Endoscopic ultrasound for structured surveillance after curative treatment of esophageal cancer

Abstract

Background Structured surveillance after treatment of esophageal cancer is not established. Due to a paucity of data, no agreement exists on how surveillance should be performed. The main argument against intensive follow-up in esophageal cancer is that it may not lead to true survival advantage.

Methods Structured surveillance was performed in 42 patients after multimodal therapy with peri-operative chemotherapy (29) or definitive chemoradiotherapy (13) of esophageal cancer. The surveillance protocol included gastroscopy, endoscopic ultrasound, chest X-ray, abdominal ultrasound, and CEA measurement at regular intervals of up to five years. We analyzed relapse rate, time to relapse, localization of recurrence, diagnosis within or without structured surveillance, diagnostic method providing the first evidence of a relapse, treatment of recurrence, and outcome.

Results Median follow-up was 48 months; 18/42 patients suffered from tumor relapse, with 16 asymptomatic patients diagnosed within structured surveillance. Median time to recurrence was 9 months. Isolated local or locoregional recurrence occurred in 6, and isolated distant relapse in 9 patients. All patients with isolated locoregional recurrence were exclusively diagnosed with endoscopic ultrasound. Six patients received curatively intended therapy with surgery or chemoradiation, leading to long-lasting survival.

Conclusion Structured surveillance offers the chance to identify limited and asymptomatic tumor relapse. Especially in cases of locoregional recurrence, long-lasting survival or even a cure can be achieved. Endoscopic ultrasound is the best method for the detection of locoregional tumor recurrence and should be an integral part of structured surveillance after curative treatment of esophageal cancer.

Zusammenfassung

Hintergrund Aufgrund limitierter Datenlage sind aktuell sowohl die Sinnhaftigkeit als auch die konkrete Ausgestaltung eines strukturierten Nachsorgeprotokolls nach kurativer Behandlung eines Ösosphaguskarzinoms unklar.

Methodik Wir führten bei 42 Patienten nach kurativer Therapie eines Ösophaguskarzinoms (multimodale Therapie mit perioperativer Chemotherapie: 29, definitive Radiochemotherapie: 13) eine strukturierte Nachsorge bestehend aus regelmäßiger Gastroskopie, Endosonographie, Abdomensonographie, Thorax-Röntgen und CEA-Bestimmung über insgesamt 5 Jahre durch. Erfasst wurden Rezidivrate, Zeitpunkt und Lokalisation des Rezidivs, Diagnosestellung innerhalb oder außerhalb des Nachsorgeprogrammes, zur Rezidivdiagnose führende Diagnosemodalität sowie Art der Rezidivtherapie und Langzeitprognose nach Rezidivdiagnose.

Ergebnisse Nach einer medianen Nachbeobachtungszeit von 48 Monaten entwickelten 18/42 Patienten ein Rezidiv. Dieses trat im Median nach 9 Monaten auf. Von den 18 Patienten mit Tumorrezidiv wurden 16 Patienten, sämtlich asymptomatisch, im Rahmen der strukturierten Nachsorge entdeckt. Sechs Patienten hatten ein isoliertes lokales oder lokoregionäres Rezidiv, 9 Patienten ausschließlich Fernmetastasen. Alle lokoregionären Rezidive wurden ausschließlich mittels endoskopischen Ultraschalls entdeckt. Bei sechs Patienten konnte durch eine kurativ intendierte Rezidivtherapie (Resektion oder Radiochemotherapie) ein Langzeitüberleben erreicht werden.

Schlussfolgerung mittels strukturierter Nachsorge können asymptomatische Patienten mit lokal begrenztem Tumorrezidiv frühzeitig identifiziert werden. Insbesondere bei lokoregionär begrenztem Tumorrezidiv eröffnet sich die Chance auf eine kurativ intendierte Rezidivtherapie. Die Endosonographie ist die beste Methode, derartige lokoregionär begrenzte Rezidive nachzuweisen und sollte deshalb integraler Bestandteil eines strukturierten Nachsorgeprotokolls sein.

Keywords

esophageal cancer - surveillance - endoscopic ultrasound - locoregional tumor recurrence - follow-up

Schlüsselwörter

Ösophaguskarzinom - Nachsorge - Endosonografie - Tumorrezidiv - Verlaufskontrolle

Publication History

Received: 21 March 2023

Accepted after revision: 06 July 2023

Article published online:
10 January 2024

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