Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012;83(5):300-4.
doi: 10.1159/000341353. Epub 2012 Sep 4.

Outcome of trimodality-eligible esophagogastric cancer patients who declined surgery after preoperative chemoradiation

Takashi Taketa  1 , Arlene M Correa, Akihiro Suzuki, Mariela A Blum, Pamela Chien, Jeffrey H Lee, James Welsh, Steven H Lin, Dipen M Maru, Jeremy J Erasmus, Manoop S Bhutani, Brian Weston, David C Rice, Ara A Vaporciyan, Wayne L Hofstetter, Stephen G Swisher, Jaffer A Ajani
Affiliations

Outcome of trimodality-eligible esophagogastric cancer patients who declined surgery after preoperative chemoradiation

Takashi Taketa et al. Oncology. 2012.

Abstract

Background: For patients with localized esophageal cancer (EC) who can withstand surgery, the preferred therapy is chemoradiation followed by surgery (trimodality). However, after achieving a clinical complete response [clinCR; defined as both post-chemoradiation endoscopic biopsy showing no cancer and physiologic uptake by positron emission tomography (PET)], some patients decline surgery. The literature on the outcome of such patients is sparse.

Method: Between 2002 and 2011, we identified 622 trimodality-eligible EC patients in our prospectively maintained databases. All patients had to be trimodality eligible and must have completed preoperative staging after chemoradiation that included repeat endoscopic biopsy and PET among other routine tests.

Results: Out of 622 trimodality-eligible patients identified, 61 patients (9.8%) declined surgery. All 61 patients had a clinCR. The median age was 69 years (range 47-85). Males (85.2%) and Caucasians (88.5%) were dominant. Baseline stage was II (44.2%) or III (52.5%), and histology was adenocarcinoma (65.6%) or squamous cell carcinoma (29.5%). Forty-two patients are alive at a median follow-up of 50.9 months (95% CI 39.5-62.3). The 5-year overall and relapse-free survival rates were 58.1 ± 8.4 and 35.3 ± 7.6%, respectively. Of 13 patients with local recurrence during surveillance, 12 had successful salvage resection.

Conclusion: Although the outcome of 61 EC patients with clinCR who declined surgery appears reasonable, in the absence of a validated prediction/prognosis model, surgery must be encouraged for all trimodality-eligible patients.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Kaplan-Meier overall survival plot for all 61 patients. OS denotes overall survival.
Fig. 2
Fig. 2
Kaplan-Meier relapse-free survival plot for all 61 patients. RFS denotes relapse-free survival.
See this image and copyright information in PMC

References

    1. Siegel R, Ward E, Brawley O, et al. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011;61:212–236. - PubMed
    1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90. - PubMed
    1. Stahl M, Stuschke M, Lehmann N, et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol. 2005;23:2310–2317. - PubMed
    1. Ajani JA, Barthel JS, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers. J Natl Compr Canc Netw. 2011;9:830–887. - PubMed
    1. Bedenne L, Michel P, Bouche O, et al. Chemo-radiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007;25:1160–1168. - PubMed

Publication types

MeSH terms