The additive value of restaging-CT during neoadjuvant chemotherapy for gastric cancer. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Gertsen, E.C.; de Jongh, C.; Brenkman, H.J.F.; Mertens, A.C.; Broeders, I.A.M.J.; Los, M.; Boerma, D.; ten Bokkel Huinink, D.; van Leeuwen, L.; Wessels, F.J.; van Hillegersberg, R.; Ruurda, J.P.
• Is Part Of: European journal of surgical oncology. Volume 46:Issue 7(2020)
• Page Start: 1247
• Page End: 1253
• Publication Date: 2020-07
• Subjects: Gastric cancer -- Restaging -- CT -- Interval metastases; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.04.002
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: Computed tomography (CT) is used for restaging of gastric cancer patients during neoadjuvant chemotherapy (NAC). The treatment strategy could be altered after detection of distant interval metastases, possibly leading to a reduction in unnecessary chemotherapy cycles, its related toxicity, and surgical procedures. The aim of this study was to evaluate the additive value of restaging-CT during NAC in guiding clinical decision making in gastric cancer. Materials and methods: This retrospective, multicenter cohort study identified all patients with surgically resectable gastric adenocarcinoma (cT1–4a-x, N0–3-x, M0-x), who started NAC with curative intent. Restaging-CT was performed after 2 out of 3 cycles of NAC. The primary outcome was treatment alterations made based on restaging-CT by a multidisciplinary tumor board. Confirmation of metastases was obtained by surgery or biopsy. Results: Between 2007 and 2015, CT-restaging was performed in 122 out of 152 included patients and timed after 2 cycles (n = 76) or after 3 cycles (n = 46) of NAC. Restaging-CT revealed a metastasis in 1 out of 122 restaged patients (1%) after which surgical resection was omitted, whereas 4 patients (3%) with distant interval metastases were not identified by restaging-CT and underwent a futile laparotomy. In 5 out of 76 patients (7%) disease progression was detected while undergoing NAC, leading to omission of the 3rd cycle of chemotherapy. Conclusion: The additive value of restaging-CT during NAC in gastric cancer is limited in guiding clinical decision making and therefore not recommended. Further studies may identify subgroups that may benefit of alternative diagnostic modalities.