The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.
Response to induction therapy in oesophageal and cardia carcinoma using Mandard tumour regression grade or size of residual foci (Br J Surg 2010; 97: 719-725) Sir Verlato and colleagues described the use of parameters incorporating size of residual foci and lymph node status to determine their prognostic significance following preoperative chemoradiation and oesophagectomy for locally advanced oesophageal cancer. Their efforts must be congratulated. The authors demonstrate the association of tumour regression grade with pathological lymph node status, and its correlation with disease-free and overall survival. They report a new categorization that subclassifies the response of the primary tumour but without subclassifying those with nodal involvement. This appears to indicate that, notwithstanding the response of the primary tumour, nodal involvement universally indicates a poor outcome. It would be interesting if further survival curves were shown for patients with nodal involvement according to the sizebased pathological response, although the authors did show that response to preoperative therapy was associated with nodal status and also the number of positive lymph nodes. It was previously reported by Gu and co-workers 1 in patients with residual tumour cells after preoperative chemoradiation that having a single positive lymph node appeared to achieve similar survival outcomes to no lymph node involvement. Deciphering the true effect of primary tumour response and lymph node status may provide guidance on the appropriate clinical target volume for radiotherapy delivery. For example, a larger target volume may be planned for larger tumours that would have a likelihood of having more involved lymph nodes 2 .
T.