• Zohra Faiz, Gursah Kats-Ugurlu, Véronique E M Mui, Arend Karrenbeld, Hans G M Burgerhof, PlukkerJohn T MJTMDepartment of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands., and Christel T Muijs.
• Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
• Ann. Surg. 2022 Jun 1; 275 (6): e759e765e759-e765.

ObjectiveNeoadjuvant chemoradiotherapy followed by surgery establishes a considerable pathologic complete response (pCR) in EC. The aim was to determine site of residual tumor and its prognostic impact.Summary Background DataHigh rates of residual tumor in the adventitial region even inside the radiation fields will influence current decision-making.MethodsWe evaluated resection specimens with marked target fields from 151 consecutive EC patients treated with carboplatin/paclitaxel and 41.4Gy between 2009 and 2018.ResultsIn radically resected (R0) specimens 19.8% (27/136) had a pCR (ypT0N0) and 14% nearly no response (tumor regression grade: tumor regression grade 4-5). Residual tumor commonly extended in or restricted to the adventitia (43.1%; 47/109), whereas 7.3% was in the mucosa (ypT1a), 16.5% in the submucosa (ypT1b) and 6.4% only in lymph nodes (ypT0N+). Macroscopic residues in R0-specimens of partial responders (tumor regression grade 2-3: N = 90) were found in- and outside the gross tumor volume (GTV) in 33.3% and 8.9%, and only microscopic in- and outside the clinical target volume in 58.9% and 1.1%, respectively. Residual nodal disease was observed proximally and distally to the clinical target volume in 2 and 5 patients, respectively. Disease Free Survival decreased significantly if macroscopic tumor was outside the GTV and in ypT2-4aN+.ConclusionsAfter neoadjuvant chemoradiotherapy, pCR and ypT1aN0 were seen in a limited number of R0 resected specimens (19.8% and 7.3%, respectively), whereas 6.4% had only nodal disease (yT0N+). Disease Free Survival decreased significantly if macroscopic residue was outside the GTV and in responders with only nodal disease. Therefore, we should be cautious in applying wait and see strategies.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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