Endoscopy 2019; 51(04): 326-332
DOI: 10.1055/a-0795-3220
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic ultrasound measurements for detection of residual disease after neoadjuvant chemoradiotherapy for esophageal cancer

Ruben D. van der Bogt*
1  Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
,
Bo J. Noordman*
2  Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
,
Kausilia K. Krishnadath
3  Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
,
Carlijn A. M. Roumans
1  Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
4  Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
,
Erik J. Schoon
5  Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
,
Liekele E. Oostenbrug
6  Department of Gastroenterology and Hepatology, Zuyderland Medical Center, Heerlen, the Netherlands
,
Peter D. Siersema
7  Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
,
Frank P. Vleggaar
8  Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
,
J. Jan B. van Lanschot
2  Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
,
Manon C. W. Spaander
1  Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
› Author Affiliations
TRIAL REGISTRATION: Prospective multicenter single-arm diagnostic cohort study NTR4834 at trialregister.nl
Further Information

Publication History

submitted 12 July 2018

accepted after revision 04 October 2018

Publication Date:
29 November 2018 (eFirst)

Abstract

Background Endoscopic ultrasound (EUS) measurements of residual thickness and residual area have been suggested to correlate with histopathological residual tumor after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer. This study assessed the predictive value of EUS-based measurements using tumor thickness and tumor area before nCRT, and residual thickness and residual area 6 and 12 weeks after completion of nCRT for detection of residual disease.

Methods This was a substudy of the diagnostic multicenter preSANO trial. The primary end point of the current study was the percentage of tumor regression grade (TRG) 3 – 4 (> 10 % vital tumor cells) residual disease that was detected using EUS-based measurements. Associations of absolute measurements of residual thickness/area and proportional change compared with baseline were evaluated. In the case of a statistically significant association, optimal cut-offs to distinguish TRG3 – 4 residual disease from TRG1 (no vital tumor cells) were determined using Youden’s J index.

Results 138 patients were included. Residual thickness and residual area were statistically significantly associated with TRG3 – 4 residual disease 12 weeks after completion of nCRT (odds ratio 1.36, P < 0.01 and 1.64, P = 0.02, respectively). The cut-off for residual thickness was 4.5 mm, which correctly detected 87 % of TRG3 – 4 residual disease and 52 % of TRG1. The cut-off for residual area was 0.92 cm2, which detected 89 % of TRG3 – 4 residual disease and 40 % of TRG1.

Conclusions EUS measurements of residual thickness and residual area adequately detected TRG3 – 4 residual disease with a sensitivity of almost 90 % 12 weeks after completion of nCRT. Hence, residual thickness and residual area may aid in the restaging of esophageal cancer after nCRT.

* These authors contributed equally to this work.