Pragmatic staging of oesophageal cancer using decision theory involving selective endoscopic ultrasonography, PET and laparoscopy

Findlay, John M.; Bradley, Kevin M.; Maile, Edward; Braden, Barbara; Maw, J.; Phillips‐Hughes, Jane; Gillies, Richard; Maynard, Nicholas; Middleton, Mark R.

doi:10.1002/bjs.9905

Cited by 48 publications

(45 citation statements)

References 26 publications

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“…28 In early lesions, endoscopic mucosal resection provides a good specimen for histopathological assessment. Staging measures for more advanced tumours include positron-emission tomography-computerised tomography (PET-CT) and endoscopic ultrasound, 29,30 Laparoscopy and bronchoscopy are indicated if there is suspicion of abdominal tumour spread and tumour overgrowth on bronchi, respectively. 29,31 Laparoscopy can also uncover tumoural extension on the gastric part for junctional adenocarcinomas, identify comorbidities (e.g.…”

Section: Operabilitymentioning

confidence: 99%

Oesophageal cancer

et al. 2017

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SummaryOesophageal cancer is a clinically challenging disease requiring a multidisciplinary approach.The extensive treatment may be associated with serious limitations in health-related quality of life and yet still a poor prognosis. Recent decades have witnessed a gradual improvement in prognosis in many countries. Endoscopic procedures have increasingly been used in the treatment of premalignant and early oesophageal tumours. Neoadjuvant therapy with chemotherapy or chemoradiotherapy has supplemented surgery as standard treatment of locally advanced oesophageal cancer. Surgery has become more standardised and centralised. There are several therapeutic alternatives for palliative treatment. This review aims to provide insights into the current clinical management, on-going controversies and future needs in oesophageal cancer.3

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Section: Operabilitymentioning

confidence: 99%

Oesophageal cancer

et al. 2017

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“…For esophageal and esophago-gastric cancer, contrastenhanced computed tomography (CT) remains the most commonly performed first step in staging due to the high prevalence of metastatic disease at presentation [14][15][16]. For patients being considered for a curative pathway, endoscopic ultrasound (EUS) and 18F-fluorodeoxyglu-cose positron emission tomography/CT (18F-FDG PET/ CT) are performed due to the high sensitivity and specificity of EUS for local tumor and nodal staging; and 18F-FDG PET for distant metastases [17][18][19].…”

Section: The Imaging Pathway At Stagingmentioning

confidence: 99%

Radiomics in esophageal and gastric cancer

et al. 2018

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Esophageal, esophago-gastric, and gastric cancers are major causes of cancer morbidity and cancer death. For patients with potentially resectable disease, multimodality treatment is recommended as it provides the best chance of survival. However, quality of life may be adversely affected by therapy, and with a wide variation in outcome despite multi-modality therapy, there is a clear need to improve patient stratification. Radiomic approaches provide an opportunity to improve tumor phenotyping. In this review we assess the evidence to date and discuss how these approaches could improve outcome in esophageal, esophago-gastric, and gastric cancer.

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“…All patients who underwent potentially curative surgical resection of esophageal/gastroesophageal junctional cancer and were staged initially with CT and 18 F-FDG PET/CT were identified from a departmental database (May 2006 to November 2014) (16). This included all cell types.…”

Section: Patients and Staging Protocolmentioning

confidence: 99%

“…The study was approved by the institutional clinical governance department, and the need for written informed consent was waived. Patients were also staged with endoscopic ultrasound and laparoscopy for tumors extending below the diaphragm as previously described (16). Examinations were reported by a consultant upper gastrointestinal radiologist/gastroenterologist using the contemporary American Joint Committee on Cancer TNM staging manual (sixth (17) or seventh edition (18)).…”

Section: Patients and Staging Protocolmentioning

confidence: 99%

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Predicting Pathologic Response of Esophageal Cancer to Neoadjuvant Chemotherapy: The Implications of Metabolic Nodal Response for Personalized Therapy

et al. 2016

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Only a minority of esophageal cancers demonstrates a pathologic tumor response (pTR) to neoadjuvant chemotherapy (NAC). 18 F-FDG PET/CT is often used for restaging after NAC and to assess response. Increasingly, it is used during therapy to identify unresponsive tumors and predict pTR, using avidity of the primary tumor alone. However, definitions of such metabolic tumor response (mTR) vary. We aimed to comprehensively reevaluate metabolic response assessment using accepted parameters, as well as novel concepts of metabolic nodal stage (mN) and metabolic nodal response (mNR).Methods: This was a single-center retrospective U.K. cohort study. All patients with esophageal cancer staged before NAC with PET/CT and after with CT or PET/CT and undergoing resection from 2006 to 2014 were identified. pTR was defined as Mandard tumor regression grade 1-3; imaging parameters included metrics of tumor avidity (SUV max/mean/peak ), composites of avidity and volume (including metabolic tumor volume), nodal SUV max , and our new concepts of mN stage and mNR. Results: Eighty-two (27.2%) of 301 patients demonstrated pTR. No pre-NAC PET parameters predicted pTR. In 220 patients restaged by PET/CT, the optimal tumor DSUV max threshold was a 77.8% reduction. This was as sensitive as the current PERCIST 30% reduction, but more specific with a higher negative predictive value (P , 0.001). DSUV max and Dlength independently predicted pTR, and composite avidity/spatial metrics outperformed avidity alone. Although both mTR and mNR were associated with pTR, in 82 patients with 18 F-FDG-avid nodes before NAC we observed mNR in 10 (12.2%) not demonstrating mTR. Conclusion: Current definitions of metabolic response are suboptimal and too simplistic. Composite avidity/volume measures improve prediction. mNR may further improve response assessment, by specifically assessing metastatic tumor subpopulations, likely responsible for disease relapse, and should be urgently assessed when considering aborting therapy on the basis of mTR alone.

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Pragmatic staging of oesophageal cancer using decision theory involving selective endoscopic ultrasonography, PET and laparoscopy

Abstract: Although EUS provided additional information on T and N category, its risk outweighed potential benefit in patients with T2-T4a disease on CT. Laparoscopy seemed justified for distal oesophageal tumours of T2 or greater.

Cited by 48 publications

References 26 publications

Oesophageal cancer

Oesophageal cancer

Radiomics in esophageal and gastric cancer

Predicting Pathologic Response of Esophageal Cancer to Neoadjuvant Chemotherapy: The Implications of Metabolic Nodal Response for Personalized Therapy

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