The preoperative work-up of patients with esophageal cancer: What is the value of endoscopic ultrasonograpy (EUS) after PET/CT?

Boer, H.E.M. de (Hiske) (2015) The preoperative work-up of patients with esophageal cancer: What is the value of endoscopic ultrasonograpy (EUS) after PET/CT? thesis, Medicine.

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Abstract

Background: The optimal staging sequence in esophageal cancer patients is still debatable. Positron emission tomography/computed tomography (PET/CT) and endoscopic ultrasonography (EUS) are used in a non-specific order. Most European countries perform EUS first followed by CT or PET/CT, whereas it is just the reverse in the US. Moreover the need for an invasive EUS method remains unknown. This retrospective study assessed the additional value of EUS after PET/CT and the influence or benefit of EUS on the treatment decision making and if patients could be selected for EUS based on PET/CT (EUS on demand). Patients and Method: All symptomatic esophageal cancer patients (T1-4a,N0-3M0), diagnosed between 2009 and 2015 at the University Medical Centre Groningen, were eligible for analysis. The primary outcome was the additional value of EUS after PET/CT, defined as lymph node (LN) up/down staging, metastasis outside of the locoregional area, and additional information on curability (T4b and M+). We also assessed how often EUS had influenced the treatment: including a possible change of the radiation area (tumor target volumes), the resectability (T4b), or detected distant metastasis. In addition, we defined when EUS should be made, based on the PET/CT, and assessed if we could select patients that would benefit from EUS. Results: A total of 299 patients were eligible for inclusion, of whom 62.5% had a complete EUS, 19.1% an incomplete, and 18.4% did not receive an EUS. EUS after PET/CT gave additional information in 169 patients (69.3%) and changed the treatment plan in 69 patients (28%). We found that patients with an EUS significantly (P<0.001) more often had a useful EUS, according to the above mentioned definition of a valuable EUS. However, using this definition we would have missed 31 patients (14.9%) who seemed to benefit from EUS. Conclusion: Although EUS gave additional information after PET/CT in most cases, it only changed the treatment after PET/CT in 28 % of the patients. We were able to select patients, based on the PET/CT, that would benefit from EUS. However, this definition should be optimized to become applicable in all patients with esophageal cancer.

Item Type:	Thesis (Thesis)
Supervisor name:	Plukker, Prof. Dr. J.T.M.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:02
Last Modified:	25 Jun 2020 11:02
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2181

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