Utility of Radiation After Neoadjuvant Chemotherapy for Surgically Resectable Esophageal Cancer
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...
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| Veröffentlicht in: | Annals of surgical oncology 2020-03, Vol.27 (3), p.662-670 |
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| creator | Macedo, Francis I. Mesquita-Neto, Jose Wilson Kelly, Kristin N. Azab, Basem Yakoub, Danny Merchant, Nipun B. Livingstone, Alan S. Franceschi, Dido |
| description | 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
|
| doi_str_mv | 10.1245/s10434-019-07788-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_webof</sourceid><recordid>TN_cdi_webofscience_primary_000500488500003</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2350713093</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-f3495ee326909a46fd45a7725e1ab751a104a5294f2235bd36987289a59b25193</originalsourceid><addsrcrecordid>eNqNkU1r3DAQhkVpadJt_0APRdBLoTgdfVnWMZj0A0IKaXMWsj3e9eK1tpKcsv--2jhNoIfQiySGZ4Z3HhHylsEZ41J9igykkAUwU4DWVVWYZ-SUqVySZcWe5zeUuchLdUJexbgFYFqAeklOBMu4VvyU2Js0jEM6UN_Ta9cNLg1-oud9wkCv0LtuO9-6KdF6gzufNhjc_kB7H-iPOayH1o3jgV5jxDa5ZkR6Ef1-49boRlq7qcXwmrzo3Rjxzf29IjefL37WX4vL71--1eeXRSu0SkUvpFGIgpcGjJNl30nltOYKmWu0Yi6v6hQ3sudcqKYTpak0r4xTpuGKGbEiH5a5--B_zRiT3Q2xxXF0E_o5Wi44lBKqbGBF3v-Dbv0cppwuUwo0E2BEpvhCtcHHGLC3-zDsXDhYBvao3y76bdZv7_TbY4p396PnZofdQ8tf3xn4uAC_sfF9bAfMkh4wAFAAsqryCXDMUP0_XQ_p7vNqP08pt4qlNWZ8WmN4XPKJ_H8AmnmvcA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2350713093</pqid></control><display><type>article</type><title>Utility of Radiation After Neoadjuvant Chemotherapy for Surgically Resectable Esophageal Cancer</title><source>Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /></source><source>SpringerLink Journals - AutoHoldings</source><creator>Macedo, Francis I. ; Mesquita-Neto, Jose Wilson ; Kelly, Kristin N. ; Azab, Basem ; Yakoub, Danny ; Merchant, Nipun B. ; Livingstone, Alan S. ; Franceschi, Dido</creator><creatorcontrib>Macedo, Francis I. ; Mesquita-Neto, Jose Wilson ; Kelly, Kristin N. ; Azab, Basem ; Yakoub, Danny ; Merchant, Nipun B. ; Livingstone, Alan S. ; Franceschi, Dido</creatorcontrib><description>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.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-019-07788-9</identifier><identifier>PMID: 31788752</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Biopsy ; Cancer ; Cancer therapies ; Chemoradiotherapy ; Chemotherapy ; Esophageal cancer ; Esophagus ; Life Sciences & Biomedicine ; Lymph nodes ; Medicine ; Medicine & Public Health ; Mortality ; Oncology ; Science & Technology ; Surgery ; Surgical Oncology ; Survival ; Thoracic Oncology</subject><ispartof>Annals of surgical oncology, 2020-03, Vol.27 (3), p.662-670</ispartof><rights>Society of Surgical Oncology 2019</rights><rights>Annals of Surgical Oncology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>4</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000500488500003</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c375t-f3495ee326909a46fd45a7725e1ab751a104a5294f2235bd36987289a59b25193</citedby><cites>FETCH-LOGICAL-c375t-f3495ee326909a46fd45a7725e1ab751a104a5294f2235bd36987289a59b25193</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-019-07788-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-019-07788-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,28253,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31788752$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Macedo, Francis I.</creatorcontrib><creatorcontrib>Mesquita-Neto, Jose Wilson</creatorcontrib><creatorcontrib>Kelly, Kristin N.</creatorcontrib><creatorcontrib>Azab, Basem</creatorcontrib><creatorcontrib>Yakoub, Danny</creatorcontrib><creatorcontrib>Merchant, Nipun B.</creatorcontrib><creatorcontrib>Livingstone, Alan S.</creatorcontrib><creatorcontrib>Franceschi, Dido</creatorcontrib><title>Utility of Radiation After Neoadjuvant Chemotherapy for Surgically Resectable Esophageal Cancer</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>ANN SURG ONCOL</addtitle><addtitle>Ann Surg Oncol</addtitle><description>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.</description><subject>Biopsy</subject><subject>Cancer</subject><subject>Cancer therapies</subject><subject>Chemoradiotherapy</subject><subject>Chemotherapy</subject><subject>Esophageal cancer</subject><subject>Esophagus</subject><subject>Life Sciences & Biomedicine</subject><subject>Lymph nodes</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Oncology</subject><subject>Science & Technology</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival</subject><subject>Thoracic Oncology</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkU1r3DAQhkVpadJt_0APRdBLoTgdfVnWMZj0A0IKaXMWsj3e9eK1tpKcsv--2jhNoIfQiySGZ4Z3HhHylsEZ41J9igykkAUwU4DWVVWYZ-SUqVySZcWe5zeUuchLdUJexbgFYFqAeklOBMu4VvyU2Js0jEM6UN_Ta9cNLg1-oud9wkCv0LtuO9-6KdF6gzufNhjc_kB7H-iPOayH1o3jgV5jxDa5ZkR6Ef1-49boRlq7qcXwmrzo3Rjxzf29IjefL37WX4vL71--1eeXRSu0SkUvpFGIgpcGjJNl30nltOYKmWu0Yi6v6hQ3sudcqKYTpak0r4xTpuGKGbEiH5a5--B_zRiT3Q2xxXF0E_o5Wi44lBKqbGBF3v-Dbv0cppwuUwo0E2BEpvhCtcHHGLC3-zDsXDhYBvao3y76bdZv7_TbY4p396PnZofdQ8tf3xn4uAC_sfF9bAfMkh4wAFAAsqryCXDMUP0_XQ_p7vNqP08pt4qlNWZ8WmN4XPKJ_H8AmnmvcA</recordid><startdate>20200301</startdate><enddate>20200301</enddate><creator>Macedo, Francis I.</creator><creator>Mesquita-Neto, Jose Wilson</creator><creator>Kelly, Kristin N.</creator><creator>Azab, Basem</creator><creator>Yakoub, Danny</creator><creator>Merchant, Nipun B.</creator><creator>Livingstone, Alan S.</creator><creator>Franceschi, Dido</creator><general>Springer International Publishing</general><general>Springer Nature</general><general>Springer Nature B.V</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20200301</creationdate><title>Utility of Radiation After Neoadjuvant Chemotherapy for Surgically Resectable Esophageal Cancer</title><author>Macedo, Francis I. ; Mesquita-Neto, Jose Wilson ; Kelly, Kristin N. ; Azab, Basem ; Yakoub, Danny ; Merchant, Nipun B. ; Livingstone, Alan S. ; Franceschi, Dido</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-f3495ee326909a46fd45a7725e1ab751a104a5294f2235bd36987289a59b25193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Biopsy</topic><topic>Cancer</topic><topic>Cancer therapies</topic><topic>Chemoradiotherapy</topic><topic>Chemotherapy</topic><topic>Esophageal cancer</topic><topic>Esophagus</topic><topic>Life Sciences & Biomedicine</topic><topic>Lymph nodes</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Oncology</topic><topic>Science & Technology</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival</topic><topic>Thoracic Oncology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Macedo, Francis I.</creatorcontrib><creatorcontrib>Mesquita-Neto, Jose Wilson</creatorcontrib><creatorcontrib>Kelly, Kristin N.</creatorcontrib><creatorcontrib>Azab, Basem</creatorcontrib><creatorcontrib>Yakoub, Danny</creatorcontrib><creatorcontrib>Merchant, Nipun B.</creatorcontrib><creatorcontrib>Livingstone, Alan S.</creatorcontrib><creatorcontrib>Franceschi, Dido</creatorcontrib><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Macedo, Francis I.</au><au>Mesquita-Neto, Jose Wilson</au><au>Kelly, Kristin N.</au><au>Azab, Basem</au><au>Yakoub, Danny</au><au>Merchant, Nipun B.</au><au>Livingstone, Alan S.</au><au>Franceschi, Dido</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Utility of Radiation After Neoadjuvant Chemotherapy for Surgically Resectable Esophageal Cancer</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><stitle>ANN SURG ONCOL</stitle><addtitle>Ann Surg Oncol</addtitle><date>2020-03-01</date><risdate>2020</risdate><volume>27</volume><issue>3</issue><spage>662</spage><epage>670</epage><pages>662-670</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31788752</pmid><doi>10.1245/s10434-019-07788-9</doi><tpages>9</tpages></addata></record> |
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| subjects | Biopsy Cancer Cancer therapies Chemoradiotherapy Chemotherapy Esophageal cancer Esophagus Life Sciences & Biomedicine Lymph nodes Medicine Medicine & Public Health Mortality Oncology Science & Technology Surgery Surgical Oncology Survival Thoracic Oncology |
| title | Utility of Radiation After Neoadjuvant Chemotherapy for Surgically Resectable Esophageal Cancer |
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