Endoscopic ultrasound restaging after neoadjuvant chemotherapy in esophageal cancer

Afonso Ribeiro, Dido Franceschi, Javier Parra, Alan Livingstone, Mayra Lima, Kara Hamilton-Nelson, Bach Ardalan

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

BACKGROUND: The role of endoscopic ultrasound (EUS) to evaluate treatment response postneoadjuvant therapy for restaging esophageal cancer prior to surgical resection is uncertain. Accuracy of EUS is lower but potential to predict response to chemoradiation indicates that EUS may be helpful prior to surgery. OBJECTIVE: To determine staging accuracy of EUS after neoadjuvant chemotherapy, predictors of tumor response, and survival in locally advanced esophageal cancer. METHODS: Single-center retrospective evaluation of patients with locally advanced esophageal cancer on a prospective chemotherapy study. Patients who underwent EUS without FNA pre- and postchemotherapy were included. RESULTS: A total of 49 patients (43 men and 6 women) were evaluated with EUS pre- and postneoadjuvant chemotherapy. Forty-seven patients had tumor localized at the GE junction and two had mid-esophageal lesions. The median survival time was 53 months. Tumor and nodal staging accuracy postchemotherapy were 60% (27 of 45). T-stage accuracy postchemotherapy was superior in patients without a response to chemotherapy (95.7% vs 26.1%, p < 0.0001). More than 50% in reduction of tumor thickness postchemotherapy was associated with tumor downstage and better survival. N0 disease on final pathology was the best predictor of improved survival. CONCLUSION: Accuracy of EUS postchemotherapy is lower than initial staging accuracy; therefore the ability to predict downstaging based on EUS is marginal. Pathology N1 disease postchemotherapy is the best predictor of survival. EUS staging postneoadjuvant chemotherapy should focus on improving nodal staging accuracy with FNA.

Original languageEnglish
Pages (from-to)1216-1221
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume101
Issue number6
DOIs
StatePublished - Jun 1 2006

Fingerprint

Esophageal Neoplasms
Drug Therapy
Survival
Neoplasms
Pathology
Neoplasm Staging
Prospective Studies
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Endoscopic ultrasound restaging after neoadjuvant chemotherapy in esophageal cancer. / Ribeiro, Afonso; Franceschi, Dido; Parra, Javier; Livingstone, Alan; Lima, Mayra; Hamilton-Nelson, Kara; Ardalan, Bach.

In: American Journal of Gastroenterology, Vol. 101, No. 6, 01.06.2006, p. 1216-1221.

Research output: Contribution to journalArticle

Ribeiro, Afonso ; Franceschi, Dido ; Parra, Javier ; Livingstone, Alan ; Lima, Mayra ; Hamilton-Nelson, Kara ; Ardalan, Bach. / Endoscopic ultrasound restaging after neoadjuvant chemotherapy in esophageal cancer. In: American Journal of Gastroenterology. 2006 ; Vol. 101, No. 6. pp. 1216-1221.
@article{dd67afd8e68b4b8e8925cd4ef87a1236,
title = "Endoscopic ultrasound restaging after neoadjuvant chemotherapy in esophageal cancer",
abstract = "BACKGROUND: The role of endoscopic ultrasound (EUS) to evaluate treatment response postneoadjuvant therapy for restaging esophageal cancer prior to surgical resection is uncertain. Accuracy of EUS is lower but potential to predict response to chemoradiation indicates that EUS may be helpful prior to surgery. OBJECTIVE: To determine staging accuracy of EUS after neoadjuvant chemotherapy, predictors of tumor response, and survival in locally advanced esophageal cancer. METHODS: Single-center retrospective evaluation of patients with locally advanced esophageal cancer on a prospective chemotherapy study. Patients who underwent EUS without FNA pre- and postchemotherapy were included. RESULTS: A total of 49 patients (43 men and 6 women) were evaluated with EUS pre- and postneoadjuvant chemotherapy. Forty-seven patients had tumor localized at the GE junction and two had mid-esophageal lesions. The median survival time was 53 months. Tumor and nodal staging accuracy postchemotherapy were 60{\%} (27 of 45). T-stage accuracy postchemotherapy was superior in patients without a response to chemotherapy (95.7{\%} vs 26.1{\%}, p < 0.0001). More than 50{\%} in reduction of tumor thickness postchemotherapy was associated with tumor downstage and better survival. N0 disease on final pathology was the best predictor of improved survival. CONCLUSION: Accuracy of EUS postchemotherapy is lower than initial staging accuracy; therefore the ability to predict downstaging based on EUS is marginal. Pathology N1 disease postchemotherapy is the best predictor of survival. EUS staging postneoadjuvant chemotherapy should focus on improving nodal staging accuracy with FNA.",
author = "Afonso Ribeiro and Dido Franceschi and Javier Parra and Alan Livingstone and Mayra Lima and Kara Hamilton-Nelson and Bach Ardalan",
year = "2006",
month = "6",
day = "1",
doi = "10.1111/j.1572-0241.2006.00692.x",
language = "English",
volume = "101",
pages = "1216--1221",
journal = "American Journal of Gastroenterology",
issn = "0002-9270",
publisher = "Nature Publishing Group",
number = "6",

}

TY - JOUR

T1 - Endoscopic ultrasound restaging after neoadjuvant chemotherapy in esophageal cancer

AU - Ribeiro, Afonso

AU - Franceschi, Dido

AU - Parra, Javier

AU - Livingstone, Alan

AU - Lima, Mayra

AU - Hamilton-Nelson, Kara

AU - Ardalan, Bach

PY - 2006/6/1

Y1 - 2006/6/1

N2 - BACKGROUND: The role of endoscopic ultrasound (EUS) to evaluate treatment response postneoadjuvant therapy for restaging esophageal cancer prior to surgical resection is uncertain. Accuracy of EUS is lower but potential to predict response to chemoradiation indicates that EUS may be helpful prior to surgery. OBJECTIVE: To determine staging accuracy of EUS after neoadjuvant chemotherapy, predictors of tumor response, and survival in locally advanced esophageal cancer. METHODS: Single-center retrospective evaluation of patients with locally advanced esophageal cancer on a prospective chemotherapy study. Patients who underwent EUS without FNA pre- and postchemotherapy were included. RESULTS: A total of 49 patients (43 men and 6 women) were evaluated with EUS pre- and postneoadjuvant chemotherapy. Forty-seven patients had tumor localized at the GE junction and two had mid-esophageal lesions. The median survival time was 53 months. Tumor and nodal staging accuracy postchemotherapy were 60% (27 of 45). T-stage accuracy postchemotherapy was superior in patients without a response to chemotherapy (95.7% vs 26.1%, p < 0.0001). More than 50% in reduction of tumor thickness postchemotherapy was associated with tumor downstage and better survival. N0 disease on final pathology was the best predictor of improved survival. CONCLUSION: Accuracy of EUS postchemotherapy is lower than initial staging accuracy; therefore the ability to predict downstaging based on EUS is marginal. Pathology N1 disease postchemotherapy is the best predictor of survival. EUS staging postneoadjuvant chemotherapy should focus on improving nodal staging accuracy with FNA.

AB - BACKGROUND: The role of endoscopic ultrasound (EUS) to evaluate treatment response postneoadjuvant therapy for restaging esophageal cancer prior to surgical resection is uncertain. Accuracy of EUS is lower but potential to predict response to chemoradiation indicates that EUS may be helpful prior to surgery. OBJECTIVE: To determine staging accuracy of EUS after neoadjuvant chemotherapy, predictors of tumor response, and survival in locally advanced esophageal cancer. METHODS: Single-center retrospective evaluation of patients with locally advanced esophageal cancer on a prospective chemotherapy study. Patients who underwent EUS without FNA pre- and postchemotherapy were included. RESULTS: A total of 49 patients (43 men and 6 women) were evaluated with EUS pre- and postneoadjuvant chemotherapy. Forty-seven patients had tumor localized at the GE junction and two had mid-esophageal lesions. The median survival time was 53 months. Tumor and nodal staging accuracy postchemotherapy were 60% (27 of 45). T-stage accuracy postchemotherapy was superior in patients without a response to chemotherapy (95.7% vs 26.1%, p < 0.0001). More than 50% in reduction of tumor thickness postchemotherapy was associated with tumor downstage and better survival. N0 disease on final pathology was the best predictor of improved survival. CONCLUSION: Accuracy of EUS postchemotherapy is lower than initial staging accuracy; therefore the ability to predict downstaging based on EUS is marginal. Pathology N1 disease postchemotherapy is the best predictor of survival. EUS staging postneoadjuvant chemotherapy should focus on improving nodal staging accuracy with FNA.

UR - http://www.scopus.com/inward/record.url?scp=33744792104&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33744792104&partnerID=8YFLogxK

U2 - 10.1111/j.1572-0241.2006.00692.x

DO - 10.1111/j.1572-0241.2006.00692.x

M3 - Article

C2 - 16771940

AN - SCOPUS:33744792104

VL - 101

SP - 1216

EP - 1221

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 6

ER -