Does Complete Pathologic Response Come to Those Who Wait?

Excerpt

Esophageal cancer remains a leading cause of cancer death worldwide, with multimodality therapy accepted as the standard of care.1 Neoadjuvant chemoradiotherapy prior to surgery has been shown to improve overall survival, with pathologic complete response (pCR) representing an independent predictor of overall survival.2^,3 While there are trials that suggest a neoadjuvant chemoradiation-to-surgery (CRT-S) interval of 6–8 weeks, there are no specific guidelines to support an optimum interval.4 Furthermore, the association of CRT-S with pCR has not been definitively established. To address this, Azab et al. retrospectively studied 5181 esophageal cancer patients [81% adenocarcinoma, 18% squamous cell carcinoma (SCC)], using the National Cancer Data Base, who had CRT prior to definitive surgical resection, and examined several endpoints: overall survival, 90-day mortality, and pCR. The CRT-S interval was evaluated as a continuous variable, as well as a quintile system (Q1, 15–37 days; Q2, 38–45 days; Q3, 46–53 days; Q4, 54–64 days; Q5, 65–90 days), showing a significant increase of pCR rate and 90-day mortality across quintiles (18%, 21%, 24%, 25%, and 29%, respectively, p < 0.001; 5.7%, 6.2%, 6.8%, 8.5%, and 8.2%, respectively, p = 0.002).5 …