Should preoperative, post-chemoradiotherapy endoscopy be routine for esophageal cancer patients?

Abstract

Chemoradiation therapy is used widely for locoregional esophageal cancer. Patients with persistent disease may benefit from surgery. Preoperative esophagoscopy can identify persistent tumor but its accuracy is uncertain. The primary objective of this study is to assess the extent of agreement between esophagoscopy and surgical pathology in patients treated with neoadjuvant chemoradiation. A retrospective chart review of patients who underwent chemoradiation, preoperative endoscopy and surgery from January 1996 to December 2002 was performed. Cohen's kappa statistic was used to measure the degree of agreement between findings at endoscopic biopsy and surgical pathology. Thirty cases were identified. All patients received chemoradiation followed by surgical resection. There was insufficient agreement between tumor size (kappa 0.25, standard error 0.17, P = 0.07) and appearance (kappa 0.19, standard error 0.18, P = 0.14). Preoperative endoscopy revealed atypia/inflammation in 15 cases and dysplasia in eight. Of these 23 cases, 11 were adenocarcinomas at surgery. Only nine patients had concurrence between surgical pathology and endoscopy. The positive and negative predictive values of esophagoscopy for identifying residual tumor were 100% and 11%, respectively. Our data suggests that after chemoradiation, esophagoscopy is unreliable for excluding residual disease. The roles of other modalities need to be explored.

Optimal Timing of Endoscopic Evaluation of the Primary Site of Esophageal Cancer After Chemoradiotherapy or Radiotherapy: A Retrospective Analysis

“…Several previous studies have reported that pathological findings from endoscopic biopsy are strong, reliable indicators of the presence of viable cancer cells 25–28 . In the present study, however, four cases showed histologically confirmed evidence of viable cancer cells at the first examination but found no evidence at the next.…”

Neoadjuvant chemoradiotherapy followed by esophagectomy versus definitive chemoradiotherapy in resectable stage II/III (T1-3N0, 1M0) esophageal squamous cell carcinoma

“…In 7 of 14 patients diagnosed as clinical CR in the CRT + Surg group, a small amount of viable tumor cells was proved to remain in the primary lesion by histological examination. Microscopic residual tumor after CRT can hardly be detected even by endoscopic biopsies because the residual tumor crest often exists in the submucosal or deeper layers [20]. Positron emission tomography (PET) would be the most sensitive modality available to detect carcinomas including esophageal carcinoma.…”

Clinical utility of postchemoradiation endoscopic brush cytology and biopsy in predicting residual esophageal adenocarcinoma

“…Previous studies that evaluated endoscopic biopsy for predicting residual cancer after CRT have reported results similar to ours, including high positive predictive value (range, 92-100%) and specificity (range, 85-100%), but low sensitivity (range, 22-54%) and negative predictive value (range, 11-58%). 8,14,23,30,31 Additional studies have reported false-negative preoperative biopsies in 40% to 66% of patients who previously had what was determined to be a complete response to CRT. 14,32,33 It also has been demonstrated that esophageal biopsies taken from patients who completed CRT underestimated the histologic response within diseased tissue in up to 29% of patients.…”