Complete Pathologic Response After Neoadjuvant Chemoradiation for Esophageal

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 Ø Esophageal Cancer (EC) often presents with locally advanced disease (LAD) Ø 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 Ø Correlation exists between response to NT and oncologic outcome Ø Complete pathologic response (p. CR) seems to be best prognostic indicator for improved cancer related survival Ø Adequate rates of p. CR important quality marker for esophageal treatment programs

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

Methods Ø Retrospective review of all patients with newly diagnosed EC referred for surgical consultation from 2006 through 2008 Ø Survival was evaluated with Kaplan-Meier method Ø 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 54% (15) 29% (8) 14% (4) 3% (1)

Pretreatment Stage - IR 54% (7) 23% (3) 7. 5% (1)

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

Pathologic Response Ø 27 of 28 NT patients completed regimen and underwent resection Ø 68% of NT patients were downstaged based on final pathologic analysis Ø 13/28 (46%) NT patients had a p. CR

Survival (%) Survival – NT vs IR Initial #s/Demos/Etc p = 0. 03 6 12 18 24 30 Time (Months) 36

Pathologic Response & Recurrence Pre Treatment staging breakdown p = 0. 68

Recurrence - NT vs IR Pre Treatment staging breakdown p = 0. 64

Conclusions v. Acceptable rates of p. CR can be obtained following NT in Stage II and III EC patients in an integrated community based practice v. Greater patient accrual and follow up will be required to better assess potential benefit in this patient group

Acknowledgements v Research Team at CCNW: Rachel Garman, Michelle Osso, Ben Peressini v. Co-Authors: Maryam Parviz MD, Hakan Kaya MD, Christopher Lee MD, Ryan Holbrook MD

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