| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 3303943 | Gastrointestinal Endoscopy | 2010 | 8 Pages |
BackgroundEUS response assessment in patients with locally advanced esophageal cancer undergoing neoadjuvant chemoradiation therapy (CRT) is limited by disintegration of the involved anatomic structures.ObjectivePredictive and prognostic values of a prospectively defined maximum tumor thickness (MTT).DesignProspective open-label phase ll study (SAKK 75/02).SettingMulticenter, nationwide.PatientsOf 66 patients with primary CRT, 56 underwent en bloc esophagectomy.InterventionsEUS-measured MTT before and 2-5 weeks after CRT (yMTT).Main Outcome MeasurementsCutoffs: (1) absolute thickness (yMTT) after CRT ≤6 mm; (2) relative reduction compared with baseline (ratio yMTT/MTT) ≤50%. Correlation between EUS measurements and histopathologic tumor regression grade (TRG) and overall survival (OS).ResultsSixteen of 56 patients were not included for EUS evaluation (10 severe stenosis, 5 MTT not measured, 1 intolerance to second EUS). Characteristics (n = 40) were as follow: median age, 60 years; squamous cell carcinoma, 42%; and adenocarcinoma (AC), 58%. Initial stage was: 10 T2N1, 3 T3N0, 26 T3N1, 1 T3Nx; 14 of 23 AC Siewert type 1. Wilcoxon rank sum test showed significant correlation of TRG1 with yMTT ≤6 mm (P = .008) and yMTT/MTT ≤50% (P = .003). The effect of yMTT on TRG1 was significant (P = .0193; odds ratio, 0.687 [95% CI, 0.502-0.941]). The predefined cutoff of ≤6 mm for yMTT was predictive for TRG1 (P = .0037; Fisher exact test). After a median follow-up of 28.6 months, there was a clear trend for benefit in OS with yMTT ≤6 mm and yMTT/MTT ≤50%.LimitationsSmall sample size.ConclusionIn a multicenter setting, MTT measured by EUS after CRT was highly predictive for response and showed a clear trend for predicting survival. (Clinical trial registration number: NCT00072033.)
