Predictive Value of Endoscopic Observations and Biopsy After Neoadjuvant Chemoradiotherapy in Assessing the Pathologic Complete Response of Patients With Esophageal Squamous Cell Carcinoma

Abstract

IntroductionNo standard method has been defined to evaluate the therapeutic response of esophageal cancer to neoadjuvant chemoradiotherapy (CRT). This study aimed to determine the predictive value of endoscopic evaluation and biopsy after CRT in predicting the complete pathological response to neoadjuvant CRT in patients with esophageal squamous cell carcinoma (SCC).Materials and MethodThis prospective, descriptive study was conducted on patients with stage II and III esophageal SCC who could undergo esophagectomy. Patients underwent neoadjuvant CRT. Four to six weeks after the end of treatment, re-endoscopy was performed and a biopsy was taken in the presence of a tumor lesion. In the absence of a tumor lesion, the marked site of the esophagus was removed as a blind biopsy. Gastrologist observations during endoscopy and the result of the pathological examination of an endoscopic biopsy were recorded. The patient underwent esophagectomy. The pathology obtained from endoscopic biopsy was compared with the pathology response obtained from esophagectomy.ResultsSixty-nine patients were included in the study, of which 32 underwent esophagectomy. In an endoscopic examination after CRT, 28 patients had macroscopic tumor remnants and 4 patients did not. Pathological examination of the samples obtained from endoscopy showed no tumor remnants in 10 patients (31.3%), and in 22 patients (68.7%), living tumor remnants were seen in the biopsy specimen. Pathologic evaluation of the samples obtained by surgical resection showed that in 13 patients, there were no viable carcinomas in the esophagus or lymph nodes removed, and the rate of pathologic complete response was 40.6. Sensitivity, specificity, positive predictive, and negative predictive values of endoscopic observations were 94.7, 23, 64.2, and 75%, respectively. Preoperative biopsy sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 68.4, 30.7, 59, and 40%, respectively.ConclusionConsidering the negative and positive predictive values of endoscopic observations and biopsy after neoadjuvant CRT, it seems that these two methods alone are not suitable for assessing the pathologic complete response after neoadjuvant treatment.

A novel CT-based radiomics model for predicting response and prognosis of chemoradiotherapy in esophageal squamous cell carcinoma

“…According to the criteria from 11th edition of the Esophageal Cancer Handling Regulations, endoscopic primary lesions were evaluated as follows: (1) all endoscopic findings suggestive of neoplastic lesions have disappeared, (2) there is pathologically no cancer detected by endoscopic biopsy of the primary lesion that was present before treatment, (3) the entire esophagus can be observed by endoscopy, (4) there are no endoscopic findings suggestive of active esophagitis (no swelling alteration, no white moss). A complete response was achieved when all of the above findings (1) to (4) were satisfied 16 . Patients who did not meet the response definition were categorized as non-responders.…”

The Use of Trimodality Treatment in Patients With Locally Advanced Oesophageal Squamous Cell Carcinoma: An Experience From a Large Cancer Centre in Pakistan

“…The CROSS trial, which was a benchmark for nCRT, showed a pCR rate of 49% in the squamous cell cancer group [5]. Similarly, another study done in Iran showed that 40.6% of the patients with SCC achieved pCR [15].…”

A Novel CT-Based Radiomics Model for Predicting Response and Prognosis of Chemoradiotherapy in Esophageal Squamous Cell Carcinoma

“…According to the criteria from 11th edition of the Esophageal Cancer Handling Regulations, endoscopic primary lesions were evaluated as follows: 1) all endoscopic ndings suggestive of neoplastic lesions have disappeared, 2) there is pathologically no cancer detected by endoscopic biopsy of the primary lesion that was present before treatment, 3) the entire esophagus can be observed by endoscopy, 4) there are no endoscopic ndings suggestive of active esophagitis (no swelling alteration, no white moss). A complete response was achieved when all of the above ndings 1) to 4) were satis ed 19 . Patients who did not meet the response de nition were categorized as non-responders.…”