Outcome of trimodality-eligible esophagogastric cancer patients who declined surgery after preoperative chemoradiation.
Outcome of trimodality-eligible esophagogastric cancer patients who declined surgery after preoperative chemoradiation.
复制标题
符合三联治疗条件、术前放化疗后拒绝手术的食管胃癌患者的结果。
作者：
Taketa,Takashi;Correa,ArleneM;Suzuki,Akihiro;Blum,MarielaA;Chien,Pamela;Lee,JeffreyH;Welsh,James;Lin,StevenH;Maru,DipenM;Erasmus,JeremyJ;Bhutani,ManoopS;Weston,Brian;Rice,DavidC;Vaporciyan,AraA;Hofstetter,WayneL;Swi
BackgroundFor patients with localized esophageal cancer (EC) who can withstand surgery, the preferred therapy is chemoradiation followed by surgery (trimodality). However, after achieving a clinical complete response [clinCR; defined as both post-chemoradiation endoscopic biopsy showing no cancer and physiologic uptake by positron emission tomography (PET)], some patients decline surgery. The literature on the outcome of such patients is sparse.MethodBetween 2002 and 2011, we identified 622 trimodality-eligible EC patients in our prospectively maintained databases. All patients had to be trimodality eligible and must have completed preoperative staging after chemoradiation that included repeat endoscopic biopsy and PET among other routine tests.ResultsOut of 622 trimodality-eligible patients identified, 61 patients (9.8%) declined surgery. All 61 patients had a clinCR. The median age was 69 years (range 47–85). Males (85.2%) and Caucasians (88.5%) were dominant. Baseline stage was II (44.2%) or III (52.5%), and histology was adenocarcinoma (65.6%) or squamous cell carcinoma (29.5%). Forty-two patients are alive at a median follow-up of 50.9 months (95% CI 39.5–62.3). The 5-year overall and relapse-free survival rates were 58.1±8.4 and 35.3±7.6%, respectively. Of 13 patients with local recurrence during surveillance, 12 had successful salvage resection.ConclusionAlthough the outcome of 61 EC patients with clinCR who declined surgery appears reasonable, in the absence of a validated prediction/prognosis model, surgery must be encouraged for all trimodality-eligible patients.
