Endoscopy 2018; 50(04): S58
DOI: 10.1055/s-0038-1637200
ESGE Days 2018 oral presentations
20.04.2018 – EUS: diagnostic
Georg Thieme Verlag KG Stuttgart · New York

ENDOSONOGRAPHIC MEASUREMENTS OF TUMOR THICKNESS AND SURFACE AREA TO PREDICT TUMOR RESPONSE AFTER NEOADJUVANT CHEMORADIOTHERAPY IN PATIENTS WITH ESOPHAGEAL CANCER; A MULTICENTER PROSPECTIVE COHORT STUDY

RD van der Bogt
1   Erasmus MC – University Medical Center Rotterdam, Department of Gastroenterology, Rotterdam, Netherlands
,
BJ Noordman
2   Erasmus MC – University Medical Center Rotterdam, Department of Surgery, Rotterdam, Netherlands
,
KK Krishnadath
3   Academic Medical Center, Department of Gastroenterology, Amsterdam, Netherlands
,
CAM Roumans
1   Erasmus MC – University Medical Center Rotterdam, Department of Gastroenterology, Rotterdam, Netherlands
,
EJ Schoon
4   Catharina Hospital, Department of Gastroenterology, Eindhoven, Netherlands
,
LE Oostenbrug
5   Zuyderland Medical Center, Department of Gastroenterology, Heerlen, Netherlands
,
PD Siersema
6   Radboud University Medical Center, Department of Gastroenterology, Nijmegen, Netherlands
,
FP Vleggaar
7   University Medical Center, Department of Gastroenterology, Utrecht, Netherlands
,
JJB van Lanschot
2   Erasmus MC – University Medical Center Rotterdam, Department of Surgery, Rotterdam, Netherlands
,
MCW Spaander
1   Erasmus MC – University Medical Center Rotterdam, Department of Gastroenterology, Rotterdam, Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Endosonography (EUS) is an accurate method for initial staging in esophageal cancer, but does not accurately assess T stage after neoadjuvant chemoradiotherapy (nCRT). EUS maximum tumor thickness (MTT) and maximum tumor area (MTA) have been shown to correlate well with histopathologic residual tumor volume. This study assessed the predictive value of EUS-based measurement by using both MTT and MTA for detection of residual disease after completion of nCRT.

Methods:

This was a multicenter prospective cohort study within the preSANO study. Patients with esophageal cancer were treated according to the CROSS-regimen. In all patients a radial EUS was performed with measurement of MTT and MTA pre-treatment and at 6 weeks after completion of nCRT. In case patients had no tumor in biopsies at 6 weeks post-treatment, a third EUS measurement was performed at 12 weeks. The primary aim of this study was to assess the accuracy to detect TRG 3 – 4 residual tumors by EUS-based measurements. For this study, a TRG1 was considered a complete response. An univariate logistic regression model and a receiver-operating characteristic curve were used to determine the association between EUS-based measurements and residual tumor.

Results:

Out of 207 patients included in the preSANO trial a total of 156 underwent surgery. After revision of all EUS measurements, a total of 138 patients were included for analysis. MTT and MTA were significantly associated with residual tumor at 12 weeks (odds ratio 1.36, p < 0.01 and 1.64, p = 0.02, resp.). A cut-off of 4.5 mm for MTT had a sensitivity of 87% and specificity of 52%. For MTA, a cut-off of 0.92 cm2 was optimal, with a sensitivity of 89% and a specificity of 40%.

Conclusions:

In this multicenter prospective study we found that MTT and MTA adequately predict TRG3 and TRG4 residual tumor with a sensitivity of almost 90% at 12 weeks after completion of nCRT.