Neoadjuvant Therapy in Esophageal Cancer May be Most Effective in Subset of Patients

BUFFALO, N.Y. — Large studies have shown improved survival for patients with esophageal cancer who receive both chemotherapy and radiation ahead of surgery to remove their tumors. However, looking to isolate the driving factors behind these favorable responses, a group of surgeons and biostatisticians from Roswell Park Comprehensive Cancer Center (Roswell Park) found that this approach was much more effective in patients whose esophageal cancer had spread to the lymph nodes. This suggests the possibility that this treatment option might not be the best choice for patients with no evidence of lymphatic spread, according to the study, which was published in JAMA Surgery.

The researchers, led by Moshim Kukar, MD, and Emmanuel Gabriel, MD, PhD, of the Department of Surgical Oncology at Roswell Park, conducted a retrospective analysis using American College of Surgeons National Cancer Data Base records from 1998 to 2006. They looked primarily at overall survival three years after diagnosis of esophageal cancer. As secondary outcomes, they also looked at surgical margin status, postoperative length of stay, unplanned readmission rate and mortality within 30 days of surgery.

Patients with node-positive esophageal cancer — cancer that has spread to the lymph nodes — who received neoadjuvant chemoradiation followed by surgery had about a nearly twofold improvement in survival compared to patients who had surgery upfront without additional treatment. Among those patients with no evidence of cancer in the lymph nodes, meanwhile, no difference in survival was observed between those who received neoadjuvant chemotherapy before surgery and those who did not.

“Our analysis raises the question of whether neoadjuvant therapy provides a long-term survival benefit for patients with node-negative esophageal cancer,” notes Dr. Gabriel, a Clinical Fellow at Roswell Park and the paper’s first author. “If patients who do not have lymphatic spread do not derive an overall survival benefit from neoadjuvant therapy, then perhaps neoadjuvant therapy can be avoided.”

“These conclusions are preliminary and merit further study. There are other documented benefits of neoadjuvant therapy besides survival that should also be investigated,” adds Dr. Kukar, an Assistant Professor of Oncology at Roswell Park and senior author on the JAMA Surgery study. “But the clear demarcation we saw in response between these two groups is noteworthy.”

The researchers plan to use the study results in a survival calculator they are developing that they hope will predict outcomes for individual patients with esophageal cancer, based on unique factors and circumstances.

The paper, entitled “Association Between Clinically Staged Node-Negative Esophageal Adenocarcinoma and Overall Survival Benefit From Neoadjuvant Chemoradiation,” is available at archsurg.jamanetwork.com.

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The mission of Roswell Park Comprehensive Cancer Center is to understand, prevent and cure cancer. Founded in 1898, Roswell Park is one of the first cancer centers in the country to be named a National Cancer Institute-designated comprehensive cancer center and remains the only facility with this designation in Upstate New York. The Institute is a member of the prestigious National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers; maintains affiliate sites; and is a partner in national and international collaborative programs. For more information, visit www.roswellpark.org, call 1-800-ROSWELL (1-800-767-9355) or email AskRoswell@Roswellpark.org. Follow Roswell Park on Facebook and Twitter.