Endosonographic assessment of multimodality therapy predicts survival of esophageal carcinoma patients

BACKGROUND. Standard endosonographic (EUS) staging criteria are unreliable for staging esophageal carcinoma after neoadjuvant therapy; however, measur ement of tumor size reduction can identify patients who have achieved a pat hologic response. In the current study the authors prospectively compared s urvival between patients classified as responders and those classified as n onresponders by EUS. METHODS, The maximal transverse cross-sectional area of the tumor was measu red before and after neoadjuvant therapy in patients who were candidates fo r multimodality treatment. Response was defined as a greater than or equal to 50% reduction in tumor area. RESULTS. A total of 59 patients at 2 centers were followed for a median of 19 months. EUS assessed response in 34 patients (58%). Overall, responders had a median survival of 17.6 months compared with 14.5 months for nonrespo nders (P < 0.005). Survival was significantly longer in responders compared with nonresponders in the patient subgroup who underwent surgical resectio n (19.7 months vs. 14.6 months; P < 0.005), the patient subgroup with adeno carcinoma (21.4 months vs. 10.8 months; P < 0.005), and the patient subgrou p initially classified as having T3N1 disease (17.6 months vs. 14.1 months; P < 0.05). Survival was not found to differ significantly between responde rs and nonresponders in the subgroup of patients with squamous cell carcino ma. EUS response nas the only clinical variable that was associated with su rvival time in a multivariate analysis (relative hazard = 0.27; P < 0.005). CONCLUSIONS, Patients with esophageal carcinoma who respond to neoadjuvant treatment as identified by EUS measurement of reduction in tumor size have a significantly better prognosis than nonresponders. Cancer 2000;88:1788-95 . (C) 2000 American Cancer Society.