FA06.05: Detecting Residual Esophageal Cancer After Neoadjuvant Chemoradiation by Endoscopic Biopsies, Eus and FDG-Pet: A Systematic Review and Meta-Analysis

Abstract

Background After curatively intended neoadjuvant chemoradiotherapy (nCRT) according to CROSS plus surgery for esophageal cancer, 29% of patients have a pathologic complete response. Active surveillance after nCRT, in which patients undergo frequent clinical examinations and where esophagectomy is only offered to those with a locoregional regrowth without distant metastases, has been proposed as novel treatment option. This study provides a systematic review and meta-analysis of the literature regarding the accuracy of endoscopic biopsies, endoscopic ultrasound (EUS) and 18F-FDG PET(-CT) for detecting residual disease after nCRT for esophageal cancer. Methods A systematic literature search in Embase, Medline, Cochrane and Web of Science was performed. Two reviewers independently collected studies on the diagnostic accuracy of endoscopic biopsies, EUS and 18F-FDG PET(-CT) for detecting residual disease after nCRT at the primary tumor site or in regional lymph nodes for potentially curable esophageal adenocarcinoma (AC) or squamous cell carcinoma (SCC). Histopathological examination of the resection specimen was the reference standard. Study quality was appraised with the QUADAS-2 tool. Sensitivity and specificity values were calculated and pooled using meta-analyses. Subgroup analyses were performed to investigate possible sources of heterogeneity. Results 60 studies were included for qualitative analysis and 40 for quantitative analysis. For detecting residual disease at the primary tumor site, 11 studies evaluated endoscopic biopsies, 11 described EUS qualitatively, 14 evaluated PET qualitatively, 12 evaluated PET quantitatively, 6 of them using SUVmax and 6 of them using DSUVmax. Summary sensitivity values were 0.36 (95%CI 0.27–0.45), 0.97 (95%CI 0.94–0.98), 0.74 (95%CI 0.66–0.81), 0.68 (95%CI 0.61–0.74) and 0.68 (95%CI 0.54–0.79), respectively. Summary specificity values were 0.93 (95%CI 0.85–0.97), 0.09 (95%CI 0.04–0.19), 0.52 (95%CI 0.40–0.63), 0.70 (95%CI 0.61–0.78), 0.70 (95%CI 0.60–0.78) and respectively. For detecting residual malignant lymph nodes, 11 studies evaluated EUS with a summary sensitivity of 0.68 (95%CI 0.54–0.80) and a summary specificity of 0.58 (95%CI 0.45–0.70). Subgroup analyses demonstrated that sensitivity of endoscopic biopsy, PET DSUVmax and EUS for nodal was higher in SCC than in AC. Conclusion Current literature suggests insufficient accuracy of endoscopic biopsies, EUS and 18F-FDG PET(-CT) as individual modalities for detecting residual disease after nCRT for potentially curable esophageal cancer. Disclosure All authors have declared no conflicts of interest.

Diffusion-weighted MRI and 18F-FDG PET/CT in assessing the response to neoadjuvant chemoradiotherapy in locally advanced esophageal squamous cell carcinoma

“…Many clinical trials have been conducted to identify the value of PET parameters to predict pathological response. Several meta-analyses have indicated that 18 F-FDG PET/CT images were unable to accurately detect pathological response, the sensitivities and specificities were 60%-70% [20][21][22]. Most of these studies used SUVmax or percentage reduction of SUVmax as criterion.…”

S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus

“…Das „Re-Staging“ nach erfolgter neo-adjuvanter Therapie von Ösophaguskarzinomen und AEG-Tumoren ist in der klinischen Praxis erheblich limitiert, da die Tumoren häufig post-therapeutisch starke Regressions-Veränderungen (Nekrosen, Narben) aufweisen und entzündliche lokale Faktoren zu falsch positiven Ergebnissen bei allen bildgebenden Modalitäten führen können. Dies zeigen neue Meta-Analysen 109 110 111 deutlich, indem die gepoolte Sensitivität für CT, PET-CT, EUS und MRT zur Erfassung einer „Vollremission“ nach neo-adjuvanter Therapie zur Aufdeckung einer ypT0 – Response nur 35 % (CT), 62 % (PET-CT), < 10 % (EUS) und 80 % für das MRT betrugen. Die korrespondierende Spezifität lag dabei zwischen 73 % und 99 % (de Gouw et al).…”

S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus

“…Das „Re-Staging“ nach erfolgter neo-adjuvanter Therapie von Ösophaguskarzinomen und AEG-Tumoren ist in der klinischen Praxis erheblich limitiert, da die Tumoren häufig post-therapeutisch starke Regressions-Veränderungen (Nekrosen, Narben) aufweisen und entzündliche lokale Faktoren zu falsch positiven Ergebnissen bei allen bildgebenden Modalitäten führen können. Dies zeigen neue Meta-Analysen 100 101 102 deutlich, indem die gepoolte Sensitivität für CT, PET-CT, EUS und MRT zur Erfassung einer „Vollremission“ nach neo-adjuvanter Therapie zur Aufdeckung einer ypT0 – Response nur 35 % (CT), 62 % (PET-CT), < 10 % (EUS) und 80 % für das MRT betrugen. Die korrespondierende Spezifität lag dabei zwischen 73 % und 99 % (de Gouw et al).…”