P58 Endoscopic ultrasound is not accurate for restaging of esophageal cancer after pre-operative chemotherapy

Machlenkin, Svetlana; Meltzer, E.O.; Idelevich, Efraim; Ziv-Sokolovsky, N.; Kashtan, Hanoch

doi:10.1097/00004836-200609001-00140

Cited by 5 publications

(7 citation statements)

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“…Sixteen studies (n = 724) that met the inclusion criteria were included in the analysis as shown in Figure 1. [17][18][19][20][22][23][24][25][26][27][28][29][30][31][32][33] Data of T staging were extracted from all 16 studies while data of N staging were extracted from 13 of included studies. For all included studies, the number of patients ranged from 11 to 111.…”

Section: Resultsmentioning

confidence: 99%

“…15,16 To date, EUS instrument is improved with the development of ultrasound catheters or 'miniature probes'. These miniature probes, which are passed through standard endoscopes, can provide ultrahigh-frequency imaging (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) MHz) compared with standard echo-endoscopes (5)(6)(7)(8)(9)(10)(11)(12). Higher frequency means higher resolution of the tumor.…”

Section: Introductionmentioning

confidence: 99%

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Staging accuracy of endoscopic ultrasound for esophageal cancer after neoadjuvant chemotherapy: a meta-analysis and systematic review

et al. 2014

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This study aims to evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer after neoadjuvant chemotherapy (NAC). Articles were searched in Medline, Pubmed, Cochrane Database of Systemic Reviews, Google scholar, and EMBASE. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios (LR), and diagnostic odds ratio (DOR). Pooling was conducted using either fixed-effects model or random-effects model depending on the heterogeneity across studies. Sixteen studies (n = 724) were included in this analysis. The pooled sensitivity and specificity of EUS to diagnose T1 stage tumor was 23% (95% confidence interval [CI] 16-32%) and 95% (95%CI 93-97%), respectively. For T2 stage, EUS had a pooled sensitivity and specificity of 29% (95%CI 19-41%) and 84% (95%CI 77-88%). The pooled sensitivity and specificity of EUS were 81% (95%CI 72-88%) and 42% (95%CI 33-52%) in determining T3 stage tumor. To diagnose T4 stage tumor, EUS had a pooled sensitivity of 43% (95%CI 31-56%) and specificity of 96% (95%CI 94-97%), respectively. In determining N stage, the pooled sensitivity and specificity of EUS were 69% (95%CI 58-79%) and 52% (95%CI 42-62%). EUS is a moderately accurate technique in staging esophageal cancer after NAC. Its sensitivity is relatively high in T3 while specificity is high in other T stages (T1, T2, and T4). Tumors restaged by EUS as T4 should not be assigned to surgery because it is very likely to be inoperable. EUS is not reliable for N staging with its poor sensitivity and specificity. Subgroup analysis shows that staging accuracy did not improve with time.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Staging accuracy of endoscopic ultrasound for esophageal cancer after neoadjuvant chemotherapy: a meta-analysis and systematic review

et al. 2014

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“…Several, mostly small, studies over the past decade have attempted to address the role of EUS after NAC by comparing various variables of the tumor such as size and T and N staging, or by comparing the post-NAC EUS results with surgical pathology. A recent retrospective study reviewing 20 patients reported that T and N staging was inaccurate for 70% of the cases compared with surgical pathology and concluded that EUS is an unreliable tool for restaging esophageal cancer after NAC [10].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown overstaging of varying prevalence, with rates as high as 49% [10][11][12]. This is thought to be due to the inflammatory response and fibrosis that result as the tumor responds to the toxic effects of the chemotherapy agents.…”

Section: Discussionmentioning

confidence: 99%

The role of endoscopic ultrasound in assessing tumor response and staging after neoadjuvant chemotherapy for esophageal cancer

et al. 2011

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“…Assessmentsincludedendoscopy,computedtomography(CT)scanofthechest and abdomen, and fluorodeoxyglucose positron emission tomography (FDG-PET) imaging. Endoscopic ultrasound was used only for initial staging [14]. Response was evaluated using standard World Health Organization (WHO) criteria [15], and toxicity was graded using National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAEversion3) [16].…”

Section: Tumor Responsementioning

confidence: 99%

Prospective Phase II Study of Neoadjuvant Therapy with Cisplatin, 5-Fluorouracil, and Bevacizumab for Locally Advanced Resectable Esophageal Cancer

Idelevich¹,

Kashtan

Klein

et al. 2012

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Background: We investigated the efficacy and tolerability of cisplatin and 5-fluorouracil (5-FU) plus bevacizumab as neoadjuvant therapy for patients with locally advanced resectable esophageal cancer. Patients and Methods: In this prospective phase II study, 22 patients with adenocarcinoma and 6 with squamous cell carcinoma received 2 4-day cycles of bevacizumab 7.5 mg/kg followed by cisplatin 80 mg/m² infusion on day 1 followed by 5-FU 1,000 mg/m² as a 96-h continuous infusion on days 1–4, separated by a 3-week interval. Results: The response rate was 39%, the R0 resection rate was 43%, and the median overall survival (OS) was 17 months. The regimen was well tolerated, with the most common severe toxicities being venous thromboembolism (10%), nausea, and gastrointestinal bleeding (7% each). In 37 patients previously treated with cisplatin and 5-FU alone at our institution and thus serving as historical controls, the response rate was 30%, the R0 resection rate was 44%, and the median OS was 23 months. There was no statistically significant difference between the 2 groups of patients. Conclusion: Adding bevacizumab to cisplatin and 5-FU neoadjuvant chemotherapy was active and well tolerated but did not seem to improve the resection rate or OS compared with prior regimens, including the historical controls at our institution.

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P58 Endoscopic ultrasound is not accurate for restaging of esophageal cancer after pre-operative chemotherapy

Cited by 5 publications

References 0 publications

Staging accuracy of endoscopic ultrasound for esophageal cancer after neoadjuvant chemotherapy: a meta-analysis and systematic review

Staging accuracy of endoscopic ultrasound for esophageal cancer after neoadjuvant chemotherapy: a meta-analysis and systematic review

The role of endoscopic ultrasound in assessing tumor response and staging after neoadjuvant chemotherapy for esophageal cancer

Prospective Phase II Study of Neoadjuvant Therapy with Cisplatin, 5-Fluorouracil, and Bevacizumab for Locally Advanced Resectable Esophageal Cancer

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