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Töppler G, Röper H, Cameron S, Füzesi L, Beham A, Ramadori G. Endoscopic and endosonographic staging in the management of cancer of the stomach and the esophagogastric junction. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Töppler G, Röper H, Cameron S, Füzesi L, Beham A, Ramadori G. Endoscopic and endosonographic staging in the management of cancer of the stomach and the esophagogastric junction. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
140 Background: Staging of the primary tumor in patients with advanced adenocarcinoma of the stomach or the esophagogastric junction under chemotherapy is not generally recommended [ESMO clinical recommendations; Ann Oncol 2009]. RECIST criteria do not detect local tumor regression adequately. Standards for endoscopic staging throughout therapy have not yet been established. Methods: Here we report on20 consecutive patients with locally advanced esophago or gastric adenocarcinoma which were treated with EOX or EOF (epirubicin, oxaliplatin, capecitabine or 5-FU). After two cycles of chemotherapy, therapeutic efficacy was assessed by gastroscopy (EGD), endosonography (EUS), ultrasonography (US) and CT-scan. EGD staging criteria included luminal occlusion, the aboral length of tumor involvement, tumor exulceration, formation of polypoid tissue or superficial ulcers, and gut motility. EUS-staging criteria included uT-staging of the different layers of the esophagogastric wall as well as of the adjacent lymph-nodes. Surgery was then performed within 2 to 4 weeks after the end of the third chemotherapy cycle. Results: In all patients, an early response to chemotherapy was observed by EGD and EUS, including regression of tumor size (length and depth), and appearance: former exulcerative tissue became rather polypoid and less vulnerable, and motility was regained in areas were tumor regression was observed. For the assessment of local tumor behaviour under chemotherapy, CT-scan was of limited help, as it was only able to monitor lymphadenopathy. Only in 3/20 cases there was a concordance between the EUS and CT-scan, as verified by histopathological review of the surgical specimen. Conclusions: EGD and EUS monitor early tumor response of the primary to chemotherapy adequately in all our cases of locally advanced esophago or gastric adenocarcinoma. Endoscopic measures are helpful for the assessment of early treatment response, and might help to direct therapeutic strategies. No significant financial relationships to disclose.
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Affiliation(s)
- G. Töppler
- Department of Gastroenterology and Endocrinology, University of Goettingen, Goettingen, Germany; Department of Pathology, University of Goettingen, Goettingen, Germany; Department of General and Visceral Surgery, University of Goettingen, Goettingen, Germany
| | - H. Röper
- Department of Gastroenterology and Endocrinology, University of Goettingen, Goettingen, Germany; Department of Pathology, University of Goettingen, Goettingen, Germany; Department of General and Visceral Surgery, University of Goettingen, Goettingen, Germany
| | - S. Cameron
- Department of Gastroenterology and Endocrinology, University of Goettingen, Goettingen, Germany; Department of Pathology, University of Goettingen, Goettingen, Germany; Department of General and Visceral Surgery, University of Goettingen, Goettingen, Germany
| | - L. Füzesi
- Department of Gastroenterology and Endocrinology, University of Goettingen, Goettingen, Germany; Department of Pathology, University of Goettingen, Goettingen, Germany; Department of General and Visceral Surgery, University of Goettingen, Goettingen, Germany
| | - A. Beham
- Department of Gastroenterology and Endocrinology, University of Goettingen, Goettingen, Germany; Department of Pathology, University of Goettingen, Goettingen, Germany; Department of General and Visceral Surgery, University of Goettingen, Goettingen, Germany
| | - G. Ramadori
- Department of Gastroenterology and Endocrinology, University of Goettingen, Goettingen, Germany; Department of Pathology, University of Goettingen, Goettingen, Germany; Department of General and Visceral Surgery, University of Goettingen, Goettingen, Germany
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