TRANSABDOMINAL UTILIZATION (TAU) OF THE EEA STAPLER IN LOW by R3YiEM

VIEWS: 0 PAGES: 16

									   Complete Pathologic Response After
Neoadjuvant Chemoradiation for Esophageal
 Cancer in an Integrated Community-Based
                  Practice

    BE Wright, CM Lee, H Kaya, M Parviz
                RA Holbrook

          Cancer Care Northwest
           Spokane, Washington
                  Background
 Esophageal Cancer (EC) often presents with locally
  advanced disease (LAD)

 Chemoradiation followed by resection has become the
  multimodality management option of choice

  • Poor results with resection alone

  • Patients often unable to tolerate adjuvant
    chemoradiation

  • Improved local control with probable survival
    benefit
                   Background

 Correlation exists between response to NT and oncologic
  outcome


 Complete pathologic response (pCR) seems to be best
  prognostic indicator for improved cancer related
  survival


 Adequate rates of pCR important quality marker for
  esophageal treatment programs
                Purpose

The purpose of our review was to determine
  success rates in achieving pCR following
        neoadjuvant chemoradiation
                      Methods

 Retrospective review of all patients with newly
  diagnosed EC referred for surgical consultation from
  2006 through 2008

 Survival was evaluated with Kaplan-Meier method


 Recurrence rates were compared with Fisher’s Exact
  test
 43 Patients referred for Surgical
            Evaluation


28 Underwent NT       13 Underwent IR




         Total of 40 Resected
               Patients
     Pretreatment Stage - NT


60   54% (15)

50

40
                29% (8)
30

20                        14% (4)

10                                  3% (1)

0
     T3N1       T3N0      T2N1      T1N1
      Pretreatment Stage - IR


60    54% (7)

50

40

30              23% (3)

20
                       7.5% (1)   7.5% (1)   7.5% (1)
10

0
     T1N0       T3N1      T3N0     T2N1      T2N0
     Neoadjuvant Regimen


    14% (4)

                                      Cisplatin/5-FU

29% (8)           57% (16)
                                      Carbo/Taxol


                                      Oxaliplatin/5-FU




Concurrent Radiation Therapy 4500cGy, +/- 540 cGy boost
             Pathologic Response

 27 of 28 NT patients completed regimen and underwent
  resection


 68% of NT patients were downstaged based on final
  pathologic analysis


 13/28 (46%) NT patients had a pCR
                                 Survival – NT vs IR
                                             Survival Plot (PL estimates)
                    Survivor
                      1.00


               NT

               IR

                                      Initial #s/Demos/Etc
Survival (%)




                      0.75




                      0.50




                      0.25
                                 p = 0.03


                      0.00
                             0        250         500            750             1000           1250

                                  6         12          18     24           30          36   Times




                                             Time (Months)
Pathologic Response & Recurrence

 Recurrence in the pCR Patients vs Recurrence in the Partial/Non-
                      Responding Patients

         Pre Treatment staging breakdown
                   36.00%


40.00%
35.00%
                23.00%
30.00%                                          pCR Patients (N=13)
25.00%
                                                Partial/Non-Responding Patients
20.00%
                                                (N=14)
15.00%
10.00%
 5.00%
                                                 p = 0.68
 0.00%
                     Recurrence - NT vs IR

         Recurrence in the Neo-Adjuvant Therapy Group vs Patients Who
          Should Have Had Neo-Adjuvant Therapy, But Went Straight to
                          Immediate Resection Instead

45.00%
                Pre Treatment staging breakdown
                                 40.00%
40.00%
                                                      Neo-Adjuvant Therapy Group
35.00%                                                (N=27)
                     29.00%
30.00%
25.00%
20.00%                                                Patients Who Should Have Had
15.00%                                                Neo-Adjuvant Therapy, But Went
10.00%                                                Straight to Immediate Resection
                                                      Instead (N=5)
 5.00%
 0.00%                                                        p = 0.64
                Conclusions

 Acceptable rates of pCR can be obtained
following NT in Stage II and III EC patients in
    an integrated community based practice

Greater patient accrual and follow up will be
required to better assess potential benefit in this
                  patient group
         Acknowledgements


 Research Team at CCNW: Rachel Garman,
        Michelle Osso, Ben Peressini

   Co-Authors: Maryam Parviz MD,
  Hakan Kaya MD, Christopher Lee MD,
          Ryan Holbrook MD
Thank You

								
To top