1. Persistent Dysphagia After Induction Chemotherapy in Patients with Esophageal Adenocarcinoma Predicts Poor Post-Operative Outcomes.
- Author
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McNamara MJ, Adelstein DJ, Allende DS, Bodmann JW, Ives DI, Murthy SC, Raymond D, Raja S, Rodriguez CP, Sohal D, Stephans KL, Videtic GMM, and Rybicki LA
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma pathology, Adult, Aged, Chemoradiotherapy, Adjuvant, Chemotherapy, Adjuvant, Cisplatin therapeutic use, Deglutition Disorders chemically induced, Disease-Free Survival, Epirubicin therapeutic use, Esophageal Neoplasms mortality, Esophageal Neoplasms pathology, Female, Fluorouracil therapeutic use, Humans, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Recurrence, Local therapy, Neoplasm Staging, Organoplatinum Compounds therapeutic use, Oxaliplatin, Postoperative Care methods, Preoperative Care methods, Preoperative Period, Prognosis, Treatment Outcome, Adenocarcinoma therapy, Antineoplastic Agents therapeutic use, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Deglutition Disorders epidemiology, Esophageal Neoplasms therapy, Induction Chemotherapy adverse effects, Neoplasm Recurrence, Local epidemiology
- Abstract
Purpose: Preoperative therapy is frequently employed in the management of esophageal adenocarcinoma. However, many patients are found to have advanced pathologic stage and have poor outcomes. A prognostic factor which identifies this patient population before surgery would be desirable, as alternative treatment strategies may be warranted., Methods: Between 2/08 and 1/12, 60 evaluable patients with locally advanced esophageal adenocarcinoma enrolled in single-arm phase II trial of induction chemotherapy, surgery, and post-operative adjuvant chemo-radiotherapy (CRT). A clinical stage of T3, N1, or M1a (AJCC 6th) was required for eligibility. Induction chemotherapy with epirubicin 50 mg/m
2 d1, oxaliplatin 130 mg/m2 d1, and fluorouracil 200 mg/m2 /day continuous infusion for 3 weeks, was given every 21 days for 3 cycles and was followed by surgical resection. Adjuvant CRT consisted of 50-55 Gy @ 1.8-2.0 Gy/day and 2 cycles of cisplatin (20 mg/m2 /day) and fluorouracil (1000 mg/m2 /day) given as 96-h infusions during weeks 1 and 4 of radiotherapy. Dysphagia was assessed at baseline and after induction chemotherapy., Results: Persistent dysphagia was associated with worse distant metastatic control [HR 3.48 (1.43-8.43), p = 0.006], recurrence free survival [HR 3.04 (1.34-6.92), p = 0.008], and overall survival [HR 3.31 (1.43-7.66), p = 0.005]. Persistent dysphagia was associated with more advanced pathologic T descriptor (pT) (p = 0.048) and N descriptor (pN) (p = 0.002), a greater median number of involved lymph nodes (3 v 1, p = 0.003), and greater residual tumor viability (p = 0.05). No patients with persistent dysphagia had pT0-T2 or pN0 disease., Conclusions: Persistent dysphagia after induction chemotherapy is associated with more advanced pathologic stage and inferior outcomes.- Published
- 2017
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