(P053) Esophageal Cancer Pathologic Complete Response Rate After Neoadjuvant Chemoradiation: Is There a Difference Between Academic Centers vs Community Centers

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Pathologic outcomes after neoadjuvant chemoradiation for esophageal cancer were similar between patients treated at an academic center and community setting, although patients treated in the community tended to be older than patients treated at our academic center. These results will need to be validated with a larger dataset. The pCR rate after neoadjuvant chemoradiation at our institution was 21%, consistent with published data.

Wendy Gao, MD, Gurleen Dhami, MD, Brant K. Oelschlager, MD, Veena Shankaran, MD, Shilpen Patel, MD, Smith Apisarnthanarax, MD, Jing Zeng, MD; University of Washington

INTRODUCTION: Trimodality treatment, consisting of preoperative chemoradiation followed by surgical resection, has been established as the standard of care for locally advanced esophageal cancer. Rates of pathologic complete response (pCR) range from 29% to 40% in phase III trials. We reviewed our institution’s pCR rate and assessed whether there is a difference for patients treated at our academic institution vs in the community.

METHODS: Consecutive patients with esophageal cancer who underwent esophagectomies at our institutionafter chemoradiation from January 2012 to October 2014 were included in this retrospective analysis. Patient characteristics, staging, histology, and pathologic response data were collected. Chi-square and t-tests were used to compare patient groups. 

RESULTS: A total of 51 patients were found to have undergone resection after chemoradiation for esophageal cancer between January 2012 to October 2014; 28 patients (55%) were treated at our academic center, and 23 (45%) were treated in the community. Patients treated in the community were older (median age: 65 vs 61 yr; P = .047). Staging distribution was similar for the two patient groups: community stage: II = 34%, IIIA = 43%, and IIIB = 23%; academic center stage: II = 39%, IIIA = 53%, and IIIB = 7%. Most patients had adenocarcinoma (88.2%) vs 9.8% squamous cell and 2% adenosquamous. Location of the tumors was distal esophagus in 47 patients (92.1%) and midesophagus in 4 (7.9%). Median radiation dose was 50.4 Gy (range: 37.8–50.4 Gy) for all patients. All patients treated at our center received carboplatin and paclitaxel (carbo/taxol) vs 10% of patients in the community receiving regimens other than carbo/taxol (one docetaxel, cisplatin, and 5-fluorouracil [5-FU] [DCF]; one 5-FU/oxaliplatin; and one alternating carbo/taxol with 5-FU/oxaliplatin).

Pathologic complete tumor response occurred in 21.5% of patients. By histology, the pCR rate was 50% for squamous cell (2/4 patients), and 19% for adenocarcinoma (9/47 patients). For the primary tumor, there was downstaging in 41.2% of tumors, no change in 35.3%, and upstaging in 2%. Pathologic complete nodal response occurred in 41.2%, downstaging occurred in 3.9%, there was no change in 35.3%, and upstaging occurred in 19.6% of patients. There was no statistically significant difference in pCR rate between patients who received neoadjuvant chemoradiation at University of Washington Medical Center (21%) vs at an outside institution (17%) (P = 1.0).

CONCLUSIONS: Pathologic outcomes after neoadjuvant chemoradiation for esophageal cancer were similar between patients treated at an academic center and community setting, although patients treated in the community tended to be older than patients treated at our academic center. These results will need to be validated with a larger dataset. The pCR rate after neoadjuvant chemoradiation at our institution was 21%, consistent with published data.

Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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