Chadin Tharavej, Patpong Navicharern, Supaut Pungpapong, Krit Kittisin, Suthep Udomsaweangsup. Chulalongkorn University
Background: Upfront chemoradiation (CRT) currently is a standard treatment for locally advanced esophageal cancer. Whether surgery is needed in patients with endoscopic complete response is debatable. We hypothesized that significant number of clinical endoscopic complete response have microscopic residual disease. The aim of this study was to invesitigate clinicopathological outcome of esophagectomy in patients with endoscopic complete response after CRT in locally advanced squamous cell esophageal cancer.
Methods: Patients with locally advanced resectable squamous cell esophageal cancer (T3-T4/N0-1/M0) were included. Patients with significant comorbidity or unfit for surgery were excluded. All patients had planned tranthoracic esophagectomy with 2-field lymphadenectomy 4 months after concurrent 50 Gy of radiotherapy with 2 cycles of 5FU and cis-platin. Endoscopic complete response (enCR) was defined when no mucosal abnormality/negative biopsies were identified. Clinicopathological outcome was examined.
Results: Of 67 patients treated with upfront chemoradiation, 51 had endoscopic complete response and underwent esophagectomy with 2-field lymphadenectomy. Operative mortality was 2%. R-0 resection was 89%. Incidence of pathological complete response (pCR) was 43% and 57% had histologic residual tumor. Five-year survival was 30.5% (50% for pCR and 20% for non-pCR, p=0.04 ). Locoregional recurrence was identified in 24% of enCR with esophageal resection. On histologic examination of 29 esophagectomized specimen with residual viable cancer cell, only 10 (34%) out of 29 specimens had tumor cell presented in mucosal layer.
Conclusion: More than 50% of advanced squamous cell esophageal cancer with clinical endoscopic response after CRT had microscopic residual disease which was R-0 amenable. Viable cancer cell presented in mucosal layer only about a third. Surveillance strategy with intensive endoscopic biopsy would not be able to detect micro residual disease in significant number of esophageal cancer patients with endoscopic complete response following chemoradiation. Planned esophagectomy in endoscopic complete response after CRT was safe and acceptable long term survival. Until an accurate marker for residual disease detection is established, planned esophagectomy, should be an optional treatment in fit patients after CRT for locally advanced squamous cell esophageal cancer.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77670
Program Number: S026
Presentation Session: Foregut 1
Presentation Type: Podium
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