Better prediction of oesophageal cancer treatment
Successfully treating oesophageal cancer without drastic surgery. This will become possible more often in the near future thanks to Peter van Rossum's PhD research at University Medical Center Utrecht. By using advanced scanning techniques, the effects of chemotherapy and irradiation are accurately displayed for the first time. This means that eventually, surgery to remove the oesophagus can be prevented for one third of the patients. Van Rossum will defend his thesis on 9 September at Utrecht University.
With new scanning techniques, we can see beforehand whether or not surgery is necessary. This means overtreatment can be prevented in the near future and individual patients can get customized treatments.
Every year, approximately 2.500 people in the Netherlands are diagnosed with oesophageal cancer. It is currently standard procedure to give a large number of them chemotherapy and irradiation to destruct as many tumour cells as possible. This is followed by drastic surgery to remove the oesophagus. Previous research has demonstrated that a third of the patients have no more tumour tissue remaining in their oesophagus after chemotherapy and irradiation. "We don't want to needlessly subject patients to such drastic surgery", researcher Peter van Rossum says. "With new scanning techniques, we can see beforehand whether or not surgery is necessary. This means overtreatment can be prevented in the near future and individual patients can get customized treatments."
Thanks to the scanning techniques, we can investigate during the treatment whether or not the chemotherapy and irradiation are working. If they don't, we can stop those treatments and decide to proceed to remove the oesophagus immediately. By stopping the treatment earlier, the patient is physically less burdened and thus fitter for the large operation.
Van Rossum researched the use of different scanning techniques in order to make the best prediction. He used MRI scans and PET scans for this purpose. An MRI scan provides detailed images of cross-sections of body parts thanks to a very strong magnetic field. For a PET scan, a small dose of radioactive sugar is injected into the patient's veins. That sugar concentrates in the places where the cancer cells are. The images of the PET scan make those sugar concentrations visible, allowing the cancer cells to be observed.
An MRI scan turns out to give a reliable image of the number of remaining cancer cells after chemotherapy and radiation in 80-90 % of the cases. For PET scans, the reliability lies around 70 %. The research will receive a follow-up -in cooperation with hospitals in Amsterdam, Groningen and Houston (Texas)- to verify the results in a bigger group of patients and to see whether or not using both scans will yield even better results. The expectation is that this will enable them to estimate with even more certainty whether or not it is necessary to remove the oesophagus.
To honour Peter van Rossum's PhD defence, University Medical Center Utrecht will have a symposium on the individualisation of oesophageal- ancer treatments on 8 and 9 September. International top experts will discuss the newest insights and developments there.
This study is closely related to Utrecht University’s strategic research theme Life Sciences, under the sub-theme of Cancer.