Güler, S. (Sahin) (2012) Changing pattern of recurrences after neoadjuvant chemoradiation in esophageal cancer patients. thesis, Medicine.
Full text available on request.Abstract
Background: In the last decade chemo-radiotherapy (CRT) is firmly established in the curative treatment of esophageal carcinoma. It leads to a survival benefit of more than 10-13% in curatively treatable patients. This effect seems to be caused mainly by a downstaging or downsizing of the tumor with a reduction in local recurrences. In this retrospective cohort study, we investigated the impact of neoadjuvant CRT on the pattern of recurrences. We also compared the effect of the neoadjuvant CRT on the development of metastases between the group of responders and non responders. Methods: This study was based on patients with esophageal carcinoma who were treated with curative intent between January 2002 and December 2010. 44 patients who received a neoadjuvant CRT, the so-called CRT group, were matched a one to one basis with 108 patients who have been treated by surgery alone, leading to a final inclusion of 88 patients, who have been followed for at least one year. Only patients with histological proven adenocarcinoma or squamous cell carcinoma of the esophagus or gastroesophageal junction were included in the study. The clinical and pathological features, survival and recurrence pattern were recorded. In the analysis of recurrences we used the Chi-square and Student T-test. Results: In the CRT group the recurrence rate was 40.9% (n=18). This was significantly less than in the surgery alone group where 29 (72.5%) recurrences occurred (P=0.004). Furthermore, there were fewer local (P=0.005) and locoregional recurrences (P=0.035) after CRT. Significant more lung metastases and distant lymph node recurrences were seen in the CRT group (P=0.018 and P=0.041; respectively). In the surgery alone group distant recurrences occurred frequently in the liver (20.7%), bone (17.2%) and skin/soft tissue (17.2%). However the distant recurrences in the CRT group occurred frequently in the lungs (38.9%), distant lymph nodes (33.3%), liver (22.2%) and other organs (22.2%). In the CRT group we observed a relatively few skeletal metastases (5.6%), while cerebral recurrences were seen relatively often (11.1%). Both disease-free and overall survival were better in the CRT group compared to the surgery alone group (P=0.034 and P=0.014, respectively). The improved disease-free survival was due to improved local disease-free survival (P=0.008). Pathological complete response (pCR) on the CRT was 27.3% (n=12). The locoregional disease-free survival was better in the group of pCR compared to partial and non response groups (P=0.028). Conclusion: Neoadjuvant CRT leads to a reduction in local and locoregional recurrences and also alters the pattern of distant metastases. In the CRT group significantly more lung metastases and distant lymph node recurrences were diagnosed. The effect of neoadjuvant CRT is greater in the patients with a pCR compared to the patients with a partial or no response to the chemo-radiotherapy.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Begeleider: and Plukker, prof.dr.J.Th. chirurg-oncoloog. and Locatie: Afdeling Chirurgie, Universitair Medisch Centrum Gr |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:47 |
| Last Modified: | 25 Jun 2020 10:47 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/843 |
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