Post-therapeutic response evaluation by a combination of endoscopy and CT scan in esophagogastric adenocarcinoma after chemotherapy: better than its reputation

Abstract

Background Neoadjuvant chemotherapy is an accepted standard of care for locally advanced esophagogastric cancer. As only a subgroup benefits, a response-based tailored treatment would be of interest. The aim of our study was the evaluation of the prognostic and predictive value of clinical response in esophagogastric adenocarcinomas. Methods Clinical response based on a combination of endoscopy and computed tomography (CT) scan was evaluated retrospectively within a prospective database in center A and then transferred to center B. A total of 686/740 (A) and 184/210 (B) patients, staged cT3/4, cN0/1 underwent neoadjuvant chemotherapy and were then restaged by endoscopy and CT before undergoing tumor resection. Of 184 patients, 118 (B) additionally had an interim response assessment 4-6 weeks after the start of chemotherapy. Results In A, 479 patients (70 %) were defined as clinical nonresponders, 207 (30 %) as responders. Median survival was 38 months (nonresponders: 27 months, responders: 108 months, log-rank, p \ 0.001). Clinical and histopathological response correlated significantly (p \ 0.001). In multivariate analysis, clinical response was an independent prognostic factor (HR for death 1.4, 95 %CI 1.0-1.8, p = 0.032). In B, 140 patients (76 %) were nonresponders and 44 (24 %) responded. Median survival was 33 months, (nonresponders: 27 months, responders: not reached, Electronic supplementary material The online version of this article

Conversion therapy for peritoneal lavage cytology-positive type 4 and large type 3 gastric cancer patients selected as candidates for R0 resection by diagnostic staging laparoscopy

“…Selecting patients who should proceed to re-SL during first-line chemotherapy is also important. Blank et al [20] reported that preoperative evaluation of the response to chemotherapy by a combination of endoscopy and CT after chemotherapy was feasible in esophagogastric junctional cancer and gastric cancer patients treated with preoperative chemotherapy followed by surgical resection. They also reported that the clinical response was strongly correlated with the R0 resection rate, histological response and survival.…”

Role of histological regression grade after two neoadjuvant approaches with or without radiotherapy in locally advanced gastric cancer

“…Accurate preoperative assessment of the nodal stage seems then to be a major challenge in the attempt to provide a tailored management plan for these patients. One recent study reported that clinical response classified by a combination of CT-scan and EUS correlated with prognosis in GEJ patients treated with neoadjuvant chemotherapy and interestingly that preoperative clinical and histopathological responses were also strongly correlated ( Blank et al , 2015 ). However, the value of these image modalities seems limited in patients receiving chemoradiotherapy, given the difficulty in discriminating between residual tumour and post-radiation changes.…”

Epidermal growth factor receptor (EGFR) is an independent adverse prognostic factor in esophageal adenocarcinoma patients treated with cisplatin-based neoadjuvant chemotherapy

“…Clinical response was evaluated by endoscopy with endoluminal ultrasound and CT scan after the first and second cycle as described previously [ 54 ]. Response was defined as at least 50% reduction in the size of the primary tumor, as measured by endoscopy and imaging studies [ 55 ].…”