TY - JOUR
T1 - Prolonged Time to Surgery After Neoadjuvant Chemoradiotherapy Increases Histopathological Response Without Affecting Survival in Patients With Esophageal or Junctional Cancer
AU - Shapiro, Joel
AU - van Hagen, Pieter
AU - Lingsma, Hester F.
AU - Wijnhoven, Bas P. L.
AU - Biermann, Katharina
AU - ten Kate, Fiebo J. W.
AU - Steyerberg, Ewout W.
AU - van der Gaast, Ate
AU - van Lanschot, J. Jan B.
AU - AUTHOR GROUP
AU - Hulshof, Maarten C. C. M.
AU - van Berge Henegouwen, Mark I.
AU - van Laarhoven, Hanneke W. M.
AU - Nieuwenhuijzen, Grard A. P.
AU - Hospers, Geke A. P.
AU - Bonenkamp, Johannes J.
AU - Cuesta, Miguel A.
AU - Blaisse, Reinoud J. B.
AU - Busch, Olivier R. C.
AU - Creemers, Geert-Jan
AU - Punt, Cornelis J. A.
AU - Plukker, John T. M.
AU - Verheul, Henk M. W.
AU - Spillenaar Bilgen, Ernst J.
AU - van Dekken, Herman
AU - van der Sangen, Maurice J. C.
AU - Rozema, Tom
AU - Beukema, Jannet C.
AU - Piet, Anna H. M.
AU - van Rij, Caroline M.
AU - Reinders, Janny G.
AU - Tilanus, Hugo W.
PY - 2014
Y1 - 2014
N2 - Objective: To determine the relation between time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) and pathologically complete response (pCR), surgical outcome, and survival in patients with esophageal cancer. Background: Standard treatment for potentially curable esophageal cancer is nCRT plus surgery after 4 to 6 weeks. In rectal cancer patients, evidence suggests that prolonged TTS is associated with a higher pCR rate and possibly with better survival. Methods: We identified patients treated with nCRT plus surgery for esophageal cancer between 2001 and 2011. TTS (last day of radiotherapy to day of surgery) varied mainly for logistical reasons. Minimal follow-up was 24 months. The effect of TTS on pCR rate, postoperative complications, and survival was determined with (ordinal) logistic, linear, and Cox regression, respectively. Results: In total, 325 patients were included. Median TTS was 48 days (p25-p75=40-60). After 45 days, TTSwas associated with an increased probability of pCR [odds ratio (OR) = 1.35 per additional week of TSS, P = 0.0004] and a small increased risk of postoperative complications (OR = 1.20, P <0.001). Prolonged TTS had no effect on disease-free and overall survivals (HR = 1.00 and HR = 1.06 per additional week of TSS, P = 0.976 and P = 0.139, respectively). Conclusions: Prolonged TTS after nCRT increases the probability of pCR and is associated with a slightly increased probability of postoperative complications, without affecting disease-free and overall survivals. We conclude that TTS can be safely prolonged from the usual 4 to 6 weeks up to at least 12 weeks, which facilitates a more conservative wait-and-see strategy after neoadjuvant chemoradiotherapy to be tested
AB - Objective: To determine the relation between time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) and pathologically complete response (pCR), surgical outcome, and survival in patients with esophageal cancer. Background: Standard treatment for potentially curable esophageal cancer is nCRT plus surgery after 4 to 6 weeks. In rectal cancer patients, evidence suggests that prolonged TTS is associated with a higher pCR rate and possibly with better survival. Methods: We identified patients treated with nCRT plus surgery for esophageal cancer between 2001 and 2011. TTS (last day of radiotherapy to day of surgery) varied mainly for logistical reasons. Minimal follow-up was 24 months. The effect of TTS on pCR rate, postoperative complications, and survival was determined with (ordinal) logistic, linear, and Cox regression, respectively. Results: In total, 325 patients were included. Median TTS was 48 days (p25-p75=40-60). After 45 days, TTSwas associated with an increased probability of pCR [odds ratio (OR) = 1.35 per additional week of TSS, P = 0.0004] and a small increased risk of postoperative complications (OR = 1.20, P <0.001). Prolonged TTS had no effect on disease-free and overall survivals (HR = 1.00 and HR = 1.06 per additional week of TSS, P = 0.976 and P = 0.139, respectively). Conclusions: Prolonged TTS after nCRT increases the probability of pCR and is associated with a slightly increased probability of postoperative complications, without affecting disease-free and overall survivals. We conclude that TTS can be safely prolonged from the usual 4 to 6 weeks up to at least 12 weeks, which facilitates a more conservative wait-and-see strategy after neoadjuvant chemoradiotherapy to be tested
U2 - https://doi.org/10.1097/SLA.0000000000000966
DO - https://doi.org/10.1097/SLA.0000000000000966
M3 - Article
C2 - 25379852
SN - 0003-4932
VL - 260
SP - 807
EP - 814
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -