Annals of Surgical Oncology

, Volume 19, Issue 5, pp 1678–1684

Pathologic Nonresponders after Neoadjuvant Chemoradiation for Esophageal Cancer Demonstrate no Survival Benefit Compared with Patients Treated with Primary Esophagectomy

  • George W. Dittrick
  • Jill M Weber
  • Ravi Shridhar
  • Sarah Hoffe
  • Marcovalerio Melis
  • Khaldoun Almhanna
  • James Barthel
  • James McLoughlin
  • Richard C. Karl
  • Kenneth L. Meredith
Thoracic Oncology

DOI: 10.1245/s10434-011-2078-4

Cite this article as:
Dittrick, G.W., Weber, J.M., Shridhar, R. et al. Ann Surg Oncol (2012) 19: 1678. doi:10.1245/s10434-011-2078-4

Abstract

Background

Neoadjuvant chemoradiation (NCRT) has become the preferred treatment for patients with locally advanced esophageal cancer. Survival often is correlated to degree of pathologic response; however, outcomes in patients who are found to be pathologic nonresponders (pNR) remain uninvestigated. This study was designed to evaluate survival in pNR to NCRT compared with patients treated with primary esophagectomy (PE).

Methods

Using our comprehensive esophageal cancer database, we identified patients treated with NCRT and deemed pNR along with patients who proceeded to PE. Clinical and pathologic data were compared using Fisher’s exact and χ2, whereas Kaplan–Meier estimates were used for survival analysis.

Results

We identified 63 patients treated with NCRT and were found to have a pNR, and 81 patients who underwent PE. Disease-free (DFS) and overall survival (OS) were significantly decreased in the pNR group compared with those treated with PE (10 vs. 50 months (0–152), P < 0.001 and 13 vs. 50 months (0–152), P < 0.001, respectively). For patients with stage II disease, DFS and OS were similarly decreased in pathologic nonresponders (13 vs. 62 months (0–120), P < 0.001 and 31 vs. 62 months (0–120), P = 0.024, respectively). There were no differences in DFS or OS for patients with stage III disease (10 vs. 14 months (0–152), P = 0.29 and 10 vs. 19 months (0–152), P = 0.16, respectively).

Conclusions

Pathologic nonresponders to NCRT for esophageal cancer receive no benefit in DFS or OS compared with patients treated with PE. For patients with stage II disease, DFS and OS are, in fact, significantly decreased in the pNR.

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • George W. Dittrick
    • 1
  • Jill M Weber
    • 1
  • Ravi Shridhar
    • 2
  • Sarah Hoffe
    • 2
  • Marcovalerio Melis
    • 3
  • Khaldoun Almhanna
    • 1
  • James Barthel
    • 2
  • James McLoughlin
    • 4
  • Richard C. Karl
    • 1
  • Kenneth L. Meredith
    • 1
    • 5
  1. 1.Department of Gastrointestinal OncologyMoffitt Cancer CenterTampaUSA
  2. 2.Department of Radiation OncologyMoffitt Cancer CenterTampaUSA
  3. 3.Department of SurgeryNew York Presbyterian Veterans AdministrationNew YorkUSA
  4. 4.Department of SurgeryMedical College of GeorgiaAugustaUSA
  5. 5.Section Head of Esophagogastric OncologyH. Lee Moffitt Cancer and Research InstituteTampaUSA