Does Barrett's esophagus respond to chemoradiation therapy for adenocarcinoma of the esophagus?
Presented at the 2009 Gastrointestinal Cancers Symposium, January 13-15, San Francisco, California.
Received 4 July 2009; accepted 25 September 2009. published online 09 December 2009.
Background
Adenocarcinoma of the esophagus is frequently associated with Barrett's esophagus (BE). The response of esophageal adenocarcinoma to chemoradiation therapy is well described; however, the effect of chemoradiation on tumor-associated BE has not been specifically reported.
Objective
To determine the response of tumor-associated BE to chemoradiation therapy.
Design
Retrospective cohort study.
Setting
A single National Cancer Institute Comprehensive Cancer Care Center experience.
Patients
The study cohort consisted of 43 patients with stage I to IVA esophageal adenocarcinoma associated with BE who received either neoadjuvant or definitive chemoradiation therapy and underwent either esophagectomy or surveillance at our institution.
Main Outcome Measurement
The presence and extent of BE after chemoradiation therapy of esophageal adenocarcinoma associated with endoscopically documented pretreatment BE.
Results
BE persisted after chemoradiation therapy in 93% (40/43) of cases (95% CI, 83%-99%). Twenty-seven patients received neoadjuvant chemoradiation therapy before esophagectomy. Persistent BE was detected in all 27 surgical specimens (100%). In 59% (16/27) of the cases, there was complete pathologic tumor response. Sixteen patients received definitive chemoradiation therapy. Persistent pretreatment BE was identified in 88% (14/16) by surveillance endoscopy (95% CI, 60%-98%). The mean length of BE before and after chemoradiation was 6.6 cm and 5.8 cm, respectively (P = .38).
Limitations
Retrospective design, small sample size, and single-site data collection.
Conclusions
Chemoradiation therapy of esophageal adenocarcinoma does not eliminate tumor-associated BE, nor does it affect the length of the BE segment.
Current affiliations: Departments of Gastrointestinal Oncology (J.S.B., J.L.L., J.R.S.) and Radiation Oncology (S.E.H., I.A., T.J.D., C.W.S.), H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, Department of Medicine (S.T.K.), University of South Florida College of Medicine, Tampa, Florida, USA
Reprint requests: James S. Barthel, MD, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
ABSTRACT