title: Outcome of trimodality-eligible esophagogastric cancer patients who declined surgery after preoperative chemoradiation.
abstract: BACKGROUND
  For patients with localized esophageal cancer (EC) who can withstand surgery, the preferred therapy is chemoradiation followed by surgery (trimodality). However, after achieving a clinical complete response [clinCR; defined as both post-chemoradiation endoscopic biopsy showing no cancer and physiologic uptake by positron emission tomography (PET)], some patients decline surgery. The literature on the outcome of such patients is sparse.
  
  
  METHODS
  Between 2002 and 2011, we identified 622 trimodality-eligible EC patients in our prospectively maintained databases. All patients had to be trimodality eligible and must have completed preoperative staging after chemoradiation that included repeat endoscopic biopsy and PET among other routine tests.
  
  
  RESULTS
  Out of 622 trimodality-eligible patients identified, 61 patients (9.8%) declined surgery. All 61 patients had a clinCR. The median age was 69 years (range 47-85). Males (85.2%) and Caucasians (88.5%) were dominant. Baseline stage was II (44.2%) or III (52.5%), and histology was adenocarcinoma (65.6%) or squamous cell carcinoma (29.5%). Forty-two patients are alive at a median follow-up of 50.9 months (95% CI 39.5-62.3). The 5-year overall and relapse-free survival rates were 58.1 ± 8.4 and 35.3 ± 7.6%, respectively. Of 13 patients with local recurrence during surveillance, 12 had successful salvage resection.
  
  
  CONCLUSIONS
  Although the outcome of 61 EC patients with clinCR who declined surgery appears reasonable, in the absence of a validated prediction/prognosis model, surgery must be encouraged for all trimodality-eligible patients.
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Takashi
authors.initials: T
authors.lastname: Taketa
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Akihiro
authors.initials: A
authors.lastname: Suzuki
authors.forename: Mariela A
authors.initials: MA
authors.lastname: Blum
authors.forename: Pamela
authors.initials: P
authors.lastname: Chien
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.forename: James
authors.initials: J
authors.lastname: Welsh
authors.forename: Steven H
authors.initials: SH
authors.lastname: Lin
authors.forename: Dipen M
authors.initials: DM
authors.lastname: Maru
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Erasmus
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: Brian
authors.initials: B
authors.lastname: Weston
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000628:therapy; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D005743:Gastrectomy; D005773:Gastroscopy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D016312:Treatment Refusal