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Showing content from https://pubmed.ncbi.nlm.nih.gov/33485662/ below:

Safety and feasibility of esophagectomy following combined immunotherapy and chemoradiotherapy for esophageal cancer

. 2021 Mar;161(3):836-843.e1. doi: 10.1016/j.jtcvs.2020.11.106. Epub 2020 Dec 17. Safety and feasibility of esophagectomy following combined immunotherapy and chemoradiotherapy for esophageal cancer

Affiliations

¹ Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
² Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
³ Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
⁴ Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
⁵ Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: molenad@mskcc.org.

PMID: 33485662
PMCID: PMC7889638
DOI: 10.1016/j.jtcvs.2020.11.106

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Safety and feasibility of esophagectomy following combined immunotherapy and chemoradiotherapy for esophageal cancer

Smita Sihag et al. J Thorac Cardiovasc Surg. 2021 Mar.

. 2021 Mar;161(3):836-843.e1. doi: 10.1016/j.jtcvs.2020.11.106. Epub 2020 Dec 17. Affiliations

¹ Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
² Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
³ Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
⁴ Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
⁵ Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: molenad@mskcc.org.

PMID: 33485662
PMCID: PMC7889638
DOI: 10.1016/j.jtcvs.2020.11.106

Item in Clipboard

Abstract

Objectives: We sought to determine the safety and feasibility of esophagectomy after neoadjuvant immunotherapy and chemoradiotherapy in clinical trial patients with locally advanced esophageal cancer.

Methods: We retrospectively identified patients who were treated with neoadjuvant immunotherapy and chemoradiotherapy (n = 25) or chemoradiotherapy alone (n = 143) at our institution between 2017 and 2020. The primary end point was risk of 30-day major complications (Clavien-Dindo classification system grade ≥ 3), which was assessed between groups using a multivariable log-binomial regression model to obtain adjusted relative risk ratios. Secondary end points were interval to surgery, 30-day readmission rate, and 30-day mortality.

Results: All included patients successfully completed neoadjuvant therapy and underwent esophagectomy with negative margins. Age, sex, performance status, clinical stage, histologic subtype, procedure type, and operative approach were similar between groups. Neoadjuvant immunotherapy was not associated with a statistically significantly increased risk of developing a major pulmonary (relative risk, 1.43; 95% confidence interval, 0.53-3.84; P = .5), anastomotic (relative risk, 1.34; 95% confidence interval, 0.45-3.94; P = .6), or other complication (relative risk, 1.29; 95% confidence interval, 0.26-6.28; P = .8). Median (interquartile range) interval to surgery was 54 days (47-61 days) in the immune checkpoint inhibitor group versus 53 days (47-66 days) in the control group (P = .6). Minimally invasive approaches were successful in 72% of cases, with only 1 conversion. Thirty-day mortality and readmission rates were 0% and 17%, respectively, in the immune checkpoint inhibitor group and 1.4% and 13%, respectively, in the control group.

Conclusions: On the basis of our preliminary experience, esophagectomy appears to be safe and feasible following combined neoadjuvant immunotherapy and standard chemoradiotherapy for locally advanced esophageal cancer.

Keywords: chemoradiotherapy; esophageal cancer; esophagectomy; immunotherapy.

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Figures
FIGURE 1.

Consolidated Standards of Reporting Trials…

FIGURE 1.

Consolidated Standards of Reporting Trials diagrams of the immune checkpoint inhibitor ( ICI…

FIGURE 1.

Consolidated Standards of Reporting Trials diagrams of the immune checkpoint inhibitor (ICI) group (A) and control group (B) in the context of ongoing clinical trial enrollment. Information is current as of May 2020. MSK, Memorial Sloan Kettering Cancer Center.

FIGURE 2.

On the basis of this…

FIGURE 2.

On the basis of this preliminary experience, esophagectomy appears to be safe and…

FIGURE 2.

On the basis of this preliminary experience, esophagectomy appears to be safe and feasible after combined immunotherapy and chemoradiotherapy for esophageal cancer. ICI, Immune checkpoint inhibitor; PET, positron-emission tomography; CT, computed tomography; SUV, standardized uptake value; fx, fraction; AUC, area under the curve.