title: Neoadjuvant chemoradiotherapy followed by surgery for esophageal adenocarcinoma: significance of microscopically positive circumferential radial margins.
abstract: OBJECTIVE
  The incidence and consequence of an isolated involved circumferential radial margin (CRM) after resection for esophageal adenocarcinoma in the setting of neoadjuvant chemoradiotherapy (CRT) has not been reported. We aimed to determine the frequency and significance of a close (<1 mm) or involved CRM in patients undergoing esophagectomy after CRT.
  
  
  METHODS
  We retrospectively analyzed the data from patients undergoing resection from 1997 to 2008 for esophageal adenocarcinoma after neoadjuvant CRT. A positive CRM was defined as microscopic tumor at or less than 1 mm of the radial margin. An R1 resection was tumor at the radial margin. Only patients with ypT3 or greater tumors were included. R2 resections were excluded. Statistical comparisons were performed using Cox regression and Kaplan-Meier analyses.
  
  
  RESULTS
  A total of 160 patients met the inclusion criteria, 42 (26%) had a positive CRM. The median survival did not significantly differ between the CRM-negative and -positive groups (28 vs 50 months, P = .84). A propensity score matching analysis also failed to find a significant difference in outcomes. When analyzed by tumor present at the margin (R1), R0 patients had a longer median survival compared with R1 patients (28 vs 8 months, P = .01). This difference, however, was not seen on propensity score matching.
  
  
  CONCLUSIONS
  Resections of locally advanced esophageal adenocarcinoma with residual transmural viable tumor after CRT frequently showed involvement of the radial margin with tumor either close to or at the margin. Tumor close (<1 mm) to the radial margin did not result in a significant decrease in overall or disease-free survival or increase in local recurrence.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Harvin
authors.forename: Guy
authors.initials: G
authors.lastname: Lahat
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Jared
authors.initials: J
authors.lastname: Lee
authors.forename: Dipen
authors.initials: D
authors.lastname: Maru
authors.forename: Jaffer
authors.initials: J
authors.lastname: Ajani
authors.forename: Edith M
authors.initials: EM
authors.lastname: Marom
authors.forename: James
authors.initials: J
authors.lastname: Welsh
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: Garret
authors.initials: G
authors.lastname: Walsh
authors.forename: Jack
authors.initials: J
authors.lastname: Roth
authors.forename: Reza
authors.initials: R
authors.lastname: Mehran
authors.forename: Ara
authors.initials: A
authors.lastname: Vaporciyan
authors.forename: David
authors.initials: D
authors.lastname: Rice
authors.forename: Stephen
authors.initials: S
authors.lastname: Swisher
authors.forename: Wayne
authors.initials: W
authors.lastname: Hofstetter
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome