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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2013

01-12-2013 | Gastrointestinal Oncology

Interval Between Neoadjuvant Chemoradiotherapy and Surgery for Esophageal Squamous Cell Carcinoma: Does Delayed Surgery Impact Outcome?

Authors: Chien-Hong Chiu, MD, Yin-Kai Chao, MD, PhD, Hsien-Kun Chang, MD, Chen-Kan Tseng, MD, Sheng-Chieh Chan, MD, Yun-Hen Liu, MD, Wei-Hsun Chen, MD

Published in: Annals of Surgical Oncology | Issue 13/2013

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Abstract

Background

Although esophagectomy traditionally is recommended to perform within 8 weeks after neoadjuvant chemoradiotherapy (nCRT), data from neoadjuvantly treated rectal cancer patients demonstrate that delayed surgery (>8 weeks) can maximize the effect of CRT. Despite these promising data, investigators are concerned that delayed surgery may lead to tumor repopulation. We report the impact of delayed surgery in patients with esophageal cancer who were treated with nCRT.

Methods

We retrospectively studied 276 esophageal cancer patients treated with nCRT and surgery between 2002 and 2008. We compared perioperative complication, rate of pathological complete response (pCR), distribution of tumor regression grade (TRG), and overall survival (OS) in patients who underwent surgery within 8 weeks (group A) and after 8 weeks (group B) after nCRT.

Results

There were 138 patients in each group with similar pre/post-nCRT characteristics. Delayed surgery did not result in lower surgical risk or higher pCR rate. Survival outcome also did not improve following a longer surgery interval (5-year OS: group A vs. group B, 29 vs. 23 %; P = 0.3). On the contrary, a subgroup analysis showed that delayed surgery might be hazardous, especially in patients who demonstrate a good response after nCRT. The amount of residual cancer, as measured by TRG, increased significantly after a longer surgical interval (P = 0.024). Survival also decreased after a longer surgical interval (5-year OS ≤8 vs. >8 weeks, 50 vs. 35 %; P = 0.038).

Conclusions

After nCRT, esophagectomy should be performed within 8 weeks, especially in patients with good response.
Literature
1.
Biagi JJ, Raphael MJ, Mackillop WJ, et al. Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA. 2011;305:2335–42.PubMedCrossRef
2.
Mahmud SM, Fong B, Fahmy N, et al. Effect of preoperative delay on survival in patients with bladder cancer undergoing cystectomy in Quebec: a population-based study. J Urol. 2006;175:78–83; discussion 83.PubMedCrossRef
3.
Huang J, Barbera L, Brouwers M, et al. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol. 2003;21:555–63.PubMedCrossRef
4.
Grotenhuis BA, van Hagen P, Wijnhoven BP, et al. Delay in diagnostic workup and treatment of esophageal cancer. J Gastrointest Surg. 2010;14:476–83.PubMedCrossRef
5.
Lee CT, Madii R, Daignault S, et al. Cystectomy delay more than 3 months from initial bladder cancer diagnosis results in decreased disease specific and overall survival. J Urol. 2006;175:1262–7; discussion 1267.PubMedCrossRef
6.
Rothwell JF, Feehan E, Reid I, et al. Delay in treatment for oesophageal cancer. Br J Surg. 1997;84:690–3.PubMedCrossRef
7.
Rosenthal DI, Liu L, Lee JH, et al. Importance of the treatment package time in surgery and postoperative radiation therapy for squamous carcinoma of the head and neck. Head Neck. 2002;24:115–26.PubMedCrossRef
8.
Fortin A, Bairati I, Albert M, et al. Effect of treatment delay on outcome of patients with early-stage head-and-neck carcinoma receiving radical radiotherapy. Int J Radiat Oncol Biol Phys. 2002;52:929–36.PubMedCrossRef
9.
Sjoquist KM, Burmeister BH, Smithers BM, et al. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol. 2011;12:681–92.PubMedCrossRef
10.
Moore HG, Gittleman AE, Minsky BD, et al. Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection. Dis Colon Rectum. 2004;47:279–86.PubMedCrossRef
11.
Tulchinsky H, Shmueli E, Figer A, et al. An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol. 2008;15:2661–7.PubMedCrossRef
12.
Delanian S, Lefaix JL. Current management for late normal tissue injury: radiation-induced fibrosis and necrosis. Semin Radiat Oncol. 2007;17:99–107.PubMedCrossRef
13.
Kim JY, Correa AM, Vaporciyan AA, et al. Does the timing of esophagectomy after chemoradiation affect outcome? Ann Thorac Surg. 2012;93:207–2; discussion 212–3.PubMedCrossRef
14.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.PubMedCrossRef
15.
Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer. 1994;73:2680-6.PubMedCrossRef
16.
Bedenne L, Michel P, Bouche O, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007;25:1160–8.PubMedCrossRef
17.
Chao YK, Chan SC, Chang HK, et al. Salvage surgery after failed chemoradiotherapy in squamous cell carcinoma of the esophagus. Eur J Surg Oncol. 2009;35:289–94.PubMedCrossRef
18.
Smithers BM, Cullinan M, Thomas JM, et al. Outcomes from salvage esophagectomy post definitive chemoradiotherapy compared with resection following preoperative neoadjuvant chemoradiotherapy. Dis Esophagus. 2007;20:471–7.PubMedCrossRef
19.
Marks JL, Hofstetter W, Correa AM, et al. Salvage esophagectomy after failed definitive chemoradiation for esophageal adenocarcinoma. Ann Thorac Surg. 2012;94:1126–33.PubMedCrossRef
Metadata
Title
Interval Between Neoadjuvant Chemoradiotherapy and Surgery for Esophageal Squamous Cell Carcinoma: Does Delayed Surgery Impact Outcome?
Authors
Chien-Hong Chiu, MD
Yin-Kai Chao, MD, PhD
Hsien-Kun Chang, MD
Chen-Kan Tseng, MD
Sheng-Chieh Chan, MD
Yun-Hen Liu, MD
Wei-Hsun Chen, MD
Publication date
01-12-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 13/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3139-7

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