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Document type:
journal article 
Author(s):
Heger, U; Bader, F; Lordick, F; Burian, M; Langer, R; Dobritz, M; Blank, S; Bruckner, T; Becker, K; Herrmann, K; Siewert, JR; Ott, K 
Title:
Interim endoscopy results during neoadjuvant therapy for gastric cancer correlate with histopathological response and prognosis. 
Abstract:
Neoadjuvant chemotherapy for locally advanced gastric cancer leads to major histopathological response in less than 30 % of patients. Data on interim endoscopic response assessment do not exist. This exploratory prospective study evaluates early endoscopy after 50 % of the chemotherapy as predictor for later response and prognosis.Forty-seven consecutive patients were included (45 resected; 33 R0 resections). All patients received baseline endoscopy and CT scans, after 50 % of their chemotherapy (EGD-1, CT-1) and after completion of chemotherapy (EGD-2, CT-2). Interim endoscopic response (EGD-1) was assessed after having received 50 % (6 weeks) of the planned 12 weeks of neoadjuvant chemotherapy. Post-chemotherapy response was clinically assessed by a combination of CT scan (CT-2) and endoscopy (EGD-2). Histopathological response was determined by a standardized scoring system (Becker criteria). Endoscopic response was defined as a reduction of>75 % of the tumor mass.Twelve patients were responders at EGD-1 and 13 at EGD-2. Nine patients (19.1 %) were clinical responders and 7 patients (15.6 %) were histopathological responders after chemotherapy. Specificity, accuracy, and negative predictive value of the interim EGD-1 for subsequent histopathological response were 31/38 (82 %), 36/47 (76 %), and 31/33 (93 %); and for recurrence or death, 28/30 (93.3 %), 38/47 (80.9 %), and 28/35 (80.0 %). Response at EGD-1 was significantly associated with histopathological response (p = 0.010), survival (p< 0.001), and recurrence-free survival (p = 0.009).Interim endoscopy after 6 weeks predicts response and prognosis. Therefore, tailoring treatment according to interim endoscopic assessment could be feasible, but the findings of this study should be validated in a larger patient cohort. 
Journal title abbreviation:
Gastric Cancer 
Year:
2014 
Journal volume:
17 
Journal issue:
Pages contribution:
478-88 
Language:
eng 
Print-ISSN:
1436-3291 
TUM Institution:
Institut für Radiologie; Institut für Allgemeine Pathologie und pathologische Anatomie