R. et al. Pathologic Nonresponders after Neoadjuvant Chemoradiation for Esophageal Cancer Demonstrate no Survival Benefit Compared with Patients Treated with Primary Esophagectomy. Ann Surg Oncol 19, 1678–1684 (2012). https://doi.org/10.1245/s10434-011-2078-4

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  • DOI: https://doi.org/10.1245/s10434-011-2078-4

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