Pretreatment staging by endoscopic ultrasonography does not predict complete response to neoadjuvant chemoradiation in patients with esophageal carcinoma

BACKGROUND, Endoscopic ultrasonography (EUS) provides highly accurate preop erative T and N classifications in patients with esophageal carcinoma. Alth ough previous data have suggested that patients with tumors classified as T 4 by EUS do not benefit from surgical resection, these data were acquired. prior to the widespread use-of preoperative chemoradiation. The current stu dy investigated whether pretreatment EUS can predict a complete response to neoadjuvant therapy. METHODS, Patients with esophageal carcinoma (adenocarcinoma or squamous cel l carcinoma) underwent EUS classification prior to therapy. patients classi fied as T2, T3, or T4 and MO were treated with 5-fluorouracil, cisplatin, a nd radiation under protocol. Patients with T1 lesions underwent resection w ithout prior chemoradiation. Chemoradiation was followed in all cases by at tempted surgical resection. The initial EUS classification was compared wit h the final pathologic results. RESULTS. Fifty-five patients (47 males and 8 females) with a mean age of 60 .5 years (range, 31-78 years) were evaluated. There were 41 adenocarcinomas and 14 squamous cell carcinomas. Among the total population, a complete re sponse was achieved in 3 of 5 patients (60%) with tumors classified as T2 b y EUS, 14 of 42 patients (33%) with tumors classified as T3 by EUS, and 5 o f 8 patients (63%) with tumors classified as T4 by EUS (P = 0.19). A comple te response was achieved in 9 of 24 patients (38%) found to have N0 disease by EUS versus 13 of 30 patients (43%) determined to have NI disease (P = 0 .66). The results for patients with adenocarcinoma and squamous cell carcin oma were similar. CONCLUSIONS. The results of the current study demonstrate that pretreatment EUS does not predict reliably which patients with esophageal carcinoma wil l achieve a complete pathologic response to preoperative neoadjuvant chemor adiation. (C) 1999 American Cancer Society.