Active Surveillance for Esophageal SCC: Post-chemoradiotherapy

Guidelines advocate neoadjuvant chemoradiotherapy plus surgery or definitive chemoradiotherapy for esophageal squamous cell carcinoma (SCC).

Carlo A De Pasqual and the team aimed to investigate the outcomes of patients achieving a complete clinical response (cCR) after chemoradiotherapy under active surveillance.

Researchers performed an inclusive analysis, including patients with oesophageal SCC treated via chemoradiotherapy from January 2016 to June 2022. Identification was based on an institutional database, and subsequent comparisons were made between those with a cCR undergoing active surveillance and those opting for planned surgery. Survival rates were calculated using the Kaplan-Meier method, and group comparisons were executed through the log-rank test.

About the 37 patients undergoing active surveillance, distinct characteristics emerged: they were older, and tumors more frequently occupied the middle/upper-third of the esophagus compared to the 57-patient surgery group. Median follow-up durations were 28.1 months (IQR 17.2-47.1) for the active surveillance group and 20 months (12.9-39.1) for the surgery group.

In terms of overall survival, the 3-year rates stood at 50% (95% CI 31 to 67) for active surveillance and 59% (40 to 73)% for surgery (P = 0.55). However, a notable difference was observed in 3-year progression-free survival: 70 (43 to 85) for active surveillance versus 58 (40 to 72)% for surgery (P = 0.02). Importantly, overall and progression-free survival were comparable between the active surveillance group and the 23 patients in the surgery group who achieved a pathological complete response (CR) (ypT0 N0).

Examining recurrence rates, 7 of 37 patients (19.4%) experienced recurrence in the active surveillance group, while 16 of 49 patients (32.6%) in the surgery group faced recurrence (P = 0.26). Notably, locoregional recurrence occurred more frequently in the active surveillance group, whereas systemic recurrence was more prevalent in the surgery group.

The study concluded that active surveillance is feasible and safe for patients with oesophageal SCC who achieve a cCR following chemoradiotherapy.

Source: https://pubmed.ncbi.nlm.nih.gov/38415879/

De Pasqual CA, Weindelmayer J, Gervasi MC, et. al(2024). Active surveillance for clinical complete responders after chemoradiotherapy for oesophageal squamous cell carcinoma. Br J Surg. 2024 Jan 31;111(2):znae036. doi: 10.1093/bjs/znae036. PMID: 38415879.