William M. Whited

Optimal Therapy in Locally Advanced Esophageal Cancer: a National Cancer Database Analysis

There are over 16,000 new patients diagnosed with esophageal cancer each year in the USA. With the overall 5-year survival of approximately 18%, it is one of the leading causes of cancer deaths. In patients with esophageal cancer, undergoing a complete (R0) resection is the most important predictor of overall survival. In patients fortunate enough to have their cancer diagnosed at an early stage (stages I–IIA), resection alone without neoadjuvant therapy is currently recommended and has proved to be an acceptable therapy with good long-term survival. Unfortunately, patients often present at an advanced stage due to the absence of symptoms during the early stages of the disease. There have been several trials over the past decade designed to determine the optimal treatment for locally advanced esophageal cancer. The MAGIC trial published in 2006 was a randomized control trial comparing survival in patients undergoing neoadjuvant chemotherapy and surgery to surgery alone. This trial demonstrated that patients undergoing neoadjuvant chemotherapy and surgery had improved survival compared to the surgery alone group. Published in 2008, the CALGB 9781 trial, despite closing early due to poor accrual, did demonstrate a survival advantage in patients undergoing chemoradiation followed by surgery compared to surgery alone in patients with locally advanced esophageal cancer. More recently, the CROSS Trial demonstrated a survival benefit in patients undergoing chemotherapy and radiation prior to surgery compared to surgery alone and is arguably the most notable trial to date regarding neoadjuvant chemoradiation for esophageal cancer. Today, most consider the recommended course of treatment in patients with locally advanced esophageal cancer to be neoadjuvant chemotherapy or chemoradiation followed by esophagectomy. The purpose of this study is to determine what proportion of patients with locally advanced esophageal cancer receive the optimal treatment (neoadjuvant chemotherapy ± radiation followed by an R0 resection) and what factors influence whether patients receive this treatment.

Use of drug intoxicated donors for lung transplant: Impact on survival outcomes

The number of increasing deaths due to the opioid epidemic has led to a potential greater supply of organ donors. There is hesitancy to use drug intoxicated donors, and we evaluated their impact on post‐transplant survival.

Changing demographics of heart donors: The impact of donor drug intoxication on posttransplant survival

Recent reports have shown an increase in the number of organ donors from drug intoxication. The impact of donor drug use on survival after cardiac transplant remains unclear. The aim of our study was to illustrate changes in donor death mechanisms and assess the impact on posttransplant survival. We queried United Network of Organ Sharing thoracic transplant and deceased donor databases to identify patients undergoing heart transplantation between 2005 and 2015. We evaluated annual trends in donor death mechanisms. Recipients were propensity matched (drug‐intoxicated—non‐drug‐intoxicated = 1:2) and posttransplant survival was compared using Kaplan‐Meier curves. In total, 19 384 donor hearts were used for transplant during the period (donor age 31.6 ± 11.8 years, 72% male). Use of drug‐intoxicated donors increased from 2% (2005) to 13% (2015) and decreased from blunt injury (40%‐30%) and intracranial hemorrhage (29%‐25%). After propensity matching, posttransplant survival of drug‐intoxicated donor hearts was 90%, 82%, and 76% at 1, 3, and 5 years, which was similar to non‐drug‐intoxicated. Heart transplants using drug‐intoxicated donors have significantly increased; however, they have not adversely affected posttransplant survival. Hearts from drug‐intoxicated donors should be carefully evaluated and considered for transplant.