Neoadjuvant and Definitive Radiochemotherapeutic Approaches in Esophageal Cancer: A Retrospective Evaluation of 122 Cases in Daily Clinical Routine.

INTRODUCTION: Esophageal cancer (EC) is a common malignant tumor entity with increasing occurrence. The incidence of esophageal adenocarcinoma (AC), particularly, is constantly rising in the Western world. The mainstays of therapy with curative intent for EC in advanced stages are neoadjuvant radiochemotherapy (neoRCT) with surgery and definitive radiochemotherapy (defRCT). METHODS: We examined our internal files to identify patients suffering from EC. Palliative cases were excluded. Statistical testing was performed by χ2 test, Student's t test, Kaplan-Meier analyses, and the Mann-Whitney U test. RESULTS: One hundred and twenty-two cases were included. Histology revealed squamous cell carcinoma in 92 cases and AC in 23 cases. Ninety-five patients underwent defRCT, 27 underwent neoRCT, and 114 (in both therapy regimes) received simultaneous chemotherapy. There was no difference in the overall survival (OS) (p = 0.654; HR 1.145; 95% CI 0.629-2.086) or and progression-free survival (PFS) (p = 0.912) of patients who underwent neoRCT or defRCT. Median OS was 13.5 (2-197) months for defRCT patients and 19.5 (2-134) months for neoRCT patients (p = 0.751). Karnofsky index (KI) with a cut-off of 70% was strongest, but not a significant parameter for OS (p = 0.608) or PFS (p = 0.137). CONCLUSION: defRCT is a valid and an equal alternative to neoRCT for patients suffering from EC. Selection of patients for therapy is of crucial relevance. Further studies and improvements in follow-up are needed when neoRCT has been completed before surgery, in order to spare the patient undergoing operative treatment if there is complete remission. The identification of valid markers urgently needed to limit treatment side effects.

High on-treatment platelet reactivity and outcomes after percutaneous endovascular procedures in patients with peripheral artery disease.

BACKGROUND: High on-treatment platelet reactivity (HPR) predicts adverse cardiovascular events in patients with coronary artery disease. The impact of HPR in patients with peripheral artery disease (PAD) after peripheral endovascular procedures is unclear. PATIENTS AND METHODS: A total of 385 patients with PAD and successful percutaneous endovascular procedure were included. Patients received aspirin as a long-term treatment in addition to the P2Y12 receptor antagonist clopidogrel, as recommended after such a procedure for at least 1 month. Platelet function was assessed on a Multiplate analyzer. The primary endpoint was target lesion revascularization (TLR) at one year. Restenosis (≥ 75 %) in duplex sonography, mortality at one year and identification of independent predictors of TLR were secondary endpoints. RESULTS: TLR rates were similar in HPR and no-HPR patients (14.3 % vs. 12.7 %, hazard rate (HR) 0.94, 95 % CI 0.48 - 1.84, P = 0.86). Restenosis (≥ 75 %) in duplex sonography did not differ between the two study groups (15.6 % vs. 16.9 %, HR 1.16, 95% CI 0.62 - 2.12, P = 0.64). Independent predictors of TLR were intervention of restenotic lesions, total vessel occlusions and critical limb ischemia, but not HPR (adjusted HR 1.07, 95% CI 0.55 - 2.10, P = 0.84). No difference in mortality at one year was observed (1.3 % vs. 1.6 %, HR 1.28, 95 % CI 0.15 - 11.0, P = 0.82). CONCLUSIONS: In patients with PAD, HPR did not have a significant impact on outcomes within the first year after percutaneous endovascular intervention.