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Annals of Surgical Oncology

, Volume 21, Issue 1, pp 306–314 | Cite as

Factors Associated with Local–Regional Failure After Definitive Chemoradiation for Locally Advanced Esophageal Cancer

  • Arya Amini
  • Jaffer Ajani
  • Ritsuko Komaki
  • Pamela K. Allen
  • Bruce D. Minsky
  • Mariela Blum
  • Lianchun Xiao
  • Akihiro Suzuki
  • Wayne Hofstetter
  • Stephen Swisher
  • Daniel Gomez
  • Zhongxing Liao
  • Jeffrey H. Lee
  • Manoop S. Bhutani
  • James W. WelshEmail author
Radiation Oncology

Abstract

Background

Locally advanced esophageal cancer is often treated with a trimodality approach. While a substantial proportion of such patients initially achieve a clinical complete response (cCR) after chemoradiation, only a small proportion achieve durable control. We analyzed patients who reached cCR after definitive chemoradiation for esophageal cancer to identify clinical predictors of local disease recurrence.

Methods

We identified 141 patients who obtained initial cCR after definitive chemoradiation without surgery for esophageal cancer from 2002 through 2009. The initial response to treatment was assessed by endoscopic evaluation and biopsy results, with cCR defined as having no evidence of disease present. Patterns of failure were categorized as in-field (within the planned treatment volume [PTV]), outside the radiation treatment field, or both.

Results

At a median follow-up of 22 months (range, 6–87 months), 77 patients (55 %) had experienced disease recurrence (local or both). Of first failures, 32 (23 %) were outside the radiation field, followed by 30 (21 %) within the field, and 15 (11 %) were both. By multivariate analysis, in-field failure after cCR was associated with a pretreatment standardized uptake value on positron emission tomography of >10 (subhazard ratio [SHR] 3.31, p = 0.023) and poorly differentiated tumors (SHR 3.69, p = 0.031). All failures, in-field and out-of-field, correlated with non-Caucasian ethnicity (SHR 2.55, p = 0.001), N1 disease (SHR 2.05, p = 0.034), T3/T4 disease (SHR 3.56, p = 0.011), and older age (SHR 0.96, p = 0.008).

Conclusions

Our data suggest that selected clinical characteristics can be used to predict failure patterns after definitive chemoradiation. Such risk-assessment strategies can help individualize therapy.

Keywords

Esophageal Cancer Standardize Uptake Value Gross Tumor Volume Receive Induction Chemotherapy Intensity Modulate Proton Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

Research supported in part by donations from the Family of M. Adan Hamed, Dallas, Park, Sultan, and Smith families; the Carlos H. Cantu Family foundation; the Rivercreek and Schecter Private Foundations; the Kevin M. and Debra L. Frazier Foundation.

Disclosures

The authors declare no potential conflicts of interest.

Supplementary material

10434_2013_3303_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 27 kb)

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Arya Amini
    • 1
    • 2
  • Jaffer Ajani
    • 3
  • Ritsuko Komaki
    • 1
  • Pamela K. Allen
    • 1
  • Bruce D. Minsky
    • 1
  • Mariela Blum
    • 3
  • Lianchun Xiao
    • 4
  • Akihiro Suzuki
    • 3
  • Wayne Hofstetter
    • 5
  • Stephen Swisher
    • 5
  • Daniel Gomez
    • 1
  • Zhongxing Liao
    • 1
  • Jeffrey H. Lee
    • 6
  • Manoop S. Bhutani
    • 6
  • James W. Welsh
    • 1
    Email author
  1. 1.Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.UC Irvine School of MedicineIrvineUSA
  3. 3.Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  5. 5.Department of Thoracic and Cardiovascular SurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA
  6. 6.Department of Gastroenterology, Hepatology and NutritionThe University of Texas MD Anderson Cancer CenterHoustonUSA

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