Effect of neoadjuvant therapy on cancer staging by endoscopic ultrasound

D. O. Faigel, G. G. Ginsberg, S. L. Kadish, D. Vaughn, D. Haller, J. B. Morris, E. F. Rosato, D. Smith, M. L. Kochman

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Abstract

Neoadjuvant chemo- and/or radiotherapy (C/RT) may be given prior to resection of GI malignancies to attempt to achieve higher cure rates. The utility of endoscopic ultrasound (EUS) in assessing response to C/RT, and the effect of C/RT on EUS accuracy, are unknown. 19 patients with esophageal (n=12, Squamous 4, Adeno 8), rectal (6) or duodenal (1) cancer were treated with preoperative chemo (18 pts)(5-FU, Leukovorin, Adriamycin and/or Cisplatinum) and/or XRT (10 pts) prior to surgical resection and staging. 16 patients had EUS prior to C/RT, 17 patients following C/RT, 14 both. These results were compared to surgical patients with esophageal and rectal cancer who had undergone pre-operative EUS but had not received C/RT (Control). Comparing initial EUS to final surgical stage: T-Stage Improved No Change Worsened Response p-value C/RT 6 7 3 38% (Fisher) Control 8 34 10 15% 0.06 N-Stage C/RT 8 5 3 50% Control 7 44 5 13% 0.02 (Improved: EUS Stage > Surgical Stage, No Change: EUS Stage = Surgical Stage, Worsened: EUS Stage < Surgical Stage) Sub-group analysis demonstrated a significant effect on nodal stage for esophageal (response=44% v. 9%, p=0.03) and rectal cancer (67% v. 20%, p=0.03). EUS performed after C/RT significantly reduced staging accuracy resulting in an overall T-stage accuracy=31,% (v. Control=65%, p=0.017) and N-stage accuracy=50% (Control=79%, p=0.03), and for esophageal cancer T-stage accuracy=33% (v. Control=62%, p=0.09), N-stage accuracy=42% (Control=81 %, p=0.016). Conclusions: 1. C/RT may result in significant downstaging of GI malignancies. 2. EUS prior to C/RT may be used in conjunction with surgical staging to demonstrate the effectiveness of neoadjuvant therapy. 3. C/RT significantly decreases the accuracy of subsequent EUS staging. 4. Larger randomized studies are needed.

Original languageEnglish (US)
Number of pages1
JournalGastrointestinal endoscopy
Volume43
Issue number4
DOIs
StatePublished - Jan 1 1996

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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    Faigel, D. O., Ginsberg, G. G., Kadish, S. L., Vaughn, D., Haller, D., Morris, J. B., Rosato, E. F., Smith, D., & Kochman, M. L. (1996). Effect of neoadjuvant therapy on cancer staging by endoscopic ultrasound. Gastrointestinal endoscopy, 43(4). https://doi.org/10.1016/S0016-5107(96)80509-8