TY - JOUR
T1 - Actionable Locoregional Relapses after Therapy of Localized Esophageal Cancer
T2 - Insights from a Large Cohort
AU - Elimova, Elena
AU - Wang, Xuemei
AU - Qiao, Wei
AU - Sudo, Kazuki
AU - Wadhwa, Roopma
AU - Shiozaki, Hironori
AU - Shimodaira, Yusuke
AU - Planjery, Venkatram
AU - Charalampakis, Nikolaos
AU - Lee, Jeffrey H.
AU - Weston, Brian R.
AU - Bhutani, Manoop S.
AU - Komaki, Ritsuko
AU - Rice, David C.
AU - Swisher, Stephen G.
AU - Blum, Mariela A.
AU - Rogers, Jane E.
AU - Skinner, Heath D.
AU - Maru, Dipen M.
AU - Hofstetter, Wayne L.
AU - Ajani, Jaffer A.
N1 - Publisher Copyright:
© 2018 S. Karger AG, Basel.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Objective: The goal of surveillance after therapy of localized esophageal cancer (LEC) is to identify actionable relapses amenable to salvage; however, the current surveillance algorithms are not optimized. We report on a large cohort of LEC patients with actionable locoregional relapses (LRRs). Methods: Between 2000 and 2013, 127 (denominator = 752) patients with actionable LRR were identified. Histologic/cytologic confirmation was the gold standard. All surveillance tools (imaging, endoscopy, fine needle aspiration) were assessed. Results: Most patients were men (89%), had adenocarcinoma (79%), and had no new symptoms (72%) when diagnosed with LRR. In trimodality patients, endoscopic confirmation of positron emission tomography-computed tomography-suspected LRR occurred in only 44%, and 56% required additional tools (e.g., fine needle aspiration). Alternatively, in bimodality patients, endoscopy confirmed LRRs in 81%. Trimodality patients had a higher risk of subsequent LRR/distant metastases after the first LRR than the bimodality patients (p = 0.03). In all patients, 78% of the subsequent relapses were distant. For patients who were salvaged, survival was significantly prolonged (50.6 vs. 25.1 months, p < 0.01). Conclusions: Patients live longer after successful salvage of the LRR than if salvage is not possible. After LRR, patients have a high risk of subsequent distant metastasis and whether the second relapse is local or distant, survival is uniformly poor.
AB - Objective: The goal of surveillance after therapy of localized esophageal cancer (LEC) is to identify actionable relapses amenable to salvage; however, the current surveillance algorithms are not optimized. We report on a large cohort of LEC patients with actionable locoregional relapses (LRRs). Methods: Between 2000 and 2013, 127 (denominator = 752) patients with actionable LRR were identified. Histologic/cytologic confirmation was the gold standard. All surveillance tools (imaging, endoscopy, fine needle aspiration) were assessed. Results: Most patients were men (89%), had adenocarcinoma (79%), and had no new symptoms (72%) when diagnosed with LRR. In trimodality patients, endoscopic confirmation of positron emission tomography-computed tomography-suspected LRR occurred in only 44%, and 56% required additional tools (e.g., fine needle aspiration). Alternatively, in bimodality patients, endoscopy confirmed LRRs in 81%. Trimodality patients had a higher risk of subsequent LRR/distant metastases after the first LRR than the bimodality patients (p = 0.03). In all patients, 78% of the subsequent relapses were distant. For patients who were salvaged, survival was significantly prolonged (50.6 vs. 25.1 months, p < 0.01). Conclusions: Patients live longer after successful salvage of the LRR than if salvage is not possible. After LRR, patients have a high risk of subsequent distant metastasis and whether the second relapse is local or distant, survival is uniformly poor.
KW - Actionable locoregional relapse
KW - Esophageal cancer
KW - Localized esophageal cancer
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U2 - 10.1159/000486720
DO - 10.1159/000486720
M3 - Article
C2 - 29705797
AN - SCOPUS:85046456011
SN - 0030-2414
VL - 94
SP - 345
EP - 353
JO - Oncology (Switzerland)
JF - Oncology (Switzerland)
IS - 6
ER -