Prediction of Survival by Tumor Area on Endosonography after Definitive Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of the Esophagus

Abstract

Background: Definitive chemoradiotherapy (CRT) is a reasonable approach for patients with locally advanced esophageal cancer who are not surgical candidates. This study was performed to investigate whether endosonography (EUS) assessment of tumor area response is a useful prognostic marker in patients with squamous cell carcinoma (SCC) of the esophagus who receive definitive CRT. Methods: A total of 33 patients who received definitive CRT for locally advanced esophageal SCC were enrolled. The maximal transverse cross-sectional area of the tumor was measured before and after definitive therapy. EUS response was defined as a ≥50% reduction of the tumor area after definitive CRT. Results: Based on EUS evaluation, there were 20 nonresponders (60.6%) and 13 responders (39.4%). The median progression-free survival (PFS) was significantly longer in EUS responders than EUS nonresponders (p = 0.005). However, there was no statistical significance in overall survival according to EUS response (p = 0.120). During multivariate analysis, EUS response to definitive CRT was the only significant factor associated with PFS (p = 0.045), whereas EUS response to definitive CRT was not associated with overall survival (p = 0.221). Conclusions: A reduction of the maximal cross-sectional tumor area measured by EUS correlates with a superior prognosis in patients with locally advanced SCC of the esophagus after definitive CRT.

Predictive and prognostic markers from endoscopic ultrasound with biopsies during definitive chemoradiation therapy in esophageal squamous cell carcinoma

“…Compared with the individual value before or during treatment, we believed that the reduction in tumor thickness was more significant in tumor assessment clinically for patients with ESCC who received dCRT, which was also consistent with the findings from other previous studies [ 22 – 25 ]. Using changes in tumor thickness appears superior for early tumor response evaluation compared to downgrading traditional EUS-based T staging [ 24 , 26 ]. Another strength of this study was the relatively complete clinical data, including both tumor imaging characteristics and histopathological evaluation at baseline and during the treatment, which helped to assess the tumor response to dCRT comprehensively.…”

Diagnostic Value of Endoscopic Ultrasound after Neoadjuvant Chemotherapy for Gastric Cancer Restaging: A Meta-Analysis of Diagnostic Test

“…Unfortunately, there are not many studies with EUS post-NAC used for GC restaging probably because of low interest due to large variations between results, which often prove that the technique is not feasible in the restaging of this disease after NAC. More data can be found from studies that include patients with esophageal and rectal cancer [ 27 , 29 , 30 , 31 ]. In a study that assessed the role of EUS for patients with esophageal cancer, Mesenas et al showed high post-NAC T staging accuracy with EUS as compared with CT (66.7% vs. 57.7%) but without statistical significance ( p = 0.151).…”

Different strategy of salvage esophagectomy between residual and recurrent esophageal cancer after definitive chemoradiotherapy

“…Ordinal CT scans may not distinguish post-inflammatory changes and fibrosis from cancer cells. Recently, there have been a few reports of endoscopic ultrasonography (EUS) performed in cases of neoadjuvant CRT or definitive CRT (21,22). Although it is insufficient to detect small cancer foci in the fibrotic tissue, EUS seems to be useful to determine whether CRT was effective or not.…”