title: Complete pathologic response after neoadjuvant chemoradiotherapy for esophageal cancer is associated with enhanced survival.
abstract: BACKGROUND
  Neoadjuvant chemoradiotherapy followed by esophagogastrectomy has become the standard of care for patients with locally advanced esophageal cancer. This report analyzes our experience with this treatment approach.
  
  
  METHODS
  From January 1998 through December 2003, all patients from a single institution receiving neoadjuvant chemoradiotherapy followed by esophagogastrectomy were reviewed for operative mortality, morbidity, long-term survival, and factors affecting survival. Only patients preoperatively staged with both computed tomographic scans and endoscopic ultrasound were included.
  
  
  RESULTS
  There were 162 patients (142 men, 20 women), and the median age was 61 years (range, 22 to 81 years). Histopathology was adenocarcinoma in 143 patients and squamous cell in 19. Pretreatment clinical stage was II in 28 patients (17%), III in 111 (68%), and IV (M1a) in 23 (14%). Ivor Lewis esophagogastrectomy was the most common procedure, occurring in 132 patients. Operative mortality and morbidity was 4.9% and 37%, respectively. Pathologic response was complete in 42 patients (26%), near complete in 27 (17%), partial in 88 (54%), and unresectable in 5 (3%). Five-year survival for overall, complete, near complete, and partial response patients was 34%, 55%, 27%, and 27%, respectively (p = 0.013). Patients whose lymph nodes were rendered free of cancer showed improved overall and disease-free survival compared with patients having persistently positive lymph nodes (p = 0.019).
  
  
  CONCLUSIONS
  Esophagogastrectomy after neoadjuvant chemoradiotherapy can be performed with low mortality and morbidity. Patients with complete pathologic response have significantly improved long-term survival compared with patients with near complete and partial responses. Future efforts should be directed at understanding determinants of complete responses.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Donahue
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Li
authors.forename: David A
authors.initials: DA
authors.lastname: Schomas
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
authors.forename: Aminah
authors.initials: A
authors.lastname: Jatoi
authors.forename: Robert C
authors.initials: RC
authors.lastname: Miller
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wigle
authors.forename: K Robert
authors.initials: KR
authors.lastname: Shen
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D055815:Young Adult