Salvage strategies produced “unimpressive” results in esophageal adenocarcinoma patients with locoregional failure after preoperative chemoradiation, researchers found.
Following chemoradiotherapy with subsequent trimodality therapy including surgery, 36 percent of esophageal adenocarcinoma patients experienced distant metastases with or without locoregional failure, most of which (89 percent) occurred within 36 months of surgery, according to Jaffer Ajani, MD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues.
Of the 5 percent of patients who experienced locoregional failure following treatment, only five of 12 who underwent salvage chemotherapy survived more than 2 years, three of whom developed distant metastases, they wrote online in the Journal of Clinical Oncology.
“Thus, only 2 percent of all 518 patients beneﬁted from surveillance/salvage strategies,” they pointed out.
This new data seems to contradict a study presented at the 2013 Gastrointestinal Cancers Symposium, which showed surgery after chemoradiotherapy was associated with significant increases in 5-year overall survival (OS) compared with patients who received chemotherapy only in patients with advanced esophageal cancer.
Prior research has also shown that preoperative therapy doesn’t benefit patients in early esophageal cancer, nor does endoscopy offer improved survival benefit in patients with esophageal adenocarcinoma.
“After [trimodality therapy], patients are surveyed by various schedules and tests … the primary reason to survey patients after successful local therapy … is to implement a potentially beneﬁcial salvage therapy to overcome locoregional failure,” Ajani’s group explained. “The purpose of this study was to analyze a large cohort of patients who had [trimodality therapy] and to assess the outcome of patients for whom salvage therapy was implemented following locoregional failure.”