New criteria for complete response (CR) after definitive chemoradiotherapy for recectable squamous cell carcinoma of esophagus

Abstract

14032 Background: According to a series of clinical trials, definitive chemoradiotherapy for esophageal cancer has become one of the accepted treatment methods even for respectable-stage disease. But preciously outlined CR criteria after definitive chemoradiotherapy has not been established. The purpose of this study is to assess the validity of new criteria for CR of esophageal cancer treated with definitive chemoradiotherapy. Methods: We reviewed 40 patients with T1b-T4, N0–1, M0 (clinical TNM stageI-III) resectable esophageal cancer treated with definitive chemoradiotherapy from April 2000. The patients received 5-Fluorouracil combined with cisplatin plus 50.4–60gy of radiation. We have here designated the CR criteria after definitive chemoradiotherapy 1)able to observe the entire esophagus by endoscopy with disappearance of the tumor lesion and ulceration 2)absence of cancer cells in pathological evaluation 3) no appearance of distant metastasis by CT scan during a series of treatment, in addition 4) no new recurrent lesions at least 6 months using the multimodality observation from determination of primary-CR. Results: Primary CR was achieved in 26 in 40 patients (65%) at the end of a series of treatment. Primary-CR rate in patients with stageI,II,III was 100% (3 out of 3), 85.7% (18 out of 21), 31.2% (5 out of 16) with a remarkable difference between TNM StageI,IIand III patients. There were 6 patients (33.3%) who were confirmed to have local recurrence in stageII esophageal cancer after determination of primary-CR. Likewise, one patient (20%) of recurrent disease in stageIII. Time at first relapse from the initial date of treatment to determine CR was 50–152 days in all recurrent patients. There were no patients with recurrence in the patients who could maintain CR for 6 months over after the determination of CR with a median follow-up of 13 months. Patients maintaining CR after the determination of CR have a significant good survival rate compared with recurrent patients after determination of CR (P<0.001) Conclusions: Our new criteria considered the time from determination of CR appear to be useful for clinical application, predict favorable survival for respectable esophageal cancer patients treated with definitive chemoradiotherapy. No significant financial relationships to disclose.