Complete Pathologic Response After Neoadjuvant Chemoradiation for Esophageal Cancer in an Integrated

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Complete Pathologic Response After Neoadjuvant
Chemoradiation for Esophageal Cancer in an
Integrated Community-Based PracticeBE Wright,
CM Lee, H Kaya, M Parviz RA HolbrookCancer
Care NorthwestSpokane, Washington
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Background

• Esophageal Cancer (EC) often presents with
  locally advanced disease (LAD)
• Chemoradiation followed by resection has become
  the multimodality management option of choice
• Poor results with resection alone
• Patients often unable to tolerate adjuvant
  chemoradiation
• Improved local control with probable survival
  benefit

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Background

• Correlation exists between response to NT and
  oncologic outcome
• Complete pathologic response (pCR) seems to be
  best prognostic indicator for improved cancer
  related survival
• Adequate rates of pCR important quality marker
  for esophageal treatment programs

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Purpose

• The purpose of our review was to determine
  success rates in achieving pCR following
  neoadjuvant chemoradiation

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Methods

• Retrospective review of all patients with newly
  diagnosed EC referred for surgical consultation
  from 2006 through 2008
• Survival was evaluated with Kaplan-Meier method
• Recurrence rates were compared with Fishers
  Exact test

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43 Patients referred for Surgical Evaluation
28 Underwent NT
13 Underwent IR
Total of 40 Resected Patients
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Pretreatment Stage - NT
54 (15)
29 (8)
14 (4)
3 (1)
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Pretreatment Stage - IR
54 (7)
23 (3)
7.5 (1)
7.5 (1)
7.5 (1)
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Neoadjuvant Regimen
14 (4)
57 (16)
29 (8)
Concurrent Radiation Therapy 4500cGy, /- 540 cGy
boost
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Pathologic Response

• 27 of 28 NT patients completed regimen and
  underwent resection
• 68 of NT patients were downstaged based on final
  pathologic analysis
• 13/28 (46) NT patients had a pCR

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Survival NT vs IR

• Initial s/Demos/Etc

Survival ()
p 0.03
6
12
18
24
30
36
Time (Months)
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Pathologic Response Recurrence

• Pre Treatment staging breakdown

p 0.68
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Recurrence - NT vs IR

• Pre Treatment staging breakdown

p 0.64
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Conclusions

• Acceptable rates of pCR can be obtained following
  NT in Stage II and III EC patients in an
  integrated community based practice
• Greater patient accrual and follow up will be
  required to better assess potential benefit in
  this patient group

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Acknowledgements

• Research Team at CCNW Rachel Garman, Michelle
  Osso, Ben Peressini
• Co-Authors Maryam Parviz MD,
• Hakan Kaya MD, Christopher Lee MD,
• Ryan Holbrook MD

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Thank You