Change in chemotherapy during concurrent radiation followed by surgery after a suboptimal positron emission tomography response to induction chemotherapy improves outcomes for locally advanced esophageal adenocarcinoma Journal Article


Authors: Ku, G. Y.; Kriplani, A.; Janjigian, Y. Y.; Kelsen, D. P.; Rusch, V. W.; Bains, M.; Chou, J.; Capanu, M.; Wu, A. J.; Goodman, K. A.; Ilson, D. H.
Article Title: Change in chemotherapy during concurrent radiation followed by surgery after a suboptimal positron emission tomography response to induction chemotherapy improves outcomes for locally advanced esophageal adenocarcinoma
Abstract: BACKGROUND: A positron emission tomography (PET) scan after induction chemotherapy before preoperative chemoradiation and surgery for esophageal adenocarcinoma predicts outcomes. Some patients with progression on PET after induction chemotherapy had long-term overall survival (OS) when they were changed to alternative chemotherapy during radiation. METHODS: This study retrospectively reviewed esophageal adenocarcinoma patients who received induction chemotherapy and chemoradiation before planned surgery; all had undergone a PET scan before and after induction chemotherapy. RESULTS: There were 201 patients, and 113 (56%) were PET responders (≥35% decrease in the maximum standardized uptake value of the tumor). All PET responders received the same chemotherapy during radiation, whereas 38 of the 88 PET nonresponders (43%) changed chemotherapy. Among the 152 patients who underwent surgery, the pathologic complete response rate was 15% for PET responders and 3% for PET nonresponders who did not change chemotherapy (P =.046). The median progression-free survival (PFS; 18.9 vs 10.0 months, P < 0.01) and OS (37 vs 25.3 months, P =.02) were significantly better for PET responders versus PET nonresponders who did not change chemotherapy. The median PFS for PET nonresponders who changed chemotherapy was 17.9 months, and it was superior to the median PFS for PET nonresponders who did not change chemotherapy (P =.01). For PET nonresponders, the 5-year OS rates were 37% for those who changed chemotherapy and 25% for those who did not change chemotherapy (P =.18). CONCLUSIONS: A PET scan after induction chemotherapy predicts outcomes for locally advanced esophageal adenocarcinoma patients who undergo chemoradiation and surgery. The median PFS is improved, and trends toward improved OS appear possible in PET nonresponders who change chemotherapy during radiation. The fully accrued Cancer and Leukemia Group B 80803 study (NCT01333033) is evaluating this strategy. Cancer 2016;122:2083–90. © 2016 American Cancer Society. © 2016 American Cancer Society
Keywords: chemotherapy; esophageal adenocarcinoma; chemoradiation; induction; positron emission tomography (pet) scan
Journal Title: Cancer
Volume: 122
Issue: 13
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2016-07-01
Start Page: 2083
End Page: 2090
Language: English
DOI: 10.1002/cncr.30028
PUBMED: 27152857
PROVIDER: scopus
PMCID: PMC4911302
DOI/URL:
Notes: Article -- Export Date: 1 July 2016 -- Source: Scopus
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MSK Authors
  1. Joanne Fu-Lou Chou
    153 Chou
  2. Valerie W Rusch
    651 Rusch
  3. Geoffrey Yuyat Ku
    86 Ku
  4. Marinela Capanu
    206 Capanu
  5. Yelena Yuriy Janjigian
    145 Janjigian
  6. Abraham Jing-Ching Wu
    199 Wu
  7. David H Ilson
    269 Ilson
  8. Manjit S Bains
    227 Bains
  9. David P Kelsen
    332 Kelsen