The additive value of restaging-CT during neoadjuvant chemotherapy for gastric cancer

Abstract

Introduction: Computed tomography (CT) is used for restaging of gastric cancer patients during neoadjuvant chemotherapy (NAC). The treatment strategy could be altered after detection of distant interval metastases, possibly leading to a reduction in unnecessary chemotherapy cycles, its related toxicity, and surgical procedures. The aim of this study was to evaluate the additive value of restaging-CT during NAC in guiding clinical decision making in gastric cancer. Materials and methods: This retrospective, multicenter cohort study identified all patients with surgically resectable gastric adenocarcinoma (cT1e4a-x, N0e3-x, M0-x), who started NAC with curative intent. Restaging-CT was performed after 2 out of 3 cycles of NAC. The primary outcome was treatment alterations made based on restaging-CT by a multidisciplinary tumor board. Confirmation of metastases was obtained by surgery or biopsy. Results: Between 2007 and 2015, CT-restaging was performed in 122 out of 152 included patients and timed after 2 cycles (n ¼ 76) or after 3 cycles (n ¼ 46) of NAC. Restaging-CT revealed a metastasis in 1 out of 122 restaged patients (1%) after which surgical resection was omitted, whereas 4 patients (3%) with distant interval metastases were not identified by restaging-CT and underwent a futile laparotomy. In 5 out of 76 patients (7%) disease progression was detected while undergoing NAC, leading to omission of the 3rd cycle of chemotherapy. Conclusion:The additive value of restaging-CT during NAC in gastric cancer is limited in guiding clinical decision making and therefore not recommended. Further studies may identify subgroups that may benefit of alternative diagnostic modalities.

The value of restaging CT following neoadjuvant chemotherapy for resectable gastric cancer. A population-based study

“…3 b, some yrT3 or yrT4 cancers are found to be ypT0-2. These observations are in line with findings in a similar, recently published study from the Netherlands [ 35 ].…”

Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment—Oncological and Surgical Perspective

“…Another restriction is associated with ambiguous restaging before potential gastrectomy. According to Gertsen et al, restaging CT prevents only 1% of unnecessary laparotomies, although preoperative assessment was performed before completing NAC [29]. High volume centres present contrasting numbers with negative prognostic value (NPV) of LN involvement at a level of 90.1% among patients with early GC [21,30].…”

Intelligent Algorithm-Based CT Imaging for Evaluation of Efficacy of Docetaxel Combined with Fluorouracil on Patients with Gastric Cancer

“…With the continuous development of intelligent segmentation algorithms, they are often used to learn original images and are extensively used in image segmentation, image classification, and target image positioning [ 9 ]. Some scholars have proposed in research that combining pixel information of different scales can extract the best size information [ 10 ]. In the study, a decision tree was built based on the feature ring and the segmentation position and then used to extract the features of the CT image to obtain the optimal segmentation boundary, providing a new method for clinical prediction and diagnosis of the occurrence and development of gastric cancer.…”