Outlook in gastric/GEJ cancer poor even with pathologic complete response
MedWire News: Patients with gastric or gastroesophageal junction (GEJ) adenocarcinoma face a significant risk for recurrence and mortality even if they achieve a pathologic complete response (pCR) following neoadjuvant therapy and surgery, research shows.
The findings are reported by a US team, who call for greater awareness of this residual risk and recommend that selected individuals undergo imaging to facilitate early detection of metastastic disease.
Manish Shah (Memorial Sloan-Kettering Cancer Center, New York, USA) and co-workers undertook a retrospective review of patients at their institution who received preoperative chemotherapy or chemoradiation for gastric or GEJ adenocarcinoma, followed by complete resection.
Between 1985 and 2009 there were 609 such patients, of whom 60 (8.4%) were considered to have a pCR following surgery. The remainder had residual tumor and were classified as the non-pCR group.
During a median follow-up of 46 months, the clinical course differed between patients with and without a pCR, report the authors in the British Journal of Cancer.
Compared with non-pCR patients, those with a pCR had a significantly lower rate of recurrence at 5 years (27 vs 51%) but a significantly higher rate of central nervous system (CNS) recurrences (36 vs 4%).
However, the overall pattern of local/regional versus distant recurrence was comparable between the groups, with 43% of recurrences being local and 57% distant.
CNS recurrence proved fatal in all cases, with a mean time to recurrence of 12.6 months and a mean time from recurrence to death of 9.6 months. Of note, nearly half of the pCR patients with a local/regional recurrence had received preoperative chemoradiation (as opposed to chemotherapy).
Taken together, these observations show that patients who achieve a pCR following pre-operative therapy and surgery "still have a significant risk of recurrence and cancer-specific death following resection," write Shah et al.
Indeed, the risk for recurrence in these patients is "indistinguishable from patients who were downstaged to pathologic stage I or II following pre-operative therapy," they remark.
Given the significantly higher incidence of symptomatic CNS first recurrences in pCR patients, the team concludes: "These findings have important clinical implications: Care providers should be cognizant of the risk of symptomatic CNS recurrences in this select cohort of patients and should consider selective brain imaging for early identification and treatment of CNS metastases."
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By Joanna Lyford