Objective:
The aim of this study was to perform a meta-analysis on the
accuracy of
endoscopic biopsies,
EUS, and 18F-FDG
PET(-CT) for detecting
residual disease after
neoadjuvant chemoradiotherapy (nCRT) for
esophageal cancer.
Summary of Background Data:
After nCRT, one-third of patients have a pathologically complete response in the resection specimen. Before an active surveillance strategy could be offered to these patients, clinically complete responders should be accurately identified.
Methods:
Embase, Medline, Cochrane, and Web-of-Science were searched until February 2018 for studies on
accuracy of
endoscopic biopsies,
EUS, or
PET(-CT) for detecting locoregional
residual disease after nCRT for squamous cell- or adenocarcinoma. Pooled sensitivities and specificities were calculated using random-effect meta-analyses.
Results:
Forty-four studies were included for meta-analyses. For detecting
residual disease at the primary tumor site, 12 studies evaluated
endoscopic biopsies, 11 qualitative
EUS, 14 qualitative
PET, 8 quantitative
PET using maximum standardized uptake value (SUVmax), and 7 quantitative
PET using percentage reduction of SUVmax (%ΔSUVmax). Pooled sensitivities and specificities were 33% and 95% for
endoscopic biopsies, 96% and 8% for qualitative
EUS, 74% and 52% for qualitative
PET, 69% and 72% for
PET-SUVmax, and 73% and 63% for
PET-%ΔSUVmax. For detecting residual nodal disease, 11 studies evaluated qualitative
EUS with a pooled sensitivity and specificity of 68% and 57%, respectively. In subgroup analyses, sensitivity of
PET-%ΔSUVmax and
EUS for nodal disease was higher in squamous cell carcinoma than adenocarcinoma.
Conclusions:
Current literature suggests insufficient
accuracy of
endoscopic biopsies,
EUS, and 18F-FDG
PET(-CT) as single modalities for detecting
residual disease after nCRT for
esophageal cancer.
