Post-therapeutic response evaluation by a combination of endoscopy and CT scan in esophagogastric adenocarcinoma after chemotherapy: better than its reputation

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2015-04, Vol.18 (2), p.314-325
• Main Authors: Blank, Susanne, Lordick, Florian, Bader, Franz, Burian, Maria, Dobritz, Martin, Grenacher, Lars, Becker, Karen, Weichert, Wilko, Langer, Rupert, Sisic, Leila, Stange, Annika, Jäger, Dirk, Büchler, Markus, Bruckner, Thomas, Siewert, Jörg, Ott, Katja
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adenocarcinoma - drug therapy; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer Research; Endoscopy - methods; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophagogastric Junction - drug effects; Esophagogastric Junction - pathology; Female; Follow-Up Studies; Gastric cancer; Gastroenterology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Neoplasm Grading; Neoplasm Staging; Oncology; Original Article; Prognosis; Prospective Studies; Retrospective Studies; Stomach Neoplasms - drug therapy; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Surgical Oncology; Survival Rate; Tomography, X-Ray Computed - methods
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-014-0367-x

Background Neoadjuvant chemotherapy is an accepted standard of care for locally advanced esophagogastric cancer. As only a subgroup benefits, a response-based tailored treatment would be of interest. The aim of our study was the evaluation of the prognostic and predictive value of clinical response in esophagogastric adenocarcinomas. Methods Clinical response based on a combination of endoscopy and computed tomography (CT) scan was evaluated retrospectively within a prospective database in center A and then transferred to center B. A total of 686/740 (A) and 184/210 (B) patients, staged cT3/4, cN0/1 underwent neoadjuvant chemotherapy and were then re-staged by endoscopy and CT before undergoing tumor resection. Of 184 patients, 118 (B) additionally had an interim response assessment 4–6 weeks after the start of chemotherapy. Results In A, 479 patients (70 %) were defined as clinical nonresponders, 207 (30 %) as responders. Median survival was 38 months (nonresponders: 27 months, responders: 108 months, log-rank, p