Chemoradiation benefits patients with N4+ esophageal cancers

PHOENIX, ARIZ. – For patients with locally advanced esophageal cancer involving four or more lymph nodes, neoadjuvant chemoradiation and surgery may offer overall survival rates comparable with those of surgery alone in patients with less advanced disease, reported Dr. Hiroshi Okumura.

In a prospective study of 50 consecutive patients the 3-year survival rate for patients who received neoadjuvant chemoradiation because of extensive lymph node involvement was 71%, compared with 72% for patients with three or fewer involved nodes who were treated with surgery alone, a difference that was not significant, he reported at the annual Society for Surgical Oncology Cancer Symposium.

"The prognosis is poor for patients with esophageal squamous-cell cancer with multiple lymph-node metastases. In particular, the prognosis in patients with four or more lymph-node metastases is significantly poorer than in those with three or fewer. Chemoradiation therapy [CRT] is one of the most useful treatments. However, it remains controversial whether neoadjuvant CRT provides a significant advantage," he said.

To examine this question, Dr. Okumura of Kagoshima University, Japan, and his colleagues followed 50 patients with locally advanced esophageal squamous-cell carcinomas stages T3 or T4. Of this group, 20 patients had four or more metastatic lymph nodes and underwent CRT with 5-fluourouracil and cisplatin plus 40 Gy of radiation, and 30 patients had three or fewer metastatic lymph nodes and underwent surgery alone.

Two patients in the CRT group were subsequently found to have metastases, one to bone and one to the liver. These patients did not undergo surgery and were excluded from the final analysis.

The investigators found that of the CRT-treated patients, 8 had a grade 1 response, defined as tumor present in more than one-third of the whole lesion; 2 had a grade 2 response (tumor present in than one-third of the lesion); and 8 had a grade 3 response (no visible tumor cells).

Eight patients became node-negative (ypN0) after CRT, resulting in a decrease in mean overall metastatic lymph nodes from seven before treatment to three afterward.

Relapses occurred in four patients in the CRT group, three of whom died from cancer and one from pneumonia. In the surgery group, eight patients had relapses, and all died from their cancers.

Three-year survival by histologic response in the CRT cohort was 50% for grade 1, 100% for grade 2, and 80% for grade 3 (P = .05).

Following the presentation, Dr. Mitchell C. Posner, chief of surgical oncology at the University of Chicago, asked whether, given their results, Dr. Okumura and his colleagues would consider offering chemoradiation to patients with three or fewer metastatic lymph nodes.

Dr. Okumura replied that the number of involved lymph nodes was the key factor in the decision to offer chemoradiation in his practice.

The study was internally supported. Dr. Okumura reported having no financial disclosures.

PHOENIX, ARIZ. – For patients with locally advanced esophageal cancer involving four or more lymph nodes, neoadjuvant chemoradiation and surgery may offer overall survival rates comparable with those of surgery alone in patients with less advanced disease, reported Dr. Hiroshi Okumura.

In a prospective study of 50 consecutive patients the 3-year survival rate for patients who received neoadjuvant chemoradiation because of extensive lymph node involvement was 71%, compared with 72% for patients with three or fewer involved nodes who were treated with surgery alone, a difference that was not significant, he reported at the annual Society for Surgical Oncology Cancer Symposium.

"The prognosis is poor for patients with esophageal squamous-cell cancer with multiple lymph-node metastases. In particular, the prognosis in patients with four or more lymph-node metastases is significantly poorer than in those with three or fewer. Chemoradiation therapy [CRT] is one of the most useful treatments. However, it remains controversial whether neoadjuvant CRT provides a significant advantage," he said.

To examine this question, Dr. Okumura of Kagoshima University, Japan, and his colleagues followed 50 patients with locally advanced esophageal squamous-cell carcinomas stages T3 or T4. Of this group, 20 patients had four or more metastatic lymph nodes and underwent CRT with 5-fluourouracil and cisplatin plus 40 Gy of radiation, and 30 patients had three or fewer metastatic lymph nodes and underwent surgery alone.

Two patients in the CRT group were subsequently found to have metastases, one to bone and one to the liver. These patients did not undergo surgery and were excluded from the final analysis.

The investigators found that of the CRT-treated patients, 8 had a grade 1 response, defined as tumor present in more than one-third of the whole lesion; 2 had a grade 2 response (tumor present in than one-third of the lesion); and 8 had a grade 3 response (no visible tumor cells).

Eight patients became node-negative (ypN0) after CRT, resulting in a decrease in mean overall metastatic lymph nodes from seven before treatment to three afterward.

Relapses occurred in four patients in the CRT group, three of whom died from cancer and one from pneumonia. In the surgery group, eight patients had relapses, and all died from their cancers.

Three-year survival by histologic response in the CRT cohort was 50% for grade 1, 100% for grade 2, and 80% for grade 3 (P = .05).

Following the presentation, Dr. Mitchell C. Posner, chief of surgical oncology at the University of Chicago, asked whether, given their results, Dr. Okumura and his colleagues would consider offering chemoradiation to patients with three or fewer metastatic lymph nodes.

Dr. Okumura replied that the number of involved lymph nodes was the key factor in the decision to offer chemoradiation in his practice.

The study was internally supported. Dr. Okumura reported having no financial disclosures.

PHOENIX, ARIZ. – For patients with locally advanced esophageal cancer involving four or more lymph nodes, neoadjuvant chemoradiation and surgery may offer overall survival rates comparable with those of surgery alone in patients with less advanced disease, reported Dr. Hiroshi Okumura.

In a prospective study of 50 consecutive patients the 3-year survival rate for patients who received neoadjuvant chemoradiation because of extensive lymph node involvement was 71%, compared with 72% for patients with three or fewer involved nodes who were treated with surgery alone, a difference that was not significant, he reported at the annual Society for Surgical Oncology Cancer Symposium.

"The prognosis is poor for patients with esophageal squamous-cell cancer with multiple lymph-node metastases. In particular, the prognosis in patients with four or more lymph-node metastases is significantly poorer than in those with three or fewer. Chemoradiation therapy [CRT] is one of the most useful treatments. However, it remains controversial whether neoadjuvant CRT provides a significant advantage," he said.

To examine this question, Dr. Okumura of Kagoshima University, Japan, and his colleagues followed 50 patients with locally advanced esophageal squamous-cell carcinomas stages T3 or T4. Of this group, 20 patients had four or more metastatic lymph nodes and underwent CRT with 5-fluourouracil and cisplatin plus 40 Gy of radiation, and 30 patients had three or fewer metastatic lymph nodes and underwent surgery alone.

Two patients in the CRT group were subsequently found to have metastases, one to bone and one to the liver. These patients did not undergo surgery and were excluded from the final analysis.

The investigators found that of the CRT-treated patients, 8 had a grade 1 response, defined as tumor present in more than one-third of the whole lesion; 2 had a grade 2 response (tumor present in than one-third of the lesion); and 8 had a grade 3 response (no visible tumor cells).

Eight patients became node-negative (ypN0) after CRT, resulting in a decrease in mean overall metastatic lymph nodes from seven before treatment to three afterward.

Relapses occurred in four patients in the CRT group, three of whom died from cancer and one from pneumonia. In the surgery group, eight patients had relapses, and all died from their cancers.

Three-year survival by histologic response in the CRT cohort was 50% for grade 1, 100% for grade 2, and 80% for grade 3 (P = .05).

Following the presentation, Dr. Mitchell C. Posner, chief of surgical oncology at the University of Chicago, asked whether, given their results, Dr. Okumura and his colleagues would consider offering chemoradiation to patients with three or fewer metastatic lymph nodes.

Dr. Okumura replied that the number of involved lymph nodes was the key factor in the decision to offer chemoradiation in his practice.

The study was internally supported. Dr. Okumura reported having no financial disclosures.