Can CT-PET and Endoscopic Assessment Post-Neoadjuvant Chemoradiotherapy Predict Residual Disease in Esophageal Cancer?

Heneghan, Helen; Donohoe, Claire L.; Elliot, Jessie A; Ahmed, Zuhair; Malik, Vinod; Ravi, N; Reynolds, John V.

doi:10.1097/sla.0000000000001902

Cited by 52 publications

(37 citation statements)

References 31 publications

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“…To implement non‐surgical treatment for advanced oesophageal cancer it is critical to accurately identify pCR. CT and fluorodeoxyglucose (FDG) PET/CT are both inaccurate in discriminating residual disease from pCR owing to the presence of wall thickening and/or radiation oesophagitis. The same is true for endoscopic ultrasonography (EUS), which has an accuracy of only 36 per cent for ypT determination.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer

Vollenbrock

Voncken

Dieren

et al. 2019

British Journal of Surgery

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Background Patients with a pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) for oesophageal cancer may benefit from non‐surgical management. The aim of this study was to determine the diagnostic performance of visual response assessment of the primary tumour after nCRT on T2‐weighted (T2W) and diffusion‐weighted (DW) MRI. Methods Patients with locally advanced oesophageal cancer who underwent T2W‐ and DW‐MRI (1·5 T) before and after nCRT in two hospitals, between July 2013 and September 2017, were included in this prospective study. Three radiologists evaluated T2W images retrospectively using a five‐point score for the assessment of residual tumour in a blinded manner and immediately rescored after adding DW‐MRI. Histopathology of the resection specimen was used as the reference standard; ypT0 represented a pCR. Sensitivity, specificity, area under the receiver operating characteristic (ROC) curve (AUC) and interobserver agreement were calculated. Results Twelve of 51 patients (24 per cent) had a pCR. The sensitivity and specificity of T2W‐MRI for detection of residual tumour ranged from 90 to 100 and 8 to 25 per cent respectively. Respective values for T2W + DW‐MRI were 90–97 and 42–50 per cent. AUCs for the three readers were 0·65, 0·66 and 0·68 on T2W‐MRI, and 0·71, 0·70 and 0·70 on T2W + DW‐MRI ( P = 0·441, P = 0·611 and P = 0·828 for readers 1, 2 and 3 respectively). The κ value for interobserver agreement improved from 0·24–0·55 on T2W‐MRI to 0·55–0·71 with DW‐MRI. Conclusion Preoperative assessment of residual tumour on MRI after nCRT for oesophageal cancer is feasible with high sensitivity, reflecting a low chance of missing residual tumour. However, the specificity was low; this results in overstaging of complete responders as having residual tumour and, consequently, overtreatment.

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Section: Introductionmentioning

confidence: 99%

Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer

Vollenbrock

Voncken

Dieren

et al. 2019

British Journal of Surgery

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“…Unlike preoperative chemotherapy, pCR can be highly anticipated after preoperative chemoradiation (9). A prospective cohort study with 138 EC patients (EAC 75%) showed that when complete metabolic response (cMR) was defined as maximal value of SUVmax of <4, only 27% patients who had cMR achieved pCR after chemoradiation (27). Elliot et al also reported similar result.…”

Section: Predicting Preoperative Chemoradiation Response By Pet-ctmentioning

confidence: 81%

Personalized therapy based on image for esophageal or gastroesophageal junction adenocarcinoma

et al. 2018

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Preoperative therapy is the gold standard for esophageal or gastroesophageal junction adenocarcinoma. Positron emission tomography (PET) is not only essential for tumor staging, but changes in glucose consumption correspond with response to therapy and correlated with prognosis. Therefore, with further refinement, PET parameter can serve as a tool for personalized therapy. For instance, the Municon trials suggested the possibility of PET-response guided therapy for esophageal adenocarcinoma (EAC) patients, however there are limitations. New PET parameters such as total lesion glycolysis (TLG) or magnetic resonance imaging (MRI) may provide better response prediction. Furthermore, PET parameters combined with genomic profiling might enhance better treatment selection, prediction, and prognostication.Here, we summarized the current state of understanding and future possibilities.

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“…Even if pathologic response could be accurately determined pre-operatively, and current data suggest this is not the case (8,9), surgery may still be an important factor in disease control. In fact, given the poor longterm outcomes, trials of further adjuvant treatment even in complete responders will probably also be required to augment response and further improve long-term survival.…”

Section: Nodal Involvement and Outcomementioning

confidence: 92%

Cancer of the esophagus and esophagogastric junction: an 8th edition staging primer

Donohoe¹,

Phillips²

2017

J. Thorac. Dis.

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Can CT-PET and Endoscopic Assessment Post-Neoadjuvant Chemoradiotherapy Predict Residual Disease in Esophageal Cancer?

Cited by 52 publications

References 31 publications

Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer

Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer

Personalized therapy based on image for esophageal or gastroesophageal junction adenocarcinoma

Cancer of the esophagus and esophagogastric junction: an 8th edition staging primer

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