More on Treatment Decisions in Esophageal Cancer

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In the March 25, 2017, issue of The ASCO Post, Steven H. Lin, MD, PhD, shared his thoughts on the role of positron-emission tomography (PET) in assessing response to induction chemotherapy in patients with resectable esophageal or gastroesophageal junction cancer. He noted that complete pathologic responses were higher in the CROSS trial than in CALGB 80803.

Could this be due to the fact that the exclusion criteria in the CROSS trial eliminated many of the more high-risk patients (eg, length > 8 cm, width > 5 cm, and weight loss > 10% of body weight)? In addition, 81% of the patients in the CROSS trial had a World Health Organization performance status of 0. The six published phase II trials using induction chemotherapy prior to combined-modality therapy and surgery showed much better complete pathologic responses without eliminating these high-risk patients.

Considering the CROSS trial as the standard of care for the preoperative treatment of all patients with esophageal cancer makes little to no sense to me, especially for those with adenocarcinoma, where there is certainly greater metastatic potential. The CROSS trial used five weekly doses of carboplatin and paclitaxel in combination with radiation therapy. This represents less than two full cycles of chemotherapy, which is totally inadequate to address the metastatic potential of this disease. ■

Richard A. Brodkin, MD
Statesville, North Carolina




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