Residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer: locations undetected by endoscopic biopsies in the preSANO trial. Issue 13 (5th August 2020)

• Record Type: Journal Article
• Authors: 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
• Is Part Of: British journal of surgery. Volume 107:Issue 13(2020)
• Page Start: 1791
• Page End: 1800
• Publication Date: 2020-08-05
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.11760
• Languages: English
• ISSNs: 0007-1323

Abstract

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. Graphical Abstract: 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