Impact of pathological response and recurrence pattern on the survival of patients who develop recurrence from neoadjuvant chemoradiotherapy for locally advanced esophageal squamous cell carcinoma (ESCC).

Abstract

49 Background: Neoadjuvant chemoradiotherapy (nCRT) followed by surgery is one of indicated strategies for locally advanced ESCC. Pathological complete response (pCR) is a well-known favorable prognostic factor. However, whether pCR to nCRT impacts on the post-progression survival (PPS) is not well described before. Methods: We reviewed medical records of four studies evaluating nCRT for locally advanced ESCC between 2000 and 2015 at National Taiwan University Hospital (NCT00154804, NCT01034189, NCT01034332). CRT comprised twice weekly paclitaxel and cisplatin-based regimens and 40Gy radiotherapy in 20 fractions; esophagectomy with lymph node dissection was performed 6 to 8 weeks after completing nCRT. We analyzed the recurrence patterns and PPS between pCR and non-pCR groups. Results: Among 158 patients (pts) receiving nCRT followed by surgery, 85 pts developed recurrence (recurrence rate [RR], 53.8%) with a median follow-up of 110.2 months (mo). Among pts with recurrence, 19 were from pCR group (RR, 33.3%), and 66 from non-pCR group (RR, 65.3%). The median time to recurrence (TTR) were 12.6 and 8.5 mo for pCR and non-pCR group. The patterns of recurrence were summarized in the table. The median PPS in pCR and non-pCR group were 7.9 and 5.3 mo. In pCR group, the median PPS was similar despite different patterns of recurrence. In contrast, the median PPS of non-pCR group was numerically longer in pts with isolated locoregional recurrence and shortest in those with any distant recurrence (10.0 and 4.8 mo). Pts with recurrence more than 12 mo after surgery exhibited longer PPS than those within 12 mo in both groups. Overall, the median PPS of pts of different recurrence pattern or TTR did not differ significantly between two groups. Conclusions: The recurrence patterns may be different in pCR and non-pCR groups. Patients with early recurrence faced a poor prognosis irrespective of pathologic response. Whether pCR status and recurrence impact on PPS in pts receiving nCRT warrants additional studies.[Table: see text]