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Can Clinical Response Predict Pathologic Response Following Neoadjuvant Chemoradiation for Esophageal Cancer?
Khaitan, Puja G; Holliday, Tyler; Carroll, Austin; Hofstetter, Wayne L; Bayley, Erin M; Zhou, Nicolas; Desale, Sameer; Watson, Thomas J.
  • Khaitan PG; Department of Surgery, Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW (G253), Washington DC, 20010, USA. Puja.G.Khaitan@medstar.net.
  • Holliday T; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA. Puja.G.Khaitan@medstar.net.
  • Carroll A; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.
  • Hofstetter WL; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.
  • Bayley EM; Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Zhou N; Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Desale S; Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Watson TJ; Department of Biostatistics and Biomedical Informatics, Medstar Health Research Institute, Hyattsville, MD, USA.
J Gastrointest Surg ; 26(7): 1345-1351, 2022 07.
Article en En | MEDLINE | ID: mdl-35414141
ABSTRACT

OBJECTIVES:

Approximately 20-40% of patients with locally advanced esophageal cancer will achieve a pathologic complete response (ypCR) following neoadjuvant chemoradiotherapy (nCRT). Predicting ypCR based on a clinical complete response (ycCR) has been a challenge. This study assessed the correlation between ycCR and ypCR, as determined from esophagectomy specimens.

METHODS:

Patients undergoing esophagectomy following nCRT at three major institutions between 2005 and 2018 were reviewed. Restaging, including PET/CT, endoscopy with biopsy, and esophageal ultrasound (EUS), was performed to determine ycCR.

RESULTS:

Six hundred sixty patients were included, with 93.3% with esophageal adenocarcinoma histology. Six hundred fifty-eight of these patients underwent PET, 304 EUS, and 584 underwent a biopsy. Following nCRT, 148 (22.4%) were found to have a ypCR. Only 12/32 (37.5%) determined to have a ycCR were found to have a ypCR, while 136/628 (21.6%) with a non-ycCR were found to have a ypCR (p 0.075). Individual modality PPV was 28% for PET, 54% for EUS, and 26% for biopsy. When PET was combined with EUS, 168 reports were concordant and the PPV of ypCR was 50%, though the number of patients was low (1/2). With all 3 re-staging modalities combined, the PPV and NPV both rose to 100%.

CONCLUSIONS:

Current restaging tools cannot reliably predict ypCR after nCRT. While multimodal restaging appears to be a more accurate predictor of ypCR than any testing modality alone, patients cannot reliably be advised to avoid an esophagectomy on the assumption that ycCR predicts ypCR at this time.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Neoplasias Esofágicas / Adenocarcinoma Tipo de estudio: Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Año: 2022 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Neoplasias Esofágicas / Adenocarcinoma Tipo de estudio: Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Año: 2022 Tipo del documento: Article