Nav: Home

For patients with esophageal cancer, status of lymph nodes after preoperative therapy determines survival

May 01, 2018

SAN DIEGO - May 1, 2018 - According to a new study, the status of lymph nodes rather than the status of the primary tumor following preoperative neoadjuvant chemotherapy or chemoradiation therapy is the most important factor that determines whether patients with locally advanced esophageal cancer will survive. The study presented at the American Association for Thoracic Surgery's 98th Annual Meeting indicates that while preoperative chemotherapy and radiation therapy improve the survival of patients with esophageal cancer, patients with malignant lymph nodes following therapy were less likely to survive than patients with no cancer in the lymph nodes.

Nearly half a million patients worldwide are diagnosed with esophageal cancer each year, and its incidence has doubled in the US in the last 20 years. The combination of chemotherapy with or without radiation therapy followed by surgery with negative margins offers the best chance for long-term survival for patients with locally advanced esophageal adenocarcinoma. Preoperative neoadjuvant therapy - chemotherapy and/or radiation therapy before surgery - is frequently administered. Importantly, the tumor's response to this initial treatment has the potential to help guide further therapy.

"There is a clear benefit associated with esophagectomy as part of a multimodal treatment strategy, along with chemotherapy with or without radiation therapy. for patients with locally advanced esophageal adenocarcinoma," explains Shawn S. Groth, MD, MS, FACS, Assistant Professor, Baylor College of Medicine, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Houston, who led the study and presented the findings at the AATS meeting. "However, there has been little clinical evidence to predict which patients might benefit."

Therefore, investigators set out to describe disease response rates (no, partial, or complete response) associated with the use of neoadjuvant chemotherapy or chemoradiation therapy to evaluate the association between the degree of pathologic response and overall survival, and to characterize the relative impact on survival by evaluating the response of the primary tumor versus the response of the lymph nodes to initial therapy.

Investigators reviewed records in the National Cancer Database of nearly 3,000 patients aged 18-80 who were diagnosed between 2006 and 2012 with clinically staged, locally advanced esophageal adenocarcinoma, and who had received neoadjuvant chemotherapy or chemoradiation therapy followed by an esophagectomy with negative margins.

Of the patients in the study, 17.3 percent had a complete response and 34.5 percent had a partial response to neoadjuvant therapy. Compared with neoadjuvant chemoradiation, neoadjuvant chemotherapy was associated with lower primary tumor (21.3 percent vs. 33.9 percent) and nodal response rates (32.7 percent vs. 55.9 percent) and was less likely to achieve a partial or complete response.

Significantly, the study found that as the completeness of response increased, survival rates improved. It also determined that patients who still had cancer in lymph nodes after preoperative chemotherapy and radiation therapy, independent of how well the tumor responded to treatment, had worse survival rates than patients who had no cancer in their lymph nodes.

Pathologic nodal, rather than primary tumor, response to neoadjuvant therapy is associated with improved survival. These data suggest a need to optimize neoadjuvant strategies associated with more complete nodal response rates and to consider more aggressive adjuvant treatment for patients with residual nodal disease after esophagectomy.

According to Dr. Groth, "Given the aggressive nature of esophageal cancer, our inability to predict which patients will respond to neoadjuvant therapy, and the morbidity associated with surgical resection which currently limits the number of patients who are able to receive adjuvant treatment, certain patients with locally advanced esophageal adenocarcinoma may also benefit from this 'total upfront" approach prior to esophagectomy."

These findings could be used to help physicians counsel patients about their prognosis and determine which patients may benefit from additional chemotherapy before or after surgery.

American Association for Thoracic Surgery

Related Cancer Articles:

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.
Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.
Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.
More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.
New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.
American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.
Oncotarget: Cancer pioneer employs physics to approach cancer in last research article
In the cover article of Tuesday's issue of Oncotarget, James Frost, MD, PhD, Kenneth Pienta, MD, and the late Donald Coffey, Ph.D., use a theory of physical and biophysical symmetry to derive a new conceptualization of cancer.
Health indicators for newborns of breast cancer survivors may vary by cancer type
In a study published in the International Journal of Cancer, researchers from the UNC Lineberger Comprehensive Cancer Center analyzed health indicators for children born to young breast cancer survivors in North Carolina.
Few women with history of breast cancer and ovarian cancer take a recommended genetic test
More than 80 percent of women living with a history of breast or ovarian cancer at high-risk of having a gene mutation have never taken the test that can detect it.
Radiotherapy for invasive breast cancer increases the risk of second primary lung cancer
East Asian female breast cancer patients receiving radiotherapy have a higher risk of developing second primary lung cancer.
More Cancer News and Cancer Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Accessing Better Health
Essential health care is a right, not a privilege ... or is it? This hour, TED speakers explore how we can give everyone access to a healthier way of life, despite who you are or where you live. Guests include physician Raj Panjabi, former NYC health commissioner Mary Bassett, researcher Michael Hendryx, and neuroscientist Rachel Wurzman.
Now Playing: Science for the People

#544 Prosperity Without Growth
The societies we live in are organised around growth, objects, and driving forward a constantly expanding economy as benchmarks of success and prosperity. But this growing consumption at all costs is at odds with our understanding of what our planet can support. How do we lower the environmental impact of economic activity? How do we redefine success and prosperity separate from GDP, which politicians and governments have focused on for decades? We speak with ecological economist Tim Jackson, Professor of Sustainable Development at the University of Surrey, Director of the Centre for the Understanding of Sustainable Propserity, and author of...
Now Playing: Radiolab

An Announcement from Radiolab