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Flashcards in Esophageal Deck (12)

Name a study supporting neoadjuvant chemoradiation for esophageal cancer?

Cross Trial


What was randomized in the Cross trial?

upfront chemoradiation with surgery v surgery alone for esophageal cancer (SCC and adeno)


What was chemoradiation in Cross Trial?

Carboplatin Paclitaxel with 41 Gy of radiation


Was R0 rate improved in the Cross trial?

Yes, 80% to over 90% with chemo/RT


Was OS improved in Cross Trial?

Yes, MS of 50 months v 25 months.


What was cPR rate for SCC in Cross Trial?

nearly 50% (49%)


Do you need to complete an esophagectomy after a complete path response?

Somewhat debated. most important point is that clinically you cant predict a complete path response upfront


Are there any RCTs where surgery was radomized for esophageal cancer?

Yes Bedenne J Clin ONcol 2007 and a German RCT.

both suggest improved DSS but no improved OS. both were highly criticized for high operative mortality.


Is there value to an EGD between neoadjuvant chemoradiation and esophagectomy?

Probably not. Could use if you were really looking for a reason not to operate on someone (frail patient, hoping for a complete response)


Is there value to a PET scan between neoadjuvant chemoradiation and esophagectomy?

Again, probably not, but might help predict a response. Could use to justify not operating on a frail patient in the setting of excellent response or clear progression.


Acceptable mortality in most modern esophagectomy series?

SSO video conference said 2-5%; would probably go a little lower.


Does anything change if you wait for recurrence after clinical response to neoadjuvant chemoradiation to do a "salvage esophagectomy"?

Probably not well studied enough to give definitive answer on OS, but perioperative morbidity and mortality goes up since you must deal with the late consequences of an irradiated field.

(supposedly some MD Anderson or MSKCC data out there)