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Recurrence Patterns and Long-term Results After Induction Chemotherapy, Chemoradiotherapy, and Curative Surgery in Patients With Locally Advanced Esophageal Cancer

Thomas Steffen, Daniel Dietrich, Annelies Schnider, Christoph Kettelhack, Olivier Huber, Walter R Marti, Markus Furrer, Beat Gloor, Marc Schiesser, Sandra Thierstein, Peter Brauchli, Thomas Ruhstaller & Swiss Group For Clinical Cancer Research (SAKK)

abstract

OBJECTIVE
The long-term follow up data of 2 prospective phase II trials is reported (NCT00072033, NCT00445861), which investigated neoadjuvant chemoradiation followed by surgery in patients with esophageal carcinoma. Postoperative complications as well as prognostic factors and patterns of relapse during long-term observation are shown.

SUMMARY OF BACKGROUND DATA
Long-term follow-up is often missing in the complex setting of multimodal treatments of esophageal carcinoma; this leads to rather undifferentiated follow-up guidelines for this tumor entity.

METHODS
In the first trial, patients received induction chemotherapy followed by chemoradiation and surgery. In the second trial, cetuximab was added to the same neoadjuvant treatment concomitant with induction chemotherapy and chemoradiation.

RESULTS
Eighty-two patients underwent surgery; the median follow-up time was 6.8 and 6.4 years, respectively. Fifty-five percent were diagnosed with adenocarcinoma, 80% clinically node-positive, 68% received transthoracic esophagectomy, and 32% transhiatal or transmediastinal resection. Five patients died postoperatively in-hospital due to complications (6%). The median overall survival was 4.3 years, and the median event-free survival was 2.7 years. Patients with adenocarcinoma rarely relapsed after a 3-year event-free survival. Whereas patients with residual tumor cells after neoadjuvant therapy primarily experienced relapse within the first 2 postoperative years, this in contrast to several patients with complete remission who also experienced late relapses 4 years after surgery.

CONCLUSION
After curative surgery in a multimodal setting, the histological type and the response to neoadjuvant therapy predicted the time frame of relapse; this knowledge may influence further follow-up guidelines for esophageal carcinoma.
   
citation Steffen T, Dietrich D, Schnider A, Kettelhack C, Huber O, Marti W R, Furrer M, Gloor B, Schiesser M, Thierstein S, Brauchli P, Ruhstaller T, Swiss Group for Clinical Cancer Research (SAKK) . Recurrence Patterns and Long-term Results After Induction Chemotherapy, Chemoradiotherapy, and Curative Surgery in Patients With Locally Advanced Esophageal Cancer. Ann Surg 2017; 269:83-87.
   
type journal paper/review (English)
date of publishing 24-7-2017
journal title Ann Surg (269/1)
ISSN electronic 1528-1140
pages 83-87
PubMed 28742685
DOI 10.1097/SLA.0000000000002435
contact Ulrich Beutner