Hulshof, J.B. (2012) The efficacy of CT in determining progression of esophageal cancer after neoadjuvant chemoradiotherapy prior to surgery. thesis, Medicine.
Full text available on request.Abstract
Background: To increase the survival of patients with locally advanced esophageal cancer, patients are treated with neoadjuvant chemoradiotherapy (CRT) prior to surgery. However, not all patients respond to CRT and surgery is futile in 10-22% of the patients because of macroscopic distant metastasis. Efforts to select these patients during the neoadjuvant treatment have failed. Although not commonly advised we performed a second CT at the end of the CRT. The aim of this study is to determine the efficacy of CT in detecting patients with progressive disease during neoadjuvant chemoradiotherapy. A cost effectiveness analysis was also undertaken. Methods: Sixty-one patients with locally advanced esophageal cancer, treated with neoadjuvant CRT, were eligible for inclusion. Both the pre- and post-CRT CT images were reviewed and restaged by two experienced radiologists. The primary outcome was detection of progressive disease, either the development of distant metastasis or the development of lymph node progression. Metastases detected within 3 months after the post-CRT CT were assessed as missed metastases. The cost effectiveness of detecting progressive disease with CT was also assessed; costs made in the assessment of progressive disease were compared with the benefits of preventing unnecessary surgery. Results: The radiologists detected 3 patients with progressive disease. One of these patients had pathologically proven lymph node progression, but also had a liver and an omental/peritoneal metastasis that were found during an explorative laparotomy. In none of the remaining 58 patients metastases were found during surgery, or within 3 months after the post-CRT CT. According to this cohort, CT had a sensitivity of 100%, a specificity of 100% in detecting patients with progressive disease after neoadjuvant CRT. The use of CT in the detection of patients with progressive disease prevented the expenditure of approximately 27 Euros per patient. Conclusion: CT is an effective and cost effective method to detect progressive disease in esophageal cancer patients, after neoadjuvant CRT.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Hulshof, J.B. (Jan-Binne) |
| Supervisor name: | Plukker, Prof. J.Th. and oncologisch chirurg |
| 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/2713 |
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