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Restaging After Neoadjuvant Therapy

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Esophageal Cancer

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Abstract

Neoadjuvant therapy has been demonstrated to improve overall (OS) and disease-free survival (DFS) in patients undergoing surgical resection for locally advanced esophageal cancer. Restaging after treatment has an important role in therapeutic decision-making and determining patient prognosis. Available methodologies most often utilize a combination of endoscopy and imaging in characterization of treatment response. While endoscopic ultrasound (EUS) is routinely used in initial staging, resultant inflammation and fibrosis after treatment challenges the utility of this modality in restaging. Endoscopic biopsy similarly has a limited benefit in the assessment of treatment response. Change in metabolic response on 18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG- PET/CT) on pre- and post-treatment imaging has been demonstrated may help predict tumor regression, and consequently, patient survival. Adoption of an approach utilizing FDG-PET response to adjust neoadjuvant chemotherapy has been observed to result in an increase in the rate of pathologic complete response (pCR) and progression-free survival. Current diagnostic tools enable differentiation between responders versus nonresponders to neoadjuvant therapy; however, they remain limited in their ability to identify therapeutic response.

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Author information

Authors and Affiliations

  1. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Smita Sihag & Tamar Nobel

Authors
  1. Smita Sihag
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  2. Tamar Nobel
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Correspondence to Smita Sihag .

Editor information

Editors and Affiliations

  1. Hospital Alemán of Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina

    Francisco Schlottmann

  2. Memorial Sloan Kettering Cancer Center, New York, New York, USA

    Daniela Molena

  3. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

    Marco G. Patti

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Sihag, S., Nobel, T. (2018). Restaging After Neoadjuvant Therapy. In: Schlottmann, F., Molena, D., Patti, M. (eds) Esophageal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-91830-3_7

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  • DOI: https://doi.org/10.1007/978-3-319-91830-3_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91829-7

  • Online ISBN: 978-3-319-91830-3

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