title: Failure patterns correlate with the proportion of residual carcinoma after preoperative chemoradiotherapy for carcinoma of the esophagus.
abstract: BACKGROUND
  The current study was conducted to test the hypothesis that patterns of failure are correlated with the degree of residual carcinoma after preoperative chemoradiotherapy (CRT) in patients with esophageal carcinoma.
  
  
  METHODS
  The authors analyzed the clinical characteristics of patients with carcinoma of the esophagus who underwent preoperative CRT. The residual carcinoma in the resected specimen was categorized into 3 groups (0%, 1-50%, and > 50%). The initial patterns of failure were analyzed according to these categories.
  
  
  RESULTS
  Of the 235 patients who underwent CRT, 69 (29%) achieved a pathologic complete response (pathCR; Group A), 109 patients (46%) achieved a response but it was less than a pathCR (1-50% residual carcinoma; Group B), and 57 (24%) had no response (> 50% residual carcinoma; Group C). The time to locoregional recurrence was significantly longer for Group A compared with Group C (P = 0.05). The rate of distant metastases was significantly lower in Groups A and B compared with Group C (14% in Group A, 29% in Group B, and 33% in Group C; P = 0.03). The distant metastases-free survival was found to be significantly longer in Groups A and B compared with Group C (Group A vs. Group B, P = 0.01; Group A vs. Group C, P < 0.0001; and Group B vs. Group C, P = 0.03). A significantly higher proportion of patients in the responding groups (Groups A and B) had no disease recurrence compared with Group C (81% in Group A, 67% in Group B, and 61% in Group C; P = 0.04). The overall survival and disease-free survival were found to be significantly longer in Groups A and B compared with Group C.
  
  
  CONCLUSIONS
  Data from the current study demonstrate that the proportion of residual carcinoma after preoperative CRT is significantly correlated with patterns of locoregional and distant failure. Future investigations should focus on reducing the proportion of residual carcinoma and metastatic disease progression in patients with esophageal carcinoma.
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Pooja R
authors.initials: PR
authors.lastname: Rohatgi
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Tsung T
authors.initials: TT
authors.lastname: Wu
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Garrett
authors.initials: G
authors.lastname: Walsh
authors.forename: Ara
authors.initials: A
authors.lastname: Vaporciyan
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Lynch
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D017211:Treatment Failure