Waiting Time from Diagnosis to Treatment has no Impact on Survival in Patients with Esophageal Cancer

Background Waiting time from diagnosis to treatment has emerged as an important quality indicator in cancer care. This study was designed to determine the impact of waiting time on long-term outcome of patients with esophageal cancer who are treated with neoadjuvant therapy followed by surgery or primary surgery. Methods Patients who underwent esophagectomy for esophageal cancer at the University Medical Center Utrecht between 2003 and 2014 were included. Patients treated with neoadjuvant therapy followed by surgery and treated with primary surgery were separately analyzed. The influence of waiting time on survival was analyzed using Cox proportional hazard analyses. Kaplan–Meier curves for short (<8 weeks) and long (≥8 weeks) waiting times were constructed. Results A total of 351 patients were included; 214 received neoadjuvant treatment, and 137 underwent primary surgery. In the neoadjuvant group, the waiting time had no impact on disease-free survival (DFS) [hazard ratio (HR) 0.96, 95 % confidence interval (CI) 0.88–1.04; p = 0.312] or overall survival (OS) (HR 0.96, 95 % CI 0.88–1.05; p = 0.372). Accordingly, no differences were found between neoadjuvantly treated patients with waiting times of <8 and ≥8 weeks in terms of DFS (p = 0.506) and OS (p = 0.693). In the primary surgery group, the waiting time had no impact on DFS (HR 1.03, 95 % CI 0.95–1.12; p = 0.443) or OS (HR 1.06, 95 % CI 0.99–1.13; p = 0.108). Waiting times of <8 weeks versus ≥8 weeks did not result in differences regarding DFS (p = 0.884) or OS (p = 0.374). Conclusions In esophageal cancer patients treated with curative intent by either neoadjuvant therapy followed by surgery or primary surgery, waiting time from diagnosis to treatment has no impact on long-term outcom

Short-Course External Beam Radiotherapy Versus Brachytherapy for Palliation of Dysphagia in Esophageal Cancer: A Matched Comparison of Two Prospective Trials

Introduction: Short-course external beam radiotherapy (EBRT) and intraluminal brachytherapy are both accepted treatments for the palliation of dysphagia in patients with incurable esophageal cancer. We compared the effects of both treatments from two prospective studies. Methods: We performed a multicenter prospective cohort study of patients with metastasized or otherwise incurable esophageal cancer requiring palliation of dysphagia from September 2016 to March 2019. Patients were treated with EBRT in five fractions of 4 Gy. Data were compared with all patients treated with a single brachytherapy dose of 12 Gy in the SIREC (Stent or Intraluminal Radiotherapy for inoperable Esophageal Cancer) trial, both between the original cohorts and between 1:1 propensity score–matched cohorts. The primary end point was an improvement of dysphagia at 3 months without reintervention. The secondary end points included toxicit

Predicting the Need for Biopsy to Detect Clinically Significant Prostate Cancer in Patients with a Magnetic Resonance Imaging–detected Prostate Imaging Reporting and Data System/Likert ≥3 Lesion: Development and Multinational External Validation of the Imperial Rapid Access to Prostate Imaging and Diagnosis Risk Score

Background: Although multiparametric magnetic resonance imaging (MRI) has highsensitivity, its lower specificity leads to a high prevalence of false-positive lesions requir-ing biopsy.Objective: To develop and externally validate a scoring system for MRI-detected ProstateImaging Reporting and Data System (PIRADS)/Likert 3 lesions containing clinically sig-nificant prostate cancer (csPCa).Design, setting, and participants: The multicentre Rapid Access to Prostate Imaging andDiagnosis (RAPID) pathway included 1189 patients referred to urology due to elevatedage-specific prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE); April 27, 2017 to October 25, 2019.</p

Towards individualized treatment for esophageal cancer

Despite recent improvements in staging, treatment, and perioperative care, esophageal cancer remains a devastating disease with a 5-year overall survival rate of only 15-25%. As prognosis is often poor, multimodality (rather than single modality) treatment approaches are frequently applied to increase the chances of cure. For patients the multitude of burdening treatment modalities are hard to undergo and exhibit substantial risks of serious side effects without knowing whether all components (e.g. chemotherapy, radiotherapy, surgery) contribute to the desired outcome on an individual basis. The studies presented in this thesis aimed to open a window to move towards individualized care for patients with esophageal cancer enabling selection of only those treatments that are best for the individual patient and omission of components that contribute little to (or even deteriorate) the well-being of the patient. In order to enable such tailor-made treatment for the individual patient with esophageal cancer, improvements in the diagnostic work-up, multimodality treatment strategies, treatment response assessment, and the risk prediction, prevention, and management of postoperative complications are indicated. The research projects presented in this thesis contribute to the realization of these improvements through the use of advanced imaging techniques and prediction models for the estimation of individual treatment efficacies and risks. Two exciting developments described in this thesis have shown promising results for allowing individualized treatment for esophageal cancer in the nearby future. First, it was indicated that in the coming years clinicians will likely become able to accurately estimate patients’ individual probability of a certain treatment efficacy after chemoradiotherapy based on MRI-based quantitative imaging parameters. Such an estimation would tremendously help clinicians and patients with informed and shared treatment decision-making. In particular the preoperative probability of a pathologic complete response is of interest for the patient, as this parameter reflects the need for additional surgical treatment. Vice versa, early identification of a high probability of non-response may be reason to modify or stop (toxic) chemoradiotherapy. Second, in this thesis the first steps were taken to develop MRI-guided radiotherapy for esophageal cancer using the MR-linac, which is a treatment modality that is currently transforming the field of radiotherapy. The MR-linac enables physicians to visualize and adapt radiotherapy in real-time during treatment based on detailed MR images. As such, the MR-linac yields unprecedented levels of precision and accuracy for each individual patient resulting in improved treatment efficacy and reduced toxicity. In addition, it implies that in the nearby future standard (rather conservative) total radiation doses –already leading to a complete disappearance of esophageal cancer in approximately 30% of cases– may be safely escalated using the MR-linac. Meanwhile, treatment response could be continuously monitored during treatment using the MRI component. These features are expected to result in a higher proportion of local cure (and good tumor responses) for esophageal cancer with fewer side effects. If so, a more restrained policy towards surgery may be practiced in a significant proportion of patients, while current non-surgical patients (due to advanced local tumor characteristics) may become new surgical candidates

Imaging strategies in the management of gastric cancer: current role and future potential of MRI

Contains fulltext : 207166.pdf (Publisher’s version ) (Open Access)Accurate preoperative staging of gastric cancer and the assessment of tumor response to neoadjuvant treatment is of importance for treatment and prognosis. Current imaging techniques, mainly endoscopic ultrasonography (EUS), computed tomography (CT) and (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET), have their limitations. Historically, the role of magnetic resonance imaging (MRI) in gastric cancer has been limited, but with the continuous technical improvements, MRI has become a more potent imaging technique for gastrointestinal malignancies. The accuracy of MRI for T- and N-staging of gastric cancer is similar to EUS and CT, making MRI a suitable alternative to other imaging strategies. There is limited evidence on the performance of MRI for M-staging of gastric cancer specifically, but MRI is widely used for diagnosing liver metastases and shows potential for diagnosing peritoneal seeding. Recent pilot studies showed that treatment response assessment as well as detection of lymph node metastases and systemic disease might benefit from functional MRI (e.g. diffusion weighted imaging and dynamic contrast enhancement). Regarding treatment guidance, additional value of MRI might be expected from its role in better defining clinical target volumes and setup verification with MR-guided radiation treatment

Imaging strategies in the management of oesophageal cancer: what's the role of MRI?

To outline the current role and future potential of magnetic resonance imaging (MRI) in the management of oesophageal cancer regarding T-staging, N-staging, tumour delineation for radiotherapy (RT) and treatment response assessment.PubMed, Embase and the Cochrane library were searched identifying all articles related to the use of MRI in oesophageal cancer. Data regarding the value of MRI in the areas of interest were extracted in order to calculate sensitivity, specificity, predictive values and accuracy for group-related outcome measures.Although historically poor, recent improvements in MRI protocols and techniques have resulted in better imaging quality and the valuable addition of functional information. In recent studies, similar or even better results have been achieved using optimised MRI compared with other imaging strategies for T- and N-staging. No studies clearly report on the role of MRI in oesophageal tumour delineation and real-time guidance for RT so far. Recent pilot studies showed that functional MRI might be capable of predicting pathological response to treatment and patient prognosis.In the near future MRI has the potential to bring improvement in staging, tumour delineation and real-time guidance for RT and assessment of treatment response, thereby complementing the limitations of currently used imaging strategies.aEuro cent MRI's role in oesophageal cancer has been somewhat limited to date.aEuro cent However MRI's ability to depict oesophageal cancer is continuously improving.aEuro cent Optimising TN-staging, radiotherapy planning and response assessment ultimately improves individualised cancer care.aEuro cent MRI potentially complements the limitations of other imaging strategies regarding these points.Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Short-Course External Beam Radiotherapy Versus Brachytherapy for Palliation of Dysphagia in Esophageal Cancer: A Matched Comparison of Two Prospective Trials

Contains fulltext : 221576.pdf (Publisher’s version ) (Open Access