Response to Preoperative Therapy in Upper Gastrointestinal Cancers
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In cancer, a response to therapy implies a reduction in the volume or activity of localized and/or metastatic tumors. In localized upper gastrointestinal cancer, there is no accepted definition of clinical response; however, tumor shrinkage is frequently observed when preoperative therapy is administered. As patients with upper gastrointestinal cancers often undergo multimodal therapy, it is therefore imperative that new definitions for assessing the response to preoperative therapy be established.
We reviewed the development of response criteria from a historical perspective, with particular emphasis on the criteria used to assess upper gastrointestinal cancers.
Observing the response to preoperative therapy appears to make it possible to distinguish between favorable and unfavorable clinical biology in the cancer. Patients who experience a response to preoperative treatment appear to fare better in terms of overall survival than those whose cancers do not respond. We reviewed the published results regarding the response to preoperative therapy and the implications of this for patients.
This review of the literature suggests that a variety of tools are available for defining the response to preoperative therapy and that these need to be exploited. Developing reliable methods of assessing the response will improve the individualization of therapy for patients with gastroesophageal cancer. There is a strong need for surrogate markers for efficacy in order to assess responses that are capable of predicting patient outcome.
KeywordsPositron Emission Tomography Esophageal Cancer Esophageal Squamous Cell Carcinoma Esophageal Adenocarcinoma Ataxia Telangiectasia Mutate
The authors are very grateful for the critical advice on this paper provided by Prof. Murray Brennan of the Memorial Sloan-Kettering Cancer Center, New York City, NY, USA. This manuscript is dedicated to U. Fink, emeritus professor of oncology, who had a major impact on response assessment in oncology during the last 20 years and J. R. Siewert, emeritus professor of surgery, who had a major impact on response assessment as well as on esophageal surgery generally within the last 25 years.
- 15.Nygaard K, Hagen S, Hansen HS, Hatlevoll R, Hultborn R, Jakobsen A et al. Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy The second Scandinavian trial in esophageal cancer. World J Surg. 1992;16(6):1104–9 (discussion 1110).PubMedCrossRefGoogle Scholar
- 17.Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TP. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 1996;335(7):462–7 (see comments) (published erratum appears in N Engl J Med. 1999 Jul 29;341(5):384).Google Scholar
- 20.Siewert JR, Stein HJ, Feith M, Bruecher BL, Bartels H, Fink U. Histologic tumor type is an independent prognostic parameter in esophageal cancer: lessons from more than 1,000 consecutive resections at a single center in the Western world. Ann Surg. 2001;234(3):360–7; discussion 368–9.PubMedCrossRefGoogle Scholar
- 25.Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L et al. New guidelines to evaluate the response to treatment in solid tumors European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92(3):205–16.PubMedCrossRefGoogle Scholar
- 28.Cerfolio RJ, Bryant AS, Ohja B, Bartolucci AA, Eloubeidi MA. The accuracy of endoscopic ultrasonography with fine-needle aspiration, integrated positron emission tomography with computed tomography, and computed tomography in restaging patients with esophageal cancer after neoadjuvant chemoradiotherapy. J Thorac Cardiovasc Surg. 2005;129(6):1232–41.PubMedCrossRefGoogle Scholar
- 37.Goldstein EB (ed) Blackwell handbook of sensation and perception, 2nd edn. Oxford: Blackwell; 2005.Google Scholar
- 45.Schneider PM, Baldus SE, Metzger R, Kocher M, Bongartz R, Bollschweiler E et al. Histomorphologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer: implications for response classification. Ann Surg. 2005;242(5):684–92.PubMedCrossRefGoogle Scholar
- 50.Kroep JR, van Groeningen CJ, Cuesta MA, Craanen ME, Hoekstra OS, Comans EF et al. Positron emission tomography using 2-deoxy-2-[18F]fluoro-D-glucose for response monitoring in locally advanced gastrooesophageal cancer; a comparison of different analytical methods. Mol Imaging Biol. 2003;5(5):337–46.PubMedCrossRefGoogle Scholar
- 52.Swisher S, Erasmus J, Masih M, Correa AM, Macapinlac H, Ajani JA et al. 2-Fluoro-2-deoxy-D-glucose positron emission tomography imaging is predictive of pathologic response and survival after preoperative chemoradiation in patients with esophageal carcinoma. Cancer. 2004;101(8):1776–85.PubMedCrossRefGoogle Scholar
- 55.Levine EA, Farmer MR, Clark P, Mishra G, Ho C, Geisinger KR et al. Predictive value of 18-fluoro-deoxy-glucose-positron emission tomography (18F-FDG-PET) in the identification of responders to chemoradiation therapy for the treatment of locally advanced esophageal cancer. Ann Surg. 2006;243(4):472–8.PubMedCrossRefGoogle Scholar
- 57.Kim MK, Ryu JS, Kim SB, Ahn JH, Kim SY, Park SI et al. Value of complete metabolic response by (18)F-fluorodeoxyglucose-positron emission tomography in oesophageal cancer for prediction of pathologic response and survival after preoperative chemoradiotherapy. Eur J Cancer. 2007;43(9):1385–91.PubMedCrossRefGoogle Scholar
- 66.Lordick F, Ott K, Krause B et al. PET to assess early metabolic response and to guide treatment of adenocarcinoma of the oesophagogastric junction: the Municon phase II trial. Lancet Oncol. 2007;46(6):263–70.Google Scholar
- 69.Brücher BLDM, Keller G, Werner M, Müller U, Lassmann S, Cabras AD et al. Using Q-RT-PCR to measure Cyclin D1, TS, TP, DPD, and Her-2/neu as predictors for response, survival, and recurrence in patients with esophageal squamous cell carcinoma following radiochemotherapy. Int J Colorectal Dis. 2008;24(1):69–77.PubMedCrossRefGoogle Scholar