Patterns of Return

Esophageal cancer returns after a pathologically complete response from neoadjuvant chemoradiotherapy

(RxWiki News) Chemotherapy and radiation therapy can be used before surgery to shrink a tumor. This is known as neoadjuvant chemoradiotherapy. If the tumor responds, doctors call this a pathologically complete response (pCR).

Researchers have discovered that esophageal cancer patients who have a pCR prior to surgery tend to live longer.

However, a pathologically complete response does not mean the disease can’t still return and spread.

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Scientists from Erasmus Medical Centre Rotterdam in Rotterdam, The Netherlands followed 188 patients for up to a median of six years. The individuals had all received chemoradiation therapy before surgery to remove the esophagus (esophagectomy). 

They were looking for the patterns of recurrence among these patients. Cancer that returned was described and classified as either locoregional (nearby) or distant.

A third of the patients – 62 – achieved a pCR following the chemoradiotherapy. The cancer returned in 39 percent of these patients compared to nearly 56 percent of those who didn’t respond to the pre-surgery therapy.

Locoregional recurrence – with or without spread to other organs - was seen in 13 percent of the pCR group and 26.4 percent among those who did achieve a pCR. The pCR folks lived longer. They had a 5-year survival rate of 52 percent compared to just under 40 percent of the non-pCR group.

The authors concluded, “Although pCR is more favorable for survival, it is not synonymous with cure or complete locoregional disease control.”

This study was published November 23 in the British Journal of Surgery. No financial information was available. No conflicts of interest were disclosed.

Review Date: 
November 29, 2012