Effect of neoadjuvant therapy on cancer staging by endoscopic ultrasound

Douglas Orrick 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)
Pages (from-to)418
Number of pages1
JournalGastrointestinal Endoscopy
Volume43
Issue number4
StatePublished - 1996
Externally publishedYes

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Neoadjuvant Therapy
Neoplasm Staging
Radiotherapy
Esophageal Neoplasms
Rectal Neoplasms
Duodenal Neoplasms
Leucovorin
Fluorouracil
Doxorubicin
Neoplasms

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Faigel, D. O., Ginsberg, G. G., Kadish, S. L., Vaughn, D., Haller, D., Morris, J. B., ... Kochman, M. L. (1996). Effect of neoadjuvant therapy on cancer staging by endoscopic ultrasound. Gastrointestinal Endoscopy, 43(4), 418.

Effect of neoadjuvant therapy on cancer staging by endoscopic ultrasound. / Faigel, Douglas Orrick; Ginsberg, G. G.; Kadish, S. L.; Vaughn, D.; Haller, D.; Morris, J. B.; Rosato, E. F.; Smith, D.; Kochman, M. L.

In: Gastrointestinal Endoscopy, Vol. 43, No. 4, 1996, p. 418.

Research output: Contribution to journalArticle

Faigel, DO, Ginsberg, GG, Kadish, SL, Vaughn, D, Haller, D, Morris, JB, Rosato, EF, Smith, D & Kochman, ML 1996, 'Effect of neoadjuvant therapy on cancer staging by endoscopic ultrasound', Gastrointestinal Endoscopy, vol. 43, no. 4, pp. 418.
Faigel DO, Ginsberg GG, Kadish SL, Vaughn D, Haller D, Morris JB et al. Effect of neoadjuvant therapy on cancer staging by endoscopic ultrasound. Gastrointestinal Endoscopy. 1996;43(4):418.
Faigel, Douglas Orrick ; Ginsberg, G. G. ; Kadish, S. L. ; Vaughn, D. ; Haller, D. ; Morris, J. B. ; Rosato, E. F. ; Smith, D. ; Kochman, M. L. / Effect of neoadjuvant therapy on cancer staging by endoscopic ultrasound. In: Gastrointestinal Endoscopy. 1996 ; Vol. 43, No. 4. pp. 418.
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title = "Effect of neoadjuvant therapy on cancer staging by endoscopic ultrasound",
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.",
author = "Faigel, {Douglas Orrick} and Ginsberg, {G. G.} and Kadish, {S. L.} and D. Vaughn and D. Haller and Morris, {J. B.} and Rosato, {E. F.} and D. Smith and Kochman, {M. L.}",
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T1 - Effect of neoadjuvant therapy on cancer staging by endoscopic ultrasound

AU - Faigel, Douglas Orrick

AU - Ginsberg, G. G.

AU - Kadish, S. L.

AU - Vaughn, D.

AU - Haller, D.

AU - Morris, J. B.

AU - Rosato, E. F.

AU - Smith, D.

AU - Kochman, M. L.

PY - 1996

Y1 - 1996

N2 - 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.

AB - 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.

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