Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
Department of Medical Oncology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
BJS Open. 2021 Mar 5;5(2). doi: 10.1093/bjsopen/zrab022.
Neoadjuvant chemoradiotherapy (nCRT) and surgery is a widely used treatment for locally advanced resectable oesophageal cancer, with 20-50 per cent of patients having a pathological complete response (pCR). Disease, however, still recurs in 20-30 per cent of these patients. The aim of this study was to assess the pattern of recurrence in patients with a pCR after nCRT and surgery.
All patients with a pCR after nCRT and surgery included in the phase II and III CROSS (ChemoRadiotherapy for Oesophageal followed by Surgery Study) trials (April 2001 to December 2008) and after the CROSS trials (September 2009 to October 2017) were identified. The site of recurrence was compared with the applied radiation and surgical fields. Outcomes were median time to recurrence, and overall and progression-free survival.
A total of 141 patients with a median follow-up of 100 (i.q.r. 64-134) months were included. Some 29 of 141 patients (20,6 per cent) developed recurrence. Of these, four had isolated locoregional recurrence, 15 had distant recurrence only, and ten had both locoregional and distant recurrence. Among the 14 patients with locoregional recurrences, five had recurrence within the radiation field, seven outside the radiation field, and two at the border. Median time to recurrence was 24 (10-62) months. The 5-year overall survival rate was 74 per cent and the recurrence-free survival rate was 70 per cent.
Despite good overall survival, recurrence still occurred in 21 per cent of patients. Most recurrences were distant, outside the radiation and surgical fields.
新辅助放化疗（nCRT）和手术是治疗局部可切除食管腺癌的常用方法，其中 20-50%的患者有病理完全缓解（pCR）。然而，仍有 20-30%的患者疾病复发。本研究旨在评估 nCRT 和手术后 pCR 患者的复发模式。
所有 nCRT 和手术后 pCR 的患者均来自 CROSS（食管放化疗后手术研究）Ⅱ期和Ⅲ期临床试验（2001 年 4 月至 2008 年 12 月）以及 CROSS 试验后（2009 年 9 月至 2017 年 10 月）。将复发部位与应用的放疗和手术野进行比较。结果为复发的中位时间、总生存期和无进展生存期。
共纳入 141 例患者，中位随访时间为 100 个月（IQR 64-134）。141 例患者中有 29 例（20.6%）发生复发。其中，4 例为孤立性局部区域复发，15 例为远处复发，10 例为局部区域和远处同时复发。在 14 例局部区域复发患者中，5 例复发于放疗野内，7 例复发于放疗野外，2 例位于放疗野边界。复发的中位时间为 24（10-62）个月。5 年总生存率为 74%，无复发生存率为 70%。
尽管总体生存良好，但仍有 21%的患者复发。大多数复发为远处、放疗野外和手术野外。
