Abstract
ABSTRACT Background Multimodal therapy with neoadjuvant chemoradiotherapy, followed by esophagectomy has offered better survival results, compared to isolated esophagectomy, in advanced esophageal cancer. In addition, patients who have a complete pathological response to neoadjuvant treatment presented greater overall survival and longer disease-free survival compared to those with incomplete response. Aim: To compare the results of overall survival and disease-free survival among patients with complete and incomplete response, submitted to neoadjuvant chemoradiotherapy, with two therapeutic regimens, followed by transhiatal esophagectomy. Methods: Retrospective study, approved by the Research Ethics Committee, analyzing the medical records of 56 patients with squamous cell carcinoma of the esophagus, divided into two groups, submitted to radiotherapy (5040 cGY) and chemotherapy (5-Fluorouracil + Cisplatin versus Paclitaxel + Carboplatin) neoadjuvants and subsequently to surgical treatment, in the period from 2005 to 2012, patients. Results The groups did not differ significantly in terms of gender, race, age, postoperative complications, disease-free survival and overall survival. The 5-year survival rate of patients with incomplete and complete response was 18.92% and 42.10%, respectively (p> 0.05). However, patients who received Paclitaxel + Carboplatin, had better complete pathological responses to neoadjuvant, compared to 5-Fluorouracil + Cisplatin (47.37% versus 21.62% - p = 0.0473, p <0.05). Conclusions There was no statistical difference in overall survival and disease-free survival for patients who had a complete pathological response to neoadjuvant. Patients submitted to the therapeutic regimen with Paclitaxel and Carboplastin, showed a significant difference with better complete pathological response and disease progression. New parameters are indicated to clarify the real value in survival, from the complete pathological response to neoadjuvant, in esophageal cancer.
Highlights
The medical records of patients submitted to transhiatal esophagectomy, by the same team of surgeons, from 2005 to 2012, were reviwed. This period included the beginning of trimodal treatment, for advanced squamous cell carcinoma of the esophagus
This study showed a pathological response (pCR) of 33.93%, which is in according with the literature . 20,24 But, differently from what would be expected, this response was not reflected in survival
The main recurrence places observed in this study were far from the treated organ, and in lower percentages than other studies . 10,14,27 This fact may mean a possible presence of metastatic and undetected disease at the time of surgery, compromising the real value of the complete pathological response, since in this finding there was no statistical difference between the groups analyzed
Summary
The low cure rate with the exclusive surgical treatment, stimulated the inclusion of multimodal treatments. Chemotherapy and associated radiotherapy have shown better survival results, while radiotherapy as the definitive modality has been reserved for patients who cannot receive chemotherapy . 16,22 Another advantage of neoadjuvant is the fact that cytoreduction and the consequent tumor reduction, the patient eats better, gains weight and acquires a more appropriate nutritional status for a possible surgical procedure, in addition to improving the quality of life due to the lower rate of dysphagia . There is a higher rate of R0 resections, in addition to the possibility of a complete response to neoadjuvant therapy, that is, a complete absence of tumor cells in the surgical specimen . There is a higher rate of R0 resections, in addition to the possibility of a complete response to neoadjuvant therapy, that is, a complete absence of tumor cells in the surgical specimen . 4,5,11,12,13,15,20,21,27
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