Scripties UMCG - Rijksuniversiteit Groningen
 
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The additive value of a restaging-CT during neoadjuvant chemotherapy for gastric cancer

(2018) Jongh, C. de

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.






 
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