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Observational Study
. 2024 Nov;31(12):7759-7766.
doi: 10.1245/s10434-024-15890-w. Epub 2024 Jul 27.

Interval Metastases After Neoadjuvant Chemoradiotherapy for Patients with Locally Advanced Esophageal Cancer: A Multicenter Observational Cohort Study

Charlène J van der Zijden  1 , Pieter C van der Sluis  2 , Bianca Mostert  3 , Joost J M E Nuyttens  4 , J Jan B van Lanschot  2 , Manon C W Spaander  5 , Roelf Valkema  6 , Peter Paul L O Coene  7 , Jan Willem T Dekker  8 , Willem E Fiets  9 , Hendrik H Hartgrink  10 , Wouter L Hazen  11 , Ewout A Kouwenhoven  12 , Grard A P Nieuwenhuijzen  13 , Camiel Rosman  14 , Johanna W van Sandick  15 , Meindert N Sosef  16 , Edwin S van der Zaag  17 , Sjoerd M Lagarde  2 , Bas P L Wijnhoven  2
Affiliations
Observational Study

Interval Metastases After Neoadjuvant Chemoradiotherapy for Patients with Locally Advanced Esophageal Cancer: A Multicenter Observational Cohort Study

Charlène J van der Zijden et al. Ann Surg Oncol. 2024 Nov.

Abstract

Background: Despite trimodality treatment, 10% to 20% of patients with esophageal cancer experience interval metastases after surgery. Restaging may identify patients who should not proceed to surgery, as well as a subgroup with limited metastases for whom long-term disease-control can be obtained. This study aimed to determine the proportion of patients with interval metastases after neoadjuvant chemoradiotherapy (nCRT) and to evaluate treatment and survival.

Methods: Patients who had cT2-4aN0-3M0 esophageal cancer treated with nCRT were identified from a trial database. Metastases detected up to 14 weeks after nCRT on 18F-FDG-PET/CT or during surgery were categorized as oligometastases (≤3 lesions located in one single organ or one extra-regional lymph node station) or as non-oligometastases. The primary outcome was the proportion of patients with metastases after nCRT. The secondary outcomes were overall survival (OS) and the site and treatment of metastases.

Results: Between 2013 and 2021, 973 patients received nCRT, and 10.3% had interval metastases. Of 100 patients, 30 (30%) had oligometastases, located mostly in non-regional lymph nodes (33.3%) or bones (26.7%). The median OS of this group was 13.8 months (95% confidence interval [CI] 9.2-27.1 months). Of 30 patients, 12 (40%) with oligometastases underwent potentially curative treatment, with a median OS of 22.8 months (95% CI 10.4-NA). The patients with non-oligometastases underwent mostly systemic therapy or BSC and had a median OS of 9 months (95% CI 7.4-10.9 months).

Conclusions: Interval metastases were detected in about 10% of patients after nCRT, underscoring the importance of re-staging with 18F-FDG-PET/CT for those who proceed to surgery. A favorable survival might be accomplished for a subgroup of patients with oligometastases.

Keywords: Chemoradiotherapy; Esophageal cancer; Esophagogastric junction cancer; Interval metastases; Palliative therapy.

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Conflict of interest statement

Bianca Mostert received research funding from Sanofi, Pfizer, and BMS and served as consulting/advisory for Lilly, Servier, BMS, Amgen and AstraZeneca. Ewout Kouwenhoven served as consulting/advisory for Intuitive Surgical. Grard Nieuwenhuijzen, Medtronic, and BMS. Bas Wijnhoven received research funding from BMS and served as consulting/advisory for BMS. The remaining authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Location of oligometastases detected after neoadjuvant chemoradiotherapy (n = 30)
Fig. 2
Fig. 2
Overview of palliative and curative-intent therapy for non-oligometastatic and oligometastatic disease. 5-FU, 5-fluorouracil
Fig. 3
Fig. 3
Survival of patients with non-oligometastatic disease and oligometastatic disease treated with either palliative therapy or potentially curative therapy. nCRT, neoadjuvant chemoradiotherapy
See this image and copyright information in PMC

References

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