Top Line: Does a prolonged time interval between neoadjuvant chemoradiation and surgery improve pathologic complete response rate for esophageal cancer?
The Study: Esophageal cancer, like rectal cancer, is often treated with neoadjuvant chemoradiation. But unlike rectal cancer, there is very little data describing the optimal timing of surgery after neoadjuvant therapy. In the randomized, phase 2 NeoRes II trial, 249 patients with SCC or adenocarcinoma of the mid-to-distal esophagus or EG junction (Siewert I-II) received neoadjuvant chemoradiation consisting of 41.4 Gy in 23 fractions and 5 cycles of carboplatin and paclitaxel. They were then randomized to wait 4-6 weeks until surgery or 10-12 weeks. At surgery, a prolonged wait did not significantly increase the pCR rate (26% v 21%). Nor were there differences in the rates of overall regression or the rates of margin negative resection. SCC had higher rates of pCR in both arms compared to adeno, however in neither histology did a longer wait result in a higher pCR rate.
TBL: Waiting 10-12 weeks instead of 4-6 weeks for surgery after nCRT for esophageal cancer does not appear to increase the observed rate of pathologic complete response. | Nilsson, Ann Oncol 2023
The Study: Esophageal cancer, like rectal cancer, is often treated with neoadjuvant chemoradiation. But unlike rectal cancer, there is very little data describing the optimal timing of surgery after neoadjuvant therapy. In the randomized, phase 2 NeoRes II trial, 249 patients with SCC or adenocarcinoma of the mid-to-distal esophagus or EG junction (Siewert I-II) received neoadjuvant chemoradiation consisting of 41.4 Gy in 23 fractions and 5 cycles of carboplatin and paclitaxel. They were then randomized to wait 4-6 weeks until surgery or 10-12 weeks. At surgery, a prolonged wait did not significantly increase the pCR rate (26% v 21%). Nor were there differences in the rates of overall regression or the rates of margin negative resection. SCC had higher rates of pCR in both arms compared to adeno, however in neither histology did a longer wait result in a higher pCR rate.
TBL: Waiting 10-12 weeks instead of 4-6 weeks for surgery after nCRT for esophageal cancer does not appear to increase the observed rate of pathologic complete response. | Nilsson, Ann Oncol 2023