Predictive value of endoscopic esophageal findings for residual esophageal cancer after neoadjuvant chemoradiotherapy

Abstract

Background Endoscopic evaluation of the esophageal mucosa may play a role in an active surveillance strategy after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer. This study investigated the yield of endoscopic findings for detection of residual disease. Methods Patients from the multicenter preSANO cohort, who underwent nCRT followed by surgery for esophageal or junctional cancer, were included. Upper endoscopy was performed 6 and 12 weeks after nCRT. Patients with residual disease at 6 weeks underwent immediate surgery. Endoscopic records were reviewed for presence of stenosis, suspicion of residual tumor, scar tissue, and ulceration. Presence and type of endoscopic findings were compared with outcome of the resection specimen. Results 118 of 156 patients (76 %) had residual disease in the resection specimen. Endoscopic suspicion of residual tumor was significantly associated with presence of residual disease. At 6 weeks, 40/112 patients with residual disease and 4/33 patients with complete response had endoscopic suspicion of residual tumor (36 % vs. 12 %; P = 0.01), while this was reported in 16/73 and 0/28 patients, respectively, at 12 weeks (22 % vs. 0 %; P < 0.01). Positive predictive value of endoscopic suspicion of residual tumor was 91 % at 6 weeks and 100 % at 12 weeks. Endoscopic findings of non-passable stenosis, passable stenosis, scar tissue, or ulceration were not associated with residual disease. Conclusions Endoscopic suspicion of residual tumor was the only endoscopic finding associated with residual disease. Based on its positive predictive value, this endoscopic finding may contribute to the diagnostic strategy used in active surveillance.

Bite-on-bite biopsies for the detection of residual esophageal cancer after neoadjuvant chemoradiotherapy

“…Of 26 patients with residual cancer that remained undetected by bite-on-bite biopsies (i. e. with a false-negative biopsy outcome; 19 %), 22 (16 %) had a clinically complete response and underwent surgery because they were allocated to the standard surgery arm, three (2 %) had a positive FNA from a suspicious lymph node, and one (1 %) had a high suspicion of residual cancer on the basis of endoscopic and PET/CT findings [15,16].…”

Active surveillance of oesophageal cancer after response to neoadjuvant chemoradiotherapy: dysphagia is uncommon

“…Nevertheless, this interval probably contained the most relevant information regarding the effects of radiotherapy-induced inflammation on dysphagia (that is dysphagia caused by swelling), as this inflammation is expected to resolve within the first year of active surveillance in patients with an ongoing cCR 19 . Furthermore, recent data have shown that 45 per cent of patients with stenosis early after nCRT and standard oesophagectomy have a complete response in the resection specimen 20 . For the subgroup of patients with such stenosis, it remains unknown whether the stenosis, with or without dysphagia, would have persisted if they had undergone active surveillance (with or without endoscopic dilatation) and remained cancer-free.…”

A prospective cohort study on active surveillance after neoadjuvant chemoradiotherapy for esophageal cancer: protocol of Surgery As Needed for Oesophageal cancer-2

“…If cytology of suspicious lymph nodes is non-representative again, the patient should be considered to have residual disease and surgical resection is advised. Endoscopic suspicion of residual tumor after nCRT is associated with presence of residual disease (positive predictive value 91%) and further treatment of these patients should therefore be discussed in a multidisciplinary team [ 18 ].…”