Original articleGeneral thoracicAdjuvant Therapy for Positive Nodes After Induction Therapy and Resection of Esophageal Cancer
Section snippets
Patients and Methods
All patients undergoing resection for primary esophageal cancer between January 2000 and July 2013 at Barnes-Jewish Hospital, St. Louis, MO, were identified from our expanded version of The Society of Thoracic Surgeons database and retrospectively analyzed in accordance with a protocol approved by the institutional review board at the Washington University School of Medicine (Fig 1). Inclusion criteria included esophagectomy for esophageal cancer, positive lymph nodes on pathologic examination,
Results
A total of 764 patients received an esophagectomy for primary esophageal cancer during the study period. Of these, 101 patients (13%) met inclusion criteria with one or more +LNs on pathologic examination after induction therapy and esophagectomy. The specific induction chemotherapeutic agent or strategy for 10 patients was not clear. Of the remaining 91, 97% of patients underwent a multidrug regimen, with cisplatin and 5-fluorouracil as the most common drug combination (n = 43 of 91 patients;
Comment
Although most accept the value of induction chemoradiotherapy before esophagectomy, and naïve patients are more commonly fit enough to tolerate adjuvant chemoradiotherapy, the utility of adjuvant therapy for patients with +LNs and who have already experienced the burdens of both induction therapy and esophagectomy remains poorly defined.
Previously reported data have shown that adjuvant therapy may improve survival in some select populations 11, 12, 13, although none of these studies included
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Survival After Induction Chemotherapy and Esophagectomy Is Not Improved by Adjuvant Chemotherapy
2019, Annals of Thoracic SurgeryAdjuvant Therapy for Node-Positive Esophageal Cancer After Induction and Surgery: A Multisite Study
2019, Annals of Thoracic SurgeryCitation Excerpt :Prior institutional studies have included small cohorts of patients and reached varied conclusions on the benefit of adjuvant treatment. In 101 patients, Brescia and colleagues7 found that adjuvant therapy was associated with an improved overall median survival of 24 vs 18 months (P = .03), with adjuvant therapy conferring a 42% reduction in mortality risk on Cox modeling (P = .05). In contrast, Stiles and colleagues8 found that adjuvant therapy was not a significant prognostic factor for overall survival (P = .9) in 96 patients, and instead, clinical and pathological tumor and nodal staging data was most important.
Validation of a Nomogram Predicting Survival After Trimodality Therapy for Esophageal Cancer
2018, Annals of Thoracic SurgeryCitation Excerpt :Given that 36% to 56% [5, 12] of the patients undergoing nCRT followed by surgery will experience disease progression after treatment with curative intent, there is currently interest in adjuvant therapies to increase systemic control in patients at high risk of disease progression [20–22]. The advantage of adjuvant chemotherapy—in terms of improvement in quality of life and OS—for this group of patients is still controversial, however [21, 22]. The current US National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) guidelines recommend observation of patients with a R0 resection after nCRT regardless of their clinicopathologic characteristics [3, 4].
From standardization to personalized medicine: Moving beyond cookie-cutter treatment of esophageal cancer
2018, Journal of Thoracic and Cardiovascular SurgeryAdjuvant chemotherapy for patients with pathologic node-positive esophageal cancer after induction chemotherapy is associated with improved survival
2018, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :In the Washington University experience of 101 node-positive patients who had undergone induction therapy (with >90% receiving induction chemoradiation therapy) followed by esophagectomy, a substantially higher proportion received adjuvant chemotherapy: approximately 44% versus 15% in our national series.5 Although our NCDB analysis did identify age as independently associated with adjuvant chemotherapy status (3% decrease in the likelihood of receiving adjuvant chemotherapy for every year increase), both analyses found no difference in adjuvant uptake based on the patient's comorbidity status.5 Furthermore, both our analysis and the analysis by Brescia and coauthors5 found a significant improvement in median overall survival (in their series 24.0 months for adjuvant patients vs 18.0 months in those without further therapy, P = .03), along with independent reductions in the overall mortality hazard.