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Shaikh T , Zaki MA , Dominello MM , Handorf E , Konski AA , Cohen SJ , Shields A , Philip P , Meyer JE
Patterns and predictors of failure following tri-modality therapy for locally advanced esophageal cancer
Acta Oncol. 2016 Mar;55(3) :303-8
PMID: 26581671 PMCID: PMC6854665 URL: http://www.ncbi.nlm.nih.gov/pubmed/26581671
AbstractBACKGROUND: Although tri-modality therapy is an acceptable standard of care in patients with locally advanced esophageal cancer, data regarding patterns of failure is lacking. We report bi-institutional patterns of failure experience treating patients using tri-modality therapy. MATERIALS AND METHODS: We retrospectively reviewed patients who underwent chemoradiation followed by esophagectomy between 2006 and 2011 at two NCI-designated cancer centers. First failure sites were categorized as local, regional nodal, or distant. Statistical analysis was performed using Fisher's exact test, non-parametric Wilcoxon rank-sum test, and multiple logistic regression. Kaplan-Meier curves were generated for relapse-free survival (RFS) and overall survival. RESULTS: A total of 132 patients met the inclusion criteria with a median age of 62 (range 36-80) and median follow-up of 28 months (range 4-128). There were a total of six (4.5%) local, 13 (10%) regional nodal, and 32 (23.5%) distant failures. Local failure was correlated with fewer lymph nodes (LN) assessed (p = 0.01) and close/positive margins (p < 0.01). Regional nodal failure was correlated with fewer LN assessed (p < 0.01) and larger pretreatment tumor size (p = 0.04). Patients with </=13 LN evaluated had an inferior locoregional RFS versus patients with >13 LN evaluated (p = 0.003). Distant recurrence was correlated with higher pathologic nodal stage (p < 0.001), ulceration (p = 0.017), perineural invasion (p = 0.029), residual disease (p = 0.004), and higher post-treatment PET SUV max (p = 0.049). Patients with a pathologic complete response (OR 0.19, 95% CI 0.05-0.68) were less likely to experience distant recurrence. CONCLUSION: Tumor and treatment factors may predict for failure in patients undergoing tri-modality therapy for locally advanced esophageal cancer. Further data is needed to identify patterns of failure in these patients.
NotesShaikh, Talha Zaki, Mark A Dominello, Michael M Handorf, Elizabeth Konski, Andre A Cohen, Steven J Shields, Anthony Philip, Philip Meyer, Joshua E eng England 2015/11/20 06:00 Acta Oncol. 2016 Mar;55(3):303-8. doi: 10.3109/0284186X.2015.1110252. Epub 2015 Nov 19.