Zuccaro G, Rice T W, Goldblum J, Medendorp S V, Becker M, Pimentel R, Gitlin L, Adelstein D J
Department of Gastroenterology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Gastroenterol. 1999 Apr;94(4):906-12. doi: 10.1111/j.1572-0241.1999.985_h.x.
Endoscopic ultrasound (EUS) provides important information in the initial staging of patients with esophageal cancer. With recent modifications in chemoradiotherapy protocols, a significant number of patients have no residual tumor at esophagectomy. The high surgical morbidity and mortality might be avoided if complete response to chemoradiotherapy could be predicted. Previously published clinical trials, with relatively small patient numbers, have suggested that EUS may accurately stage esophageal cancer after chemoradiotherapy. The aim of this study was to verify the accuracy of EUS in staging esophageal cancer after effective chemoradiotherapy.
EUS staging was performed before and after concurrent cisplatin, 5-fluorouracil, and hyperfractionated radiotherapy in 59 patients with newly diagnosed esophageal cancer. All patients underwent subsequent esophagectomy and pathological staging. The accuracy of preoperative, postchemoradiotherapy EUS was evaluated in a retrospective fashion by comparison to pathological staging.
After chemoradiotherapy, 18 patients (31%) had no residual disease at pathological staging (T0N0). However, EUS correctly predicted complete response to chemoradiotherapy (T0N0) in only three patients (17%). The accuracy of postchemoradiotherapy EUS for pathological T stage was only 37%, and its sensitivity for N1 disease was only 38%. EUS was unable to distinguish postradiation fibrosis and inflammation from residual tumor.
When aggressive preoperative chemoradiotherapy is provided to patients with esophageal cancer, the predictive value of postchemoradiotherapy EUS is inadequate for use in clinical decision making.
内镜超声（EUS）在食管癌患者的初始分期中提供重要信息。随着近期放化疗方案的改进，大量患者在食管切除时无残留肿瘤。如果能够预测对放化疗的完全反应，或许可以避免高手术发病率和死亡率。先前发表的临床试验，患者数量相对较少，提示EUS可能准确对放化疗后的食管癌进行分期。本研究的目的是验证EUS在有效放化疗后对食管癌分期的准确性。
对59例新诊断的食管癌患者在同步进行顺铂、5-氟尿嘧啶和超分割放疗前后进行EUS分期。所有患者随后均接受食管切除术及病理分期。通过与病理分期比较，以回顾性方式评估术前、放化疗后EUS的准确性。
放化疗后，18例患者（31%）在病理分期时无残留疾病（T0N0）。然而，EUS仅在3例患者（17%）中正确预测了对放化疗的完全反应（T0N0）。放化疗后EUS对病理T分期的准确性仅为37%，其对N1期疾病的敏感性仅为38%。EUS无法区分放疗后纤维化和炎症与残留肿瘤。
当对食管癌患者进行积极的术前放化疗时，放化疗后EUS的预测价值不足以用于临床决策。
