title: Clinical tools do not predict pathological complete response in patients with esophageal squamous cell cancer treated with definitive chemoradiotherapy.
abstract: Chemoradiotherapy for locally advanced esophageal squamous cell carcinoma is associated with high rates of pathological complete response. A pathological complete response is recognized to be an important predictor of improved survival, to the extent that observation rather than surgery is advocated by some in patients with presumed pathological complete response based on their clinical response. The goal of this study was to look at the ability of clinical variables to predict pathological complete response after chemoradiotherapy for locally advanced esophageal squamous cell carcinoma. We reviewed retrospectively patients with locally advanced esophageal squamous cell carcinoma who underwent chemoradiotherapy followed by surgery and compared those with pathological complete response to patients with residual disease. Between January 1996 and December 2010, 116 patients met inclusion criteria. Fifty-six percent of patients had a pathological complete response and a median survival of 128.1 months versus 28.4 months in patients with residual disease. When compared with patients with residual disease, patients with a pathological complete response had a lower post-neoadjuvant positron emission tomography (PET) maximum standardized uptake value (SUVmax), a larger decrease in PET SUVmax, a less thick tumor on post-chemoradiotherapy computed tomography and a higher rate of normal appearing post-chemoradiotherapy endoscopy with benign biopsy of the tumor bed. However, none of these characteristics alone was able to correctly identify patients with a pathological complete response, and none has significant specificity. Although the rate of pathological complete response after chemoradiotherapy is high in patients with esophageal squamous cell carcinoma, the ability of identifying patients with pathological complete response is limited. A reduction of the PET SUVmax by >70%, a normal appearing endoscopic examination, and no residual disease on biopsy all were seen in >65% of the patients with a pathological complete response. Even if these findings were unable to confirm the absence of residual disease in the primary tumor, they can help guide expectant management in high-risk patients.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, Maryland.
authors.forename: D
authors.initials: D
authors.lastname: Molena
authors.forename: H H
authors.initials: HH
authors.lastname: Sun
authors.forename: A S
authors.initials: AS
authors.lastname: Badr
authors.forename: B
authors.initials: B
authors.lastname: Mungo
authors.forename: I S
authors.initials: IS
authors.lastname: Sarkaria
authors.forename: P S
authors.initials: PS
authors.lastname: Adusumilli
authors.forename: M S
authors.initials: MS
authors.lastname: Bains
authors.forename: V W
authors.initials: VW
authors.lastname: Rusch
authors.forename: D H
authors.initials: DH
authors.lastname: Ilson
authors.forename: N P
authors.initials: NP
authors.lastname: Rizk
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D015331:Cohort Studies; D003661:Decision Support Techniques; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: chemoradiotherapy; clinical predictors; esophageal cancer; survival