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Locoregional failure rate after preoperative chemoradiation of esophageal adenocarcinoma and the outcomes of salvage strategies.
- Source :
-
Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2013 Dec 01; Vol. 31 (34), pp. 4306-10. Date of Electronic Publication: 2013 Oct 21. - Publication Year :
- 2013
-
Abstract
- Purpose: The primary purpose of surveillance of patients with esophageal adenocarcinoma (EAC) and/or esophagogastric junction adenocarcinoma after local therapy (eg, chemoradiotherapy followed by surgery or trimodality therapy [TMT]) is to implement a potentially beneficial salvage therapy to overcome possible morbidity/mortality caused by locoregional failure (LRF). However, the benefits of surveillance are not well understood. We report on LRFs and salvage strategies in a large cohort.<br />Patients and Methods: Between 2000 and 2010, 518 patients with EAC who completed TMT were analyzed for the frequency of LRF over time and salvage therapy outcomes. Standard statistical techniques were used.<br />Results: For 518 patients, the median follow-up time was 29.3 months (range, 1 to 149 months). Distant metastases (with or without LRF) occurred in 188 patients (36%), and LRF only occurred in 27 patients (5%). Eleven of 27 patients had lumen-only LRF. Most LRFs (89%) occurred within 36 months of surgery. Twelve patients had salvage chemoradiotherapy, but only five survived more than 2 years. Four patients needed salvage surgery, and three who survived more than 2 years developed distant metastases. The median overall survival of 27 patients with LRF was 17 months, and 10 patients (37%) survived more than 2 years. Thus, only 2% of all 518 patients benefited from surveillance/salvage strategies.<br />Conclusion: Our surveillance strategy, which is representative of many others currently being used, raises doubts about its effectiveness and benefits (along with concerns regarding types and times of studies and costs implications) to patients with EAC who have LRF only after TMT. Fortunately, LRFs are rare after TMT, but the salvage strategies are not highly beneficial. Our data can help develop an evidence-based surveillance strategy.
- Subjects :
- Adenocarcinoma mortality
Adenocarcinoma secondary
Adult
Aged
Disease-Free Survival
Esophageal Neoplasms mortality
Esophageal Neoplasms pathology
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local mortality
Proportional Hazards Models
Reoperation
Retrospective Studies
Risk Factors
Time Factors
Treatment Failure
Young Adult
Adenocarcinoma therapy
Chemoradiotherapy, Adjuvant
Esophageal Neoplasms therapy
Esophagectomy
Neoadjuvant Therapy
Neoplasm Recurrence, Local therapy
Salvage Therapy adverse effects
Salvage Therapy mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1527-7755
- Volume :
- 31
- Issue :
- 34
- Database :
- MEDLINE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 24145339
- Full Text :
- https://doi.org/10.1200/JCO.2013.51.7250