title: Factors associated with local-regional failure after definitive chemoradiation for locally advanced esophageal cancer.
abstract: BACKGROUND
  Locally advanced esophageal cancer is often treated with a trimodality approach. While a substantial proportion of such patients initially achieve a clinical complete response (cCR) after chemoradiation, only a small proportion achieve durable control. We analyzed patients who reached cCR after definitive chemoradiation for esophageal cancer to identify clinical predictors of local disease recurrence.
  
  
  METHODS
  We identified 141 patients who obtained initial cCR after definitive chemoradiation without surgery for esophageal cancer from 2002 through 2009. The initial response to treatment was assessed by endoscopic evaluation and biopsy results, with cCR defined as having no evidence of disease present. Patterns of failure were categorized as in-field (within the planned treatment volume [PTV]), outside the radiation treatment field, or both.
  
  
  RESULTS
  At a median follow-up of 22 months (range, 6-87 months), 77 patients (55 %) had experienced disease recurrence (local or both). Of first failures, 32 (23 %) were outside the radiation field, followed by 30 (21 %) within the field, and 15 (11 %) were both. By multivariate analysis, in-field failure after cCR was associated with a pretreatment standardized uptake value on positron emission tomography of >10 (subhazard ratio [SHR] 3.31, p = 0.023) and poorly differentiated tumors (SHR 3.69, p = 0.031). All failures, in-field and out-of-field, correlated with non-Caucasian ethnicity (SHR 2.55, p = 0.001), N1 disease (SHR 2.05, p = 0.034), T3/T4 disease (SHR 3.56, p = 0.011), and older age (SHR 0.96, p = 0.008).
  
  
  CONCLUSIONS
  Our data suggest that selected clinical characteristics can be used to predict failure patterns after definitive chemoradiation. Such risk-assessment strategies can help individualize therapy.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Arya
authors.initials: A
authors.lastname: Amini
authors.forename: Jaffer
authors.initials: J
authors.lastname: Ajani
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Allen
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Minsky
authors.forename: Mariela
authors.initials: M
authors.lastname: Blum
authors.forename: Lianchun
authors.initials: L
authors.lastname: Xiao
authors.forename: Akihiro
authors.initials: A
authors.lastname: Suzuki
authors.forename: Wayne
authors.initials: W
authors.lastname: Hofstetter
authors.forename: Stephen
authors.initials: S
authors.lastname: Swisher
authors.forename: Daniel
authors.initials: D
authors.lastname: Gomez
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: James W
authors.initials: JW
authors.lastname: Welsh
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D018278:Carcinoma, Neuroendocrine / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017211:Treatment Failure