Jongh, C. de (2018) The additive value of a restaging-CT during neoadjuvant chemotherapy for gastric cancer. thesis, Medicine.
Full text available on request.Abstract
Background: computed tomography (CT) is widely used in restaging for gastric cancer. However, the ability for a restaging-CT during neoadjuvant chemotherapy (NAC) in guiding clinical decision making and in providing prognostic value may be limited. The aim is to evaluate the additive value of restaging-CT during NAC for gastric cancer. Methods: this retrospective, multicentre cohort study in four Dutch hospitals identified all patients with a surgically resectable gastric adenocarcinoma (cT1–4aN0–3M0), who started NAC with curative intent for gastric cancer between 2007 – 2015. Results: CT-restaging was performed in 122 out of 152 included patients. A surgical resection was spared in 1 out of 122 restaged patients (1%), whereas 10 patients (9%) with irresectable disease (T4b- or M1-stage) were not identified at restaging. Treatment alternations regarding ineffective chemotherapy cycles were applicable in 5 out of 76 patients (5%). Moreover, diffuse tumors (p=0,041) and irradical resections (p=0,046) were significantly associated with survival, whereas histopathological (p=0,335) and radiological tumor response (p=0,557) were not. Conclusion: the additive value of a restaging-CT during NAC for gastric cancer is limited in guiding clinical decision making in order to avoid unnecessary surgical procedures and ineffective chemotherapy cycles. Furthermore, the restaging-CT did not provide prognostic value when compared to known prognostic markers. We do not recommend CT-restaging during NAC for gastric cancer in hospitals in the Netherlands. Alternative diagnostic modalities such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and staging laparoscopy could potentially be superior to CT and should be further investigated.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Noo, dr. M.E. de and surgeon, Deventer Ziekenhuis and During the study period, dr. M.E. de Noo was replaced as fac and Haring, drs. C.M. and affiliation coordinator of Deventer Ziekenhuis |
| Supervisor name: | Operating supervisor: and Ruurda, dr. J.P. and surgeon, University Medical Centre Utrecht |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:07 |
| Last Modified: | 25 Jun 2020 11:07 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2664 |
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