Pretreatment staging by endoscopic ultrasonography does not predict complete response to neoadjuvant chemoradiation in patients with esophageal carcinoma

Abstract

BACKGROUND Endoscopic ultrasonography (EUS) provides highly accurate preoperative T and N classifications in patients with esophageal carcinoma. Although previous data have suggested that patients with tumors classified as T4 by EUS do not benefit from surgical resection, these data were acquired prior to the widespread use of preoperative chemoradiation. The current study investigated whether pretreatment EUS can predict a complete response to neoadjuvant therapy. METHODS Patients with esophageal carcinoma (adenocarcinoma or squamous cell carcinoma) underwent EUS classification prior to therapy. Patients classified as T2, T3, or T4 and M0 were treated with 5‐fluorouracil, cisplatin, and radiation under protocol. Patients with T1 lesions underwent resection without prior chemoradiation. Chemoradiation was followed in all cases by attempted surgical resection. The initial EUS classification was compared with the final pathologic results. RESULTS Fifty‐five patients (47 males and 8 females) with a mean age of 60.5 years (range, 31–78 years) were evaluated. There were 41 adenocarcinomas and 14 squamous cell carcinomas. Among the total population, a complete response was achieved in 3 of 5 patients (60%) with tumors classified as T2 by EUS, 14 of 42 patients (33%) with tumors classified as T3 by EUS, and 5 of 8 patients (63%) with tumors classified as T4 by EUS (P = 0.19). A complete response was achieved in 9 of 24 patients (38%) found to have N0 disease by EUS versus 13 of 30 patients (43%) determined to have N1 disease (P = 0.66). The results for patients with adenocarcinoma and squamous cell carcinoma were similar. CONCLUSIONS The results of the current study demonstrate that pretreatment EUS does not predict reliably which patients with esophageal carcinoma will achieve a complete pathologic response to preoperative neoadjuvant chemoradiation. Cancer 1999;86:764–9. © 1999 American Cancer Society.

Histomorphologic Tumor Regression and Lymph Node Metastases Determine Prognosis Following Neoadjuvant Radiochemotherapy for Esophageal Cancer

“…2,13,14 Clinical response evaluation based on WHO criteria 15 is known to be highly inaccurate in esophageal cancer using conventional staging modalities, including barium swallow, endoscopy, endosonography, or CT of chest and abdomen. 16,30,31 Positron emission tomography (PET) with 18-fluorodeoxyglucose might offer improved specificity and accuracy for clinical response evaluation 32,33 or response prediction. 34 It has been shown, however, that PET imaging clearly improves staging of esophageal cancers primarily through increased sensitivity and specificity in the detection of distant metastases.…”

A large series, resection controlled study to assess the value of radial EUS in restaging gastroesophageal cancer following neoadjuvant chemotherapy

“…17 Maximal tumor area can measured at EUS and patients with a 50% or greater reduction in this index following chemoradiation are more likely to show tumor regression and lesions confined to the esophagus at the time of resection, in addition to having a survival advantage. 14,[18][19][20] Studies detailing this criterion, however, have been small. The current work uses a simple, universally applicable measure of tumor response and has demonstrated survival benefit amongst responders as compared to non-responders.…”

Useful Endoscopic Ultrasonography to Assess the Efficacy of Neoadjuvant Therapy for Advanced Esophageal Carcinoma: Based on the Response Evaluation Criteria in Solid Tumors

“…There have been reports that it is difficult to detect a histological CR in the case of extremely small residual tumors by EUS. [12][13][14] This may be because correct diagnosis is affected by consequences of neoadjuvant therapy, such as necrosis, fibrosis, inflammation and soft tissue reaction. 12,[14][15][16] In the present study, Grade 3 was not detected well by measurement of tumor thickness.…”