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Improved Prognosis with Pathologic Response in Esophageal Cancer

Explore the success rates of achieving complete pathologic response (pCR) following neoadjuvant chemoradiation for esophageal cancer. Understand the correlation between response to treatment and oncologic outcome, providing insights for better patient care.

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Improved Prognosis with Pathologic Response in Esophageal Cancer

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  1. Complete Pathologic Response After Neoadjuvant Chemoradiation for Esophageal Cancer in an Integrated Community-Based PracticeBE Wright, CM Lee, H Kaya, M Parviz RA HolbrookCancer Care NorthwestSpokane, Washington

  2. 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

  3. 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

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

  5. 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

  6. 43 Patients referred for Surgical Evaluation 28 Underwent NT 13 Underwent IR Total of 40 Resected Patients

  7. Pretreatment Stage - NT 54% (15) 29% (8) 14% (4) 3% (1)

  8. Pretreatment Stage - IR 54% (7) 23% (3) 7.5% (1) 7.5% (1) 7.5% (1)

  9. Neoadjuvant Regimen 14% (4) 57% (16) 29% (8) Concurrent Radiation Therapy 4500cGy, +/- 540 cGy boost

  10. 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

  11. Survival – NT vs IR Initial #s/Demos/Etc Survival (%) p = 0.03 6 12 18 24 30 36 Time (Months)

  12. Pathologic Response & Recurrence Pre Treatment staging breakdown p = 0.68

  13. Recurrence - NT vs IR Pre Treatment staging breakdown p = 0.64

  14. 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

  15. 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

  16. Thank You

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