For a study, the researchers sought to evaluate the overall survival of individuals with a CCR who were on active surveillance against those who had a conventional esophagectomy. After neoadjuvant chemoradiotherapy, one-third of patients with esophageal cancer had a pathologically full response in the resection specimen. Patients with CCR, as identified by diagnostics during post-chemoradiotherapy response evaluations, may benefit from active surveillance. Overall survival was compared between patients with CCR after chemoradiotherapy and active surveillance versus standard esophagectomy in a comprehensive review and meta-analysis. Individual patient data were requested from the authors. Random effects meta-analysis of randomized or propensity score-matched data was used to evaluate overall and progression-free survival. The rate of locoregional recurrence was determined. About 7 studies with 788 participants, with 196 active surveillance patients and 257 conventional esophagectomy patients following randomization or propensity score matching. All of the authors provided individual patient data. After intention-to-treat analysis, the risk of all-cause mortality for active monitoring was 1.08 [95% CI: 0.62–1.87, P=0.75] and 0.93 (95% CI: 0.56–1.54, P=0.75) after per-protocol analysis. Active surveillance had a risk of progression or all-cause death of 1.14 (95% CI: 0.83–1.58, P=0.36). The 5-year locoregional recurrence rate was 40% (95% CI: 26%–59%). Around 95% of active surveillance patients who had their esophagectomy postponed due to locoregional recurrence got radical resection. Patients with CCR who underwent active surveillance following chemoradiotherapy or a conventional esophagectomy had similar overall survival. Active surveillance and diagnostic follow-up were required, and operable patients should be offered postponed esophagectomy in locoregional recurrence.

 

Sourc:journals.lww.com/annalsofsurgery/Abstract/2022/03000/Chemoradiotherapy_Followed_by_Active_Surveillance.10.aspx