Accuracy of pathologic examination in detection of complete response after chemoradiation for esophageal cancer |
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Authors: | Chang Eugene Y Smith Christina A Corless Christopher L Thomas Charles R Hunter John G Jobe Blair A |
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Institution: | Department of Surgery, Oregon Health & Science University, Mail Code L223A, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. |
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Abstract: | BACKGROUND: Although a substantial proportion of patients undergoing neoadjuvant chemoradiation for invasive esophageal cancer develop a pathologic complete response (pCR), these patients nonetheless have a poor 5-year survival rate. We hypothesized that routine pathologic examination fails to identify some residual cancer. METHODS: Patients undergoing esophagectomy for cancer at 2 tertiary care centers were identified. Archived tumor blocks were retrieved for patients with pCR, sectioned at 50-mum intervals and reexamined for residual cancer. RESULTS: Seventy patients underwent neoadjuvant chemoradiation. Tumor blocks were available for 23 of 26 complete responders. A total of 159 blocks were reexamined. One patient was found to have a possible focus of residual invasive adenocarcinoma versus high-grade dysplasia. The remaining 22 patients had no residual disease. CONCLUSIONS: A more aggressive examination protocol for postchemoradiation esophagectomy specimens may not result in significant upstaging. Inadequate pathologic examination is likely not a major factor in the suboptimal survival in patients with pCR. |
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Keywords: | Esophageal cancer Neoadjuvant chemoradiation Pathologic complete response Staging |
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