Use of oesophagogastroscopy to assess the response of oesophageal carcinoma to neoadjuvant therapy

Brown, Wendy A.; Thomas, Janine; Gotley, D. C.; Burmeister, Bryan; Lim, Ki Hong; Martin, Ian; Walpole, Euan; Thomson, Damien; Harvey, Jennifer A.; Smithers, B. Mark

doi:10.1002/bjs.4411

Cited by 50 publications

(32 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As compared with CT and oesophagogastroscopy, EUS is more reliable for determining response to preoperative therapy (Brown et al, 2004;Westerterp et al, 2005). In an exploratory analysis, we attempted to assess the potential of EUS as a tool for outcome prediction to preoperative chemotherapy, evaluating the change in maximal tumour thickness with a decrease of X30% representing a response, the cut-off value utilised in RECIST and a simple response classifier.…”

Section: Discussionmentioning

confidence: 99%

A phase II trial of preoperative chemotherapy with epirubicin, cisplatin and capecitabine for patients with localised gastro-oesophageal junctional adenocarcinoma

et al. 2009

Self Cite

View full text Add to dashboard Cite

Preoperative cisplatin/fluorouracil is used for the treatment of localised oesophageal carcinoma. This phase II study aimed to assess the efficacy and safety of administering preoperative epirubicin/cisplatin/capecitabine (ECX). Patients with stage II or III oesophageal/ gastro-oesophageal junctional adenocarcinoma from one institution received 4 cycles of ECX (epirubicin 50 mg m À2 day 1, cisplatin 60 mg m À2 day 1, capecitabine 625 mg m À2 b.i.d. daily) followed by surgery. The primary end point was the pathological complete response (pCR) rate based on a Simon two-stage design. Secondary end points included overall and progression-free survival (OS/ PFS). Thirty-four patients were recruited: median age 60 years (range 41 -81), 91% male, 97% PS 0/1, 80% T3, 68% N1. Thirty-one patients completed four ECX cycles. Grade 3/4 toxicities X5% included neutropenia (62%), hand -foot syndrome (15%) and nausea/ vomiting (9%). Thirteen out of 28 (46%) evaluable patients responded to chemotherapy by EUS (X30% reduction in maximal tumour thickness). Twenty-six out of 34 (76%) patients underwent resection (R0 ¼ 73%, R1 ¼ 27%). Post-operatively, two patients died within 60 days of surgery. The pCR rate was 5.9% (95% CI 0 -14%) in the intent-to-treat population. According to the statistical design, this prompted early study termination. However, with a median follow-up of 34 months the median OS and 1-and 2-year survival rates were 17 months, 67 and 39% respectively. Median PFS was 13 months. Of the 14 relapsed patients, 10 presented with distant metastases. Preoperative ECX is feasible and well tolerated. Although associated with a low pCR rate, survival with ECX was comparable with published studies suggesting that pCR may not correlate with satisfactory outcome from preoperative chemotherapy for localised oesophageal adenocarcinoma.

show abstract

Section: Discussionmentioning

confidence: 99%

A phase II trial of preoperative chemotherapy with epirubicin, cisplatin and capecitabine for patients with localised gastro-oesophageal junctional adenocarcinoma

et al. 2009

Self Cite

View full text Add to dashboard Cite

show abstract

“…The response to chemoradiotherapy evaluated by endoscopy was classified as either no response, less than 50% response, more than 50% response, or complete response. These broad classifications were used in an attempt to reduce inter-observer variation (Brown et al, 2004). Tumour response evaluated by radiology was assessed according to the response evaluation criteria in solid tumours (RECIST) (Therasse et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant concurrent chemoradiation with weekly paclitaxel and carboplatin for patients with oesophageal cancer: a phase II study

et al. 2006

View full text Add to dashboard Cite

This study was performed to assess the efficacy and safety of preoperative chemoradiation consisting of carboplatin and paclitaxel and concurrent radiotherapy for patients with resectable (T2-3N0-1M0) oesophageal cancer. Treatment consisted of paclitaxel 50 mg m À2 and carboplatin AUC ¼ 2 on days 1, 8, 15, 22 and 29 and concurrent radiotherapy (41.4 Gy in 23 fractions, 5 days per week), followed by oesophagectomy. All 54 entered patients completed the chemoradiation without delay or dose-reduction. Grade 3 -4 toxicities were: neutropaenia 15%, thrombocytopaenia 2%, and oesophagitis 7.5%. After completion of the chemoradiotherapy 63% had a major endoscopical response. Fifty-two patients (96%) underwent a resection. The postoperative mortality rate was 7.7%. All patients had an R0-resection. The pathological complete response rate was 25%, and an additional 36.5% had less than 10% vital residual tumour cells. At a median follow-up of 23.2 months, the median survival time has not yet been reached. The probability of disease-free survival after 30 months was 60%. In conclusion, weekly neoadjuvant paclitaxel and carboplatin with concurrent radiotherapy is a very tolerable regimen and can be given on an outpatient basis. It achieves considerable down staging and a subsequent 100% radical resection rate in this series. A phase III trial with this regimen is now ongoing.

show abstract

“…Endoscopic rebiopsy of tumors after completion of neoadjuvant therapy has been evaluated as a means to predict histopathological response, but this approach is unreliable in the prediction of response [31,37].…”

Section: Rebiopsy Of Tumorsmentioning

confidence: 99%

“…Endoscopy Macroscopic appearance after treatment is associated with histopathological response, but with a limited accuracy of 50% (sensitivity, 57%; specificity, 36%) [37].…”

Section: Imaging Predictive Biomarkers Anatomical Imagingmentioning

confidence: 99%

Predicting Response to Treatment in Gastroesophageal Junction Adenocarcinomas: Combining Clinical, Imaging, and Molecular Biomarkers

Bain

Petty

2010

The Oncologist

View full text Add to dashboard Cite

After completing this course, the reader will be able to:1. Contrast the subtypes of gastroesophageal adenocarcinoma in order to select optimal therapeutic approaches for given subtypes.2. Compare the various tools (CT, MRI, PET, PET-CT, etc.) for evaluating response to therapy in order to determine whether to initiate new therapy.3. Evaluate response to neoadjuvant therapy, utilizing imaging, histopathogy of resected specimens, and biomarkers, to plan postoperative treatment.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTThe incidence of adenocarcinomas of the gastroesophageal junction (GEJ) is rapidly rising, and even in earlystage locoregional confined disease the 5-year survival rate rarely exceeds 25%-35%. Randomized trials and meta-analyses have demonstrated a benefit with neoadjuvant or perioperative chemotherapy and with neoadjuvant chemoradiotherapy. However, the optimal approach in individual patients is not clear and remains controversial. A consistent finding is that patients who have a histopathological response to neoadjuvant therapy are more likely to receive a survival benefit. These clinical data provide a strong argument for the urgent development of methods to predict histopathological response to neoadjuvant therapies for GEJ adeno- The Oncologist CME Program is located online at http://cme.theoncologist.com/.To take the CME activity related to this article, you must be a registered user. Gastrointestinal CancerThe

show abstract

Use of oesophagogastroscopy to assess the response of oesophageal carcinoma to neoadjuvant therapy

Abstract: Oesophagogastroscopy may be useful in the assessment of tumour response to neoadjuvant therapy. However, owing to its poor accuracy patients should not be excluded from further therapeutic intervention on the basis of this assessment alone.

Cited by 50 publications

References 24 publications

A phase II trial of preoperative chemotherapy with epirubicin, cisplatin and capecitabine for patients with localised gastro-oesophageal junctional adenocarcinoma

A phase II trial of preoperative chemotherapy with epirubicin, cisplatin and capecitabine for patients with localised gastro-oesophageal junctional adenocarcinoma

Neoadjuvant concurrent chemoradiation with weekly paclitaxel and carboplatin for patients with oesophageal cancer: a phase II study

Predicting Response to Treatment in Gastroesophageal Junction Adenocarcinomas: Combining Clinical, Imaging, and Molecular Biomarkers

Contact Info

Product

Resources

About