Locoregional Failure Rate After Preoperative Chemoradiation of Esophageal Adenocarcinoma and the Outcomes of Salvage Strategies

• Published in: Journal of clinical oncology Vol. 31; no. 34; pp. 4306 - 4310
• Main Authors: SUDO, Kazuki, TAKETA, Takashi, SKINNER, Heath D, MARU, Dipen M, RICE, David C, SWISHER, Stephen G, HOFSTETTER, Wayne L, AJANI, Jaffer A, CORREA, Arlene M, CAMPAGNA, Maria-Claudia, WADHWA, Roopma, BLUM, Mariela A, KOMAKI, Ritsuko, LEE, Jeffrey H, BHUTANI, Manoop S, WESTON, Brian
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 01.12.2013
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - secondary; Adenocarcinoma - therapy; Adult; Aged; Biological and medical sciences; Chemoradiotherapy, Adjuvant; Disease-Free Survival; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophagectomy; Esophagus; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Multivariate Analysis; Neoadjuvant Therapy; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - therapy; ORIGINAL REPORTS; Proportional Hazards Models; Reoperation; Retrospective Studies; Risk Factors; Salvage Therapy - adverse effects; Salvage Therapy - mortality; Time Factors; Treatment Failure; Tumors; Young Adult; Prognosis; Rate; Esophageal disease; Malignant tumor; Radiotherapy; Esophagus cancer; Chemotherapy; Treatment; Cancerology; Digestive diseases; Esophagus adenocarcinoma; Evolution; Strategy; Combined treatment; Preoperative; Salvage treatment; Failure; Cancer
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2013.51.7250

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. 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. 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. 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.