Residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer: locations undetected by endoscopic biopsies in the preSANO trial
Background Active surveillance has been proposed for patients with oesophageal cancer in whom there is a complete clinical response after neoadjuvant chemoradiotherapy (nCRT). However, endoscopic biopsies have limited negative predictive value in detecting residual disease. This study determined the...
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| Veröffentlicht in: | British journal of surgery 2020-12, Vol.107 (13), p.1791-1800 |
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| creator | Wilk, B. J. Eyck, B. M. Doukas, M. Spaander, M. C. W. Schoon, E. J. Krishnadath, K. K. Oostenbrug, L. E. Lagarde, S. M. Wijnhoven, B. P. L. Looijenga, L. H. J. Biermann, K. Lanschot, J. J. B. |
| description | Background
Active surveillance has been proposed for patients with oesophageal cancer in whom there is a complete clinical response after neoadjuvant chemoradiotherapy (nCRT). However, endoscopic biopsies have limited negative predictive value in detecting residual disease. This study determined the location of residual tumour following surgery to improve surveillance and endoscopic strategies.
Methods
The present study was based on patients who participated in the prospective preSANO trial with adenocarcinoma or squamous cell carcinoma of the oesophagus or oesophagogastric junction treated in four Dutch hospitals between 2013 and 2016. Resection specimens and endoscopic biopsies taken during clinical response evaluations after nCRT were reviewed by two expert gastrointestinal pathologists. The exact location of residual disease in the oesophageal wall was determined in resection specimens. Endoscopic biopsies were assessed for the presence of structures representing the submucosal layer of the oesophageal wall.
Results
In total, 119 eligible patients underwent clinical response evaluations after nCRT followed by standard surgery. Residual tumour was present in endoscopic biopsies from 70 patients, confirmed on histological analysis of the resected organ. Residual tumour was present in the resection specimen from 27 of the other 49 patients, despite endoscopic biopsies being negative. Of these 27 patients, residual tumour was located in the mucosa in 18, and in the submucosa beneath tumour‐free mucosa in eight. One patient had tumour in muscle beneath tumour‐free mucosa and submucosa.
Conclusion
Most residual disease after nCRT missed by endoscopic biopsies was located in the mucosa. Active surveillance could be improved by more sampling and considering submucosal biopsies.
Antecedentes
Se ha propuesto un seguimiento activo para los pacientes con cáncer de esófago en los que se logra una respuesta clínica completa tras quimiorradioterapia neoadyuvante (neoadjuvant chemoradiotherapy, nCRT). Sin embargo, las biopsias endoscópicas tienen un valor predictivo limitado para detectar la enfermedad residual. En este estudio se evaluó la localización del tumor residual tras la cirugía para poder determinar estrategias de seguimiento y endoscópicas.
Métodos
Este estudio se basa en pacientes que participaron en el ensayo prospectivo preSANO (adenocarcinoma o carcinoma escamoso del esófago o unión esofagogástrica en cuatro hospitales de los Países Bajos entre 2013 y 2 |
| doi_str_mv | 10.1002/bjs.11760 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7689829</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2430978505</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3240-1783579e331649e6bbbf611191c06bf62a2b44d843a92e0ade64a217685890143</originalsourceid><addsrcrecordid>eNpdksluFDEQhi0EIkPgwAsgS1y4dOKtF3NAChGrIiIROFvVdk3Gox67sd1B8xC8M85CBJxcUn3-VC7_hDzn7IgzJo7HbT7ivO_YA7LismsbwbvhIVkxxvqGSyEPyJOct4xxyVrxmBxI0be9ZP2K_PqK2bsFJup8RshIYV0w0YAR3Ha5glCo3eAuJnA-lg0mmPd0HRONmOO8gUusdy0Ei-k1naKF4mPIdAkOC9qCjo57isHFbOPsLR19nLPHTH2gVUfnhBcnX85pSR6mp-TRGqaMz-7OQ_L9_btvpx-bs_MPn05PzhorhWIN7wfZ9hql5J3S2I3juO4455pb1tVSgBiVcoOSoAUycNgpEHVBQztoxpU8JG9uvfMy7tBZDCXBZObkd5D2JoI3_3aC35jLeGWqQg9CV8GrO0GKPxbMxex8tjhNUBe3ZCOUZLofWtZW9OV_6DYuKdTnVarV7SCUvha--Hui-1H-_FQFjm-Bn37C_X2fM3MdAVMjYG4iYN5-vrgp5G_W46Wd</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2459582499</pqid></control><display><type>article</type><title>Residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer: locations undetected by endoscopic biopsies in the preSANO trial</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Wilk, B. J. ; Eyck, B. M. ; Doukas, M. ; Spaander, M. C. W. ; Schoon, E. J. ; Krishnadath, K. K. ; Oostenbrug, L. E. ; Lagarde, S. M. ; Wijnhoven, B. P. L. ; Looijenga, L. H. J. ; Biermann, K. ; Lanschot, J. J. B.</creator><creatorcontrib>Wilk, B. J. ; Eyck, B. M. ; Doukas, M. ; Spaander, M. C. W. ; Schoon, E. J. ; Krishnadath, K. K. ; Oostenbrug, L. E. ; Lagarde, S. M. ; Wijnhoven, B. P. L. ; Looijenga, L. H. J. ; Biermann, K. ; Lanschot, J. J. B.</creatorcontrib><description>Background
Active surveillance has been proposed for patients with oesophageal cancer in whom there is a complete clinical response after neoadjuvant chemoradiotherapy (nCRT). However, endoscopic biopsies have limited negative predictive value in detecting residual disease. This study determined the location of residual tumour following surgery to improve surveillance and endoscopic strategies.
Methods
The present study was based on patients who participated in the prospective preSANO trial with adenocarcinoma or squamous cell carcinoma of the oesophagus or oesophagogastric junction treated in four Dutch hospitals between 2013 and 2016. Resection specimens and endoscopic biopsies taken during clinical response evaluations after nCRT were reviewed by two expert gastrointestinal pathologists. The exact location of residual disease in the oesophageal wall was determined in resection specimens. Endoscopic biopsies were assessed for the presence of structures representing the submucosal layer of the oesophageal wall.
Results
In total, 119 eligible patients underwent clinical response evaluations after nCRT followed by standard surgery. Residual tumour was present in endoscopic biopsies from 70 patients, confirmed on histological analysis of the resected organ. Residual tumour was present in the resection specimen from 27 of the other 49 patients, despite endoscopic biopsies being negative. Of these 27 patients, residual tumour was located in the mucosa in 18, and in the submucosa beneath tumour‐free mucosa in eight. One patient had tumour in muscle beneath tumour‐free mucosa and submucosa.
Conclusion
Most residual disease after nCRT missed by endoscopic biopsies was located in the mucosa. Active surveillance could be improved by more sampling and considering submucosal biopsies.
Antecedentes
Se ha propuesto un seguimiento activo para los pacientes con cáncer de esófago en los que se logra una respuesta clínica completa tras quimiorradioterapia neoadyuvante (neoadjuvant chemoradiotherapy, nCRT). Sin embargo, las biopsias endoscópicas tienen un valor predictivo limitado para detectar la enfermedad residual. En este estudio se evaluó la localización del tumor residual tras la cirugía para poder determinar estrategias de seguimiento y endoscópicas.
Métodos
Este estudio se basa en pacientes que participaron en el ensayo prospectivo preSANO (adenocarcinoma o carcinoma escamoso del esófago o unión esofagogástrica en cuatro hospitales de los Países Bajos entre 2013 y 2016). Los especímenes quirúrgicos, así como las biopsias endoscópicas efectuadas durante las evaluaciones de la respuesta clínica después de nCRT fueron revisadas por dos patólogos gastrointestinales expertos. En los especímenes de resección, se determinó la localización exacta de la enfermedad residual en la pared del esófago. Se evaluaron las biopsias endoscópicas para identificar estructuras que constituyeran la capa submucosa de la pared del esófago.
Resultados
En total, 119 pacientes elegibles fueron sometidos a evaluaciones de la respuesta clínica tras nCRT seguida de cirugía estándar. Se detectó tumor residual en las biopsias endoscópicas de 70 pacientes, luego confirmadas en la histología de la pieza extirpada. Se identificó tumor residual en la pieza de resección de 27 de los otros 49 pacientes, a pesar de que las biopsias endoscópicas fueron negativas. En estos 27 pacientes, 18 presentaban tumor residual en la mucosa y ocho pacientes en la submucosa mas allá de una mucosa libre de tumor. Un paciente tenía tumor en el músculo más allá de una mucosa y submucosa libres de tumor.
Conclusión
La mayoría de los casos de enfermedad residual tras nCRT que no se detectaron en las biopsias endoscópicas, se localizaban en la mucosa. El seguimiento activo podría mejorar con la toma de más muestras y considerando las biopsias submucosas.
Remnant cancer missed by endoscopic biopsies was located in the mucosa in two‐thirds of patients with residual disease after neoadjuvant chemoradiotherapy (nCRT). One‐third of patients had residual disease in the submucosa underneath a tumour‐free mucosa. The yield of biopsies in active surveillance after nCRT could be improved by sampling larger areas of oesophageal mucosa and using biopsies targeting the submucosa.
What lies beneath</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.11760</identifier><identifier>PMID: 32757307</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adenocarcinoma - diagnostic imaging ; Adenocarcinoma - pathology ; Adenocarcinoma - therapy ; Aftercare ; Aged ; Biopsy ; Carcinoma, Squamous Cell - diagnostic imaging ; Carcinoma, Squamous Cell - pathology ; Carcinoma, Squamous Cell - therapy ; Chemoradiotherapy, Adjuvant ; Chemotherapy ; Endoscopy ; Esophageal cancer ; Esophageal Mucosa - diagnostic imaging ; Esophageal Mucosa - pathology ; Esophageal Neoplasms - diagnostic imaging ; Esophageal Neoplasms - pathology ; Esophageal Neoplasms - therapy ; Esophagoscopy ; Female ; Health surveillance ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm, Residual ; Original ; Predictive Value of Tests ; Prospective Studies ; Radiation therapy ; Squamous cell carcinoma ; Upper GI</subject><ispartof>British journal of surgery, 2020-12, Vol.107 (13), p.1791-1800</ispartof><rights>2020 The Authors. published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.</rights><rights>2020 The Authors. British Journal of Surgery published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.</rights><rights>2020. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3240-1783579e331649e6bbbf611191c06bf62a2b44d843a92e0ade64a217685890143</citedby><orcidid>0000-0002-6706-0628 ; 0000-0001-8717-596X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fbjs.11760$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fbjs.11760$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32757307$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wilk, B. J.</creatorcontrib><creatorcontrib>Eyck, B. M.</creatorcontrib><creatorcontrib>Doukas, M.</creatorcontrib><creatorcontrib>Spaander, M. C. W.</creatorcontrib><creatorcontrib>Schoon, E. J.</creatorcontrib><creatorcontrib>Krishnadath, K. K.</creatorcontrib><creatorcontrib>Oostenbrug, L. E.</creatorcontrib><creatorcontrib>Lagarde, S. M.</creatorcontrib><creatorcontrib>Wijnhoven, B. P. L.</creatorcontrib><creatorcontrib>Looijenga, L. H. J.</creatorcontrib><creatorcontrib>Biermann, K.</creatorcontrib><creatorcontrib>Lanschot, J. J. B.</creatorcontrib><title>Residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer: locations undetected by endoscopic biopsies in the preSANO trial</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background
Active surveillance has been proposed for patients with oesophageal cancer in whom there is a complete clinical response after neoadjuvant chemoradiotherapy (nCRT). However, endoscopic biopsies have limited negative predictive value in detecting residual disease. This study determined the location of residual tumour following surgery to improve surveillance and endoscopic strategies.
Methods
The present study was based on patients who participated in the prospective preSANO trial with adenocarcinoma or squamous cell carcinoma of the oesophagus or oesophagogastric junction treated in four Dutch hospitals between 2013 and 2016. Resection specimens and endoscopic biopsies taken during clinical response evaluations after nCRT were reviewed by two expert gastrointestinal pathologists. The exact location of residual disease in the oesophageal wall was determined in resection specimens. Endoscopic biopsies were assessed for the presence of structures representing the submucosal layer of the oesophageal wall.
Results
In total, 119 eligible patients underwent clinical response evaluations after nCRT followed by standard surgery. Residual tumour was present in endoscopic biopsies from 70 patients, confirmed on histological analysis of the resected organ. Residual tumour was present in the resection specimen from 27 of the other 49 patients, despite endoscopic biopsies being negative. Of these 27 patients, residual tumour was located in the mucosa in 18, and in the submucosa beneath tumour‐free mucosa in eight. One patient had tumour in muscle beneath tumour‐free mucosa and submucosa.
Conclusion
Most residual disease after nCRT missed by endoscopic biopsies was located in the mucosa. Active surveillance could be improved by more sampling and considering submucosal biopsies.
Antecedentes
Se ha propuesto un seguimiento activo para los pacientes con cáncer de esófago en los que se logra una respuesta clínica completa tras quimiorradioterapia neoadyuvante (neoadjuvant chemoradiotherapy, nCRT). Sin embargo, las biopsias endoscópicas tienen un valor predictivo limitado para detectar la enfermedad residual. En este estudio se evaluó la localización del tumor residual tras la cirugía para poder determinar estrategias de seguimiento y endoscópicas.
Métodos
Este estudio se basa en pacientes que participaron en el ensayo prospectivo preSANO (adenocarcinoma o carcinoma escamoso del esófago o unión esofagogástrica en cuatro hospitales de los Países Bajos entre 2013 y 2016). Los especímenes quirúrgicos, así como las biopsias endoscópicas efectuadas durante las evaluaciones de la respuesta clínica después de nCRT fueron revisadas por dos patólogos gastrointestinales expertos. En los especímenes de resección, se determinó la localización exacta de la enfermedad residual en la pared del esófago. Se evaluaron las biopsias endoscópicas para identificar estructuras que constituyeran la capa submucosa de la pared del esófago.
Resultados
En total, 119 pacientes elegibles fueron sometidos a evaluaciones de la respuesta clínica tras nCRT seguida de cirugía estándar. Se detectó tumor residual en las biopsias endoscópicas de 70 pacientes, luego confirmadas en la histología de la pieza extirpada. Se identificó tumor residual en la pieza de resección de 27 de los otros 49 pacientes, a pesar de que las biopsias endoscópicas fueron negativas. En estos 27 pacientes, 18 presentaban tumor residual en la mucosa y ocho pacientes en la submucosa mas allá de una mucosa libre de tumor. Un paciente tenía tumor en el músculo más allá de una mucosa y submucosa libres de tumor.
Conclusión
La mayoría de los casos de enfermedad residual tras nCRT que no se detectaron en las biopsias endoscópicas, se localizaban en la mucosa. El seguimiento activo podría mejorar con la toma de más muestras y considerando las biopsias submucosas.
Remnant cancer missed by endoscopic biopsies was located in the mucosa in two‐thirds of patients with residual disease after neoadjuvant chemoradiotherapy (nCRT). One‐third of patients had residual disease in the submucosa underneath a tumour‐free mucosa. The yield of biopsies in active surveillance after nCRT could be improved by sampling larger areas of oesophageal mucosa and using biopsies targeting the submucosa.
What lies beneath</description><subject>Adenocarcinoma - diagnostic imaging</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - therapy</subject><subject>Aftercare</subject><subject>Aged</subject><subject>Biopsy</subject><subject>Carcinoma, Squamous Cell - diagnostic imaging</subject><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Carcinoma, Squamous Cell - therapy</subject><subject>Chemoradiotherapy, Adjuvant</subject><subject>Chemotherapy</subject><subject>Endoscopy</subject><subject>Esophageal cancer</subject><subject>Esophageal Mucosa - diagnostic imaging</subject><subject>Esophageal Mucosa - pathology</subject><subject>Esophageal Neoplasms - diagnostic imaging</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Neoplasms - therapy</subject><subject>Esophagoscopy</subject><subject>Female</subject><subject>Health surveillance</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm, Residual</subject><subject>Original</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Radiation therapy</subject><subject>Squamous cell carcinoma</subject><subject>Upper GI</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNpdksluFDEQhi0EIkPgwAsgS1y4dOKtF3NAChGrIiIROFvVdk3Gox67sd1B8xC8M85CBJxcUn3-VC7_hDzn7IgzJo7HbT7ivO_YA7LismsbwbvhIVkxxvqGSyEPyJOct4xxyVrxmBxI0be9ZP2K_PqK2bsFJup8RshIYV0w0YAR3Ha5glCo3eAuJnA-lg0mmPd0HRONmOO8gUusdy0Ei-k1naKF4mPIdAkOC9qCjo57isHFbOPsLR19nLPHTH2gVUfnhBcnX85pSR6mp-TRGqaMz-7OQ_L9_btvpx-bs_MPn05PzhorhWIN7wfZ9hql5J3S2I3juO4455pb1tVSgBiVcoOSoAUycNgpEHVBQztoxpU8JG9uvfMy7tBZDCXBZObkd5D2JoI3_3aC35jLeGWqQg9CV8GrO0GKPxbMxex8tjhNUBe3ZCOUZLofWtZW9OV_6DYuKdTnVarV7SCUvha--Hui-1H-_FQFjm-Bn37C_X2fM3MdAVMjYG4iYN5-vrgp5G_W46Wd</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>Wilk, B. J.</creator><creator>Eyck, B. M.</creator><creator>Doukas, M.</creator><creator>Spaander, M. C. W.</creator><creator>Schoon, E. J.</creator><creator>Krishnadath, K. K.</creator><creator>Oostenbrug, L. E.</creator><creator>Lagarde, S. M.</creator><creator>Wijnhoven, B. P. L.</creator><creator>Looijenga, L. H. J.</creator><creator>Biermann, K.</creator><creator>Lanschot, J. J. B.</creator><general>John Wiley & Sons, Ltd</general><general>Oxford University Press</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6706-0628</orcidid><orcidid>https://orcid.org/0000-0001-8717-596X</orcidid></search><sort><creationdate>202012</creationdate><title>Residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer: locations undetected by endoscopic biopsies in the preSANO trial</title><author>Wilk, B. J. ; Eyck, B. M. ; Doukas, M. ; Spaander, M. C. W. ; Schoon, E. J. ; Krishnadath, K. K. ; Oostenbrug, L. E. ; Lagarde, S. M. ; Wijnhoven, B. P. L. ; Looijenga, L. H. J. ; Biermann, K. ; Lanschot, J. J. B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3240-1783579e331649e6bbbf611191c06bf62a2b44d843a92e0ade64a217685890143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adenocarcinoma - diagnostic imaging</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - therapy</topic><topic>Aftercare</topic><topic>Aged</topic><topic>Biopsy</topic><topic>Carcinoma, Squamous Cell - diagnostic imaging</topic><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Carcinoma, Squamous Cell - therapy</topic><topic>Chemoradiotherapy, Adjuvant</topic><topic>Chemotherapy</topic><topic>Endoscopy</topic><topic>Esophageal cancer</topic><topic>Esophageal Mucosa - diagnostic imaging</topic><topic>Esophageal Mucosa - pathology</topic><topic>Esophageal Neoplasms - diagnostic imaging</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Neoplasms - therapy</topic><topic>Esophagoscopy</topic><topic>Female</topic><topic>Health surveillance</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm, Residual</topic><topic>Original</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Radiation therapy</topic><topic>Squamous cell carcinoma</topic><topic>Upper GI</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wilk, B. J.</creatorcontrib><creatorcontrib>Eyck, B. M.</creatorcontrib><creatorcontrib>Doukas, M.</creatorcontrib><creatorcontrib>Spaander, M. C. W.</creatorcontrib><creatorcontrib>Schoon, E. J.</creatorcontrib><creatorcontrib>Krishnadath, K. K.</creatorcontrib><creatorcontrib>Oostenbrug, L. E.</creatorcontrib><creatorcontrib>Lagarde, S. M.</creatorcontrib><creatorcontrib>Wijnhoven, B. P. L.</creatorcontrib><creatorcontrib>Looijenga, L. H. J.</creatorcontrib><creatorcontrib>Biermann, K.</creatorcontrib><creatorcontrib>Lanschot, J. J. B.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wilk, B. J.</au><au>Eyck, B. M.</au><au>Doukas, M.</au><au>Spaander, M. C. W.</au><au>Schoon, E. J.</au><au>Krishnadath, K. K.</au><au>Oostenbrug, L. E.</au><au>Lagarde, S. M.</au><au>Wijnhoven, B. P. L.</au><au>Looijenga, L. H. J.</au><au>Biermann, K.</au><au>Lanschot, J. J. B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer: locations undetected by endoscopic biopsies in the preSANO trial</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2020-12</date><risdate>2020</risdate><volume>107</volume><issue>13</issue><spage>1791</spage><epage>1800</epage><pages>1791-1800</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><abstract>Background
Active surveillance has been proposed for patients with oesophageal cancer in whom there is a complete clinical response after neoadjuvant chemoradiotherapy (nCRT). However, endoscopic biopsies have limited negative predictive value in detecting residual disease. This study determined the location of residual tumour following surgery to improve surveillance and endoscopic strategies.
Methods
The present study was based on patients who participated in the prospective preSANO trial with adenocarcinoma or squamous cell carcinoma of the oesophagus or oesophagogastric junction treated in four Dutch hospitals between 2013 and 2016. Resection specimens and endoscopic biopsies taken during clinical response evaluations after nCRT were reviewed by two expert gastrointestinal pathologists. The exact location of residual disease in the oesophageal wall was determined in resection specimens. Endoscopic biopsies were assessed for the presence of structures representing the submucosal layer of the oesophageal wall.
Results
In total, 119 eligible patients underwent clinical response evaluations after nCRT followed by standard surgery. Residual tumour was present in endoscopic biopsies from 70 patients, confirmed on histological analysis of the resected organ. Residual tumour was present in the resection specimen from 27 of the other 49 patients, despite endoscopic biopsies being negative. Of these 27 patients, residual tumour was located in the mucosa in 18, and in the submucosa beneath tumour‐free mucosa in eight. One patient had tumour in muscle beneath tumour‐free mucosa and submucosa.
Conclusion
Most residual disease after nCRT missed by endoscopic biopsies was located in the mucosa. Active surveillance could be improved by more sampling and considering submucosal biopsies.
Antecedentes
Se ha propuesto un seguimiento activo para los pacientes con cáncer de esófago en los que se logra una respuesta clínica completa tras quimiorradioterapia neoadyuvante (neoadjuvant chemoradiotherapy, nCRT). Sin embargo, las biopsias endoscópicas tienen un valor predictivo limitado para detectar la enfermedad residual. En este estudio se evaluó la localización del tumor residual tras la cirugía para poder determinar estrategias de seguimiento y endoscópicas.
Métodos
Este estudio se basa en pacientes que participaron en el ensayo prospectivo preSANO (adenocarcinoma o carcinoma escamoso del esófago o unión esofagogástrica en cuatro hospitales de los Países Bajos entre 2013 y 2016). Los especímenes quirúrgicos, así como las biopsias endoscópicas efectuadas durante las evaluaciones de la respuesta clínica después de nCRT fueron revisadas por dos patólogos gastrointestinales expertos. En los especímenes de resección, se determinó la localización exacta de la enfermedad residual en la pared del esófago. Se evaluaron las biopsias endoscópicas para identificar estructuras que constituyeran la capa submucosa de la pared del esófago.
Resultados
En total, 119 pacientes elegibles fueron sometidos a evaluaciones de la respuesta clínica tras nCRT seguida de cirugía estándar. Se detectó tumor residual en las biopsias endoscópicas de 70 pacientes, luego confirmadas en la histología de la pieza extirpada. Se identificó tumor residual en la pieza de resección de 27 de los otros 49 pacientes, a pesar de que las biopsias endoscópicas fueron negativas. En estos 27 pacientes, 18 presentaban tumor residual en la mucosa y ocho pacientes en la submucosa mas allá de una mucosa libre de tumor. Un paciente tenía tumor en el músculo más allá de una mucosa y submucosa libres de tumor.
Conclusión
La mayoría de los casos de enfermedad residual tras nCRT que no se detectaron en las biopsias endoscópicas, se localizaban en la mucosa. El seguimiento activo podría mejorar con la toma de más muestras y considerando las biopsias submucosas.
Remnant cancer missed by endoscopic biopsies was located in the mucosa in two‐thirds of patients with residual disease after neoadjuvant chemoradiotherapy (nCRT). One‐third of patients had residual disease in the submucosa underneath a tumour‐free mucosa. The yield of biopsies in active surveillance after nCRT could be improved by sampling larger areas of oesophageal mucosa and using biopsies targeting the submucosa.
What lies beneath</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>32757307</pmid><doi>10.1002/bjs.11760</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-6706-0628</orcidid><orcidid>https://orcid.org/0000-0001-8717-596X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0007-1323 |
| ispartof | British journal of surgery, 2020-12, Vol.107 (13), p.1791-1800 |
| issn | 0007-1323 1365-2168 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7689829 |
| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adenocarcinoma - diagnostic imaging Adenocarcinoma - pathology Adenocarcinoma - therapy Aftercare Aged Biopsy Carcinoma, Squamous Cell - diagnostic imaging Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - therapy Chemoradiotherapy, Adjuvant Chemotherapy Endoscopy Esophageal cancer Esophageal Mucosa - diagnostic imaging Esophageal Mucosa - pathology Esophageal Neoplasms - diagnostic imaging Esophageal Neoplasms - pathology Esophageal Neoplasms - therapy Esophagoscopy Female Health surveillance Humans Male Middle Aged Neoadjuvant Therapy Neoplasm, Residual Original Predictive Value of Tests Prospective Studies Radiation therapy Squamous cell carcinoma Upper GI |
| title | Residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer: locations undetected by endoscopic biopsies in the preSANO trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-12T22%3A24%3A18IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Residual%20disease%20after%20neoadjuvant%20chemoradiotherapy%20for%20oesophageal%20cancer:%20locations%20undetected%20by%20endoscopic%20biopsies%20in%20the%20preSANO%20trial&rft.jtitle=British%20journal%20of%20surgery&rft.au=Wilk,%20B.%20J.&rft.date=2020-12&rft.volume=107&rft.issue=13&rft.spage=1791&rft.epage=1800&rft.pages=1791-1800&rft.issn=0007-1323&rft.eissn=1365-2168&rft_id=info:doi/10.1002/bjs.11760&rft_dat=%3Cproquest_pubme%3E2430978505%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2459582499&rft_id=info:pmid/32757307&rfr_iscdi=true |