Substantial Benefit of Intensive Surveillance Following Bimodality Therapy for Esophageal Cancer
In a study reported in the Journal of Clinical Oncology, Sudo et al found that many patients undergoing definitive chemoradiotherapy (bimodality therapy) for esophageal cancer can derive substantial survival benefit from subsequent salvage surgery, supporting a practice of intensive surveillance of such patients.
Study Details
The study involved 276 consecutive patients receiving bimodality therapy between 2002 and 2011 at The University of Texas MD Anderson Cancer Center who were followed with an aggressive surveillance program. Patients who had surgery within 6 months of chemoradiotherapy were excluded to reduce bias.
Surveillance consisted of esophagogastroduodenoscopy and multiple biopsies plus computed tomography (CT) or positron-emission tomography (PET)/CT at the first visit (5 and 8 weeks after completion of bimodality therapy). Subsequent visits occurred every 3 months for the first year, every 6 months for 2 additional years, and once a year for the next 2 years. Surveillance evaluations included blood tests, esophagogastroduodenoscopy with biopsies at every other visit, and imaging studies including CT and PET/CT at every visit.
Relapse Patterns
Median follow-up was 54.3 months. First relapses consisted of local relapse only in 23.2% of patients and distant metastases with or without local relapse in 43.5%, with no relapse observed in 33.3%. Final relapses included local relapse only in 14.5%, distant metastases only in 15.9%, and distant metastases plus local relapse in 36.2% of patients, with no relapse observed in 33.3%.
Benefit of Salvage Surgery
In total, 91% of local relapses occurred within 2 years and 98% occurred within 3 years. Of the 64 patients with local relapse only, 23 (36%) underwent salvage surgery. Median overall survival in these patients was 58.6 months, compared with 9.5 months in patients with local relapse only who were unable to undergo surgery.
The investigators concluded: “Unlike in patients undergoing trimodality therapy, for whom surveillance/salvage treatment plays a lesser role, in the [bimodality therapy] population, approximately 8% of all patients (or 36% of patients with [local relapse] only) with [local relapses] occurring more than 6 months after chemoradiotherapy can undergo salvage treatment, and their survival is excellent. Our data support vigilant surveillance, at least in the first 24 months after chemotherapy, in these patients.”
Jaffer A. Ajani, MD, of The University of Texas MD Anderson Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the Caporella, Dallas, Sultan, Park, Smith, Frazier, Oaks, Vanstekelenberg, Cantu, and Planjery Families; Schecter Private Foundation; Rivercreek Foundation; Kevin Fund; Myer Fund; Dio Fund; Milrod Fund; and grants from The University of Texas MD Anderson Cancer Center and National Cancer Institute.
For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
