Endoscopic ultrasound cannot determine suitability for esophagectomy after aggressive chemoradiotherapy for esophageal cancer

Abstract

When aggressive preoperative chemoradiotherapy is provided to patients with esophageal cancer, the predictive value of postchemoradiotherapy EUS is inadequate for use in clinical decision making.

Prospective comparison of the perceived preoperative computed tomographic, endosonographic and histopathological stage of oesophageal cancer related to body mass indices

“…Moreover, 63 patients (38%) received preoperative neoadjuvant chemotherapy, and these patients' tumours may have been down-staged, further influencing the potential accuracy of both the CT and EUS stage. Indeed, the strengths of agreement between both EUS T and N stage were better in patients who had undergone surgery alone (T stage Kw=0.696 and N stage Kw 0.569) compared with patients who had received neoadjuvant chemotherapy (T stage Kw=0.364, and N stage Kw=0.459, respectively), which is consistent with previous reports [2,9,[17][18][19][20]. Nevertheless, the study also has strengths in that it represents an original prospective study of 9 years of pragmatic specialist multidisciplinary upper GI practice by experienced clinicians with wellaudited and published results [9,11,21].…”

The role of endoscopic ultrasound in assessing tumor response and staging after neoadjuvant chemotherapy for esophageal cancer

“…The EUS staging accuracy (overall T = 39%, N = 58%) after NAC in our study was comparable with that in other published series [1,[3][4][5]9]. Several, mostly small, studies over the past decade have attempted to address the role of EUS after NAC by comparing various variables of the tumor such as size and T and N staging, or by comparing the post-NAC EUS results with surgical pathology.…”

“…In a study of 99 patients receiving NAC for gastroesophageal cancer, EUS was able to detect only two of the eight patients who had complete absence of tumor tissue (surgical pathology of T0N0) [13]. A similarly low accuracy for detecting the absence of tumor tissue after chemoradiation was shown as well [3]. T-stage to histologic T-stage Histologic T0 T1 T2 T3 T4 T0 0 In our study, none of the 17 patients who demonstrated absence of residual tumor tissue after chemotherapy were accurately identified by EUS.…”

“…Although the role of EUS in the initial staging of esophageal cancer is well established [2], its role in assessing tumor response and staging of esophageal cancers after neoadjuvant chemotherapy (NAC) is controversial due to staging inaccuracies [3][4][5][6], and this study aimed to investigate this role.…”

Minimally invasive surgical staging for esophageal cancer

“…However, even when EUS and CT scan were combined, inaccuracies still were present in 32% of cases. The accuracy of EUS can be even further diminished if chemotherapy or radiotherapy has been administered previously [14].…”