title: Distribution of Resistant Esophageal Adenocarcinoma in the Resected Specimens of Clinical Stage III Patients after Chemoradiation: Its Clinical Implications.
abstract: BACKGROUND
  We have limited knowledge of the geographic distribution of resistant esophageal adenocarcinoma (EAC) in resected specimens, but its clinical importance can be enormous.
  
  
  METHODS
  We selected patients with baseline stage III EAC who had had chemoradiation followed by surgery and had residual EAC (resistant cases only). Outcomes were correlated with various endpoints (percentage of resistant EAC and anatomic distribution).
  
  
  RESULTS
  A total of 100 clinical stage III patients were studied; 90% had an R0 resection, and 99% had either moderate or poorly differentiated EAC. Twelve percent had >50% residual cancer, 31% had 11-50% residual cancer, 53% had 1-10% residual cancer, and 3% had positive nodes only. Each compartment was frequently involved: mucosa/submucosa (66%), muscularis propria (76%), and serosa (62%); all compartments were involved in 35% of the cases. Lack of EAC (meaning response) was observed in the mucosa/submucosa (34%), muscularis propria (24%), serosa (38%), and nodes (42%). Although the endoscopic biopsies prior to surgery showed no EAC in 79% of the patients, in the surgical specimens, resistant EAC was frequently occurring in the mucosa/submucosa (66%).
  
  
  CONCLUSIONS
  Contrary to our hypothesis that resistant EAC would be frequent in the nodes, our data show that its distribution is heterogeneous and unpredictable. Most importantly, the postchemoradiation biopsies are misleading, and a decision to delay/avoid surgery based on negative biopsies can be detrimental for the patients.
authors.affiliation: Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex., USA.
authors.forename: Nastaran
authors.initials: N
authors.lastname: Neishaboori
authors.forename: Roopma
authors.initials: R
authors.lastname: Wadhwa
authors.forename: Graciela M
authors.initials: GM
authors.lastname: Nogueras-González
authors.forename: Elena
authors.initials: E
authors.lastname: Elimova
authors.forename: Hironori
authors.initials: H
authors.lastname: Shiozaki
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sudo
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Charalampakis
authors.forename: Adarsh
authors.initials: A
authors.lastname: Hiremath
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: Brian
authors.initials: B
authors.lastname: Weston
authors.forename: Mariela A
authors.initials: MA
authors.lastname: Blum
authors.forename: Jane E
authors.initials: JE
authors.lastname: Rogers
authors.forename: Jeana L
authors.initials: JL
authors.lastname: Garris
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Heath D
authors.initials: HD
authors.lastname: Skinner
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D019008:Drug Resistance, Neoplasm; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology*; D018365:Neoplasm, Residual / Q000473:pathology*; D011836:Radiation Tolerance; D012189:Retrospective Studies; D012704:Serous Membrane / Q000473:pathology*; D016019:Survival Analysis; D016896:Treatment Outcome