Interval Metastases After Neoadjuvant Chemoradiotherapy for Patients with Locally Advanced Esophageal Cancer: A Multicenter Observational Cohort Study.

Autor: van der Zijden CJ; Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands. c.vanderzijden@erasmusmc.nl., van der Sluis PC; Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands., Mostert B; Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Nuyttens JJME; Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., van Lanschot JJB; Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands., Spaander MCW; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Valkema R; Department of Nucleair Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands., Coene PPLO; Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands., Dekker JWT; Department of Surgery, Reinier de Graaf Group, Delft, The Netherlands., Fiets WE; Department of Medical Oncology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands., Hartgrink HH; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Hazen WL; Department of Gastroenterology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands., Kouwenhoven EA; Department of Surgery, Zorggroep Twente, Almelo, The Netherlands., Nieuwenhuijzen GAP; Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands., Rosman C; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., van Sandick JW; Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Sosef MN; Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands., van der Zaag ES; Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands., Lagarde SM; Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands., Wijnhoven BPL; Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Nov; Vol. 31 (12), pp. 7759-7766. Date of Electronic Publication: 2024 Jul 27.
DOI: 10.1245/s10434-024-15890-w
Abstrakt: Background: Despite trimodality treatment, 10% to 20% of patients with esophageal cancer experience interval metastases after surgery. Restaging may identify patients who should not proceed to surgery, as well as a subgroup with limited metastases for whom long-term disease-control can be obtained. This study aimed to determine the proportion of patients with interval metastases after neoadjuvant chemoradiotherapy (nCRT) and to evaluate treatment and survival.
Methods: Patients who had cT2-4aN0-3M0 esophageal cancer treated with nCRT were identified from a trial database. Metastases detected up to 14 weeks after nCRT on 18 F-FDG-PET/CT or during surgery were categorized as oligometastases (≤3 lesions located in one single organ or one extra-regional lymph node station) or as non-oligometastases. The primary outcome was the proportion of patients with metastases after nCRT. The secondary outcomes were overall survival (OS) and the site and treatment of metastases.
Results: Between 2013 and 2021, 973 patients received nCRT, and 10.3% had interval metastases. Of 100 patients, 30 (30%) had oligometastases, located mostly in non-regional lymph nodes (33.3%) or bones (26.7%). The median OS of this group was 13.8 months (95% confidence interval [CI] 9.2-27.1 months). Of 30 patients, 12 (40%) with oligometastases underwent potentially curative treatment, with a median OS of 22.8 months (95% CI 10.4-NA). The patients with non-oligometastases underwent mostly systemic therapy or BSC and had a median OS of 9 months (95% CI 7.4-10.9 months).
Conclusions: Interval metastases were detected in about 10% of patients after nCRT, underscoring the importance of re-staging with 18 F-FDG-PET/CT for those who proceed to surgery. A favorable survival might be accomplished for a subgroup of patients with oligometastases.
(© 2024. The Author(s).)
Databáze: MEDLINE
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