355. IMPACT OF ENDOSCOPIC ULTRASONOGRAPHY WITH FINE NEEDLE ASPIRATION ASSESSING CLINICAL LYMPH NODE STAGING ON RADIOTHERAPY TREATMENT PLANNING ESOPHAGEAL CANCER PATIENTS

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Abstract Background Endoscopic ultrasound (EUS) combined with fine needle aspiration (FNA) can be of additional value to fluorine-18 labeled fluorodeoxyglucose positron emission tomography computed tomography (18FDG-PET-CT) for lymph node staging in esophageal cancer patients. The study objective was to evaluate the impact of routine EUS-FNA after 18FDG-PET-CT staging on radiotherapy planning. Methods Patients with biopsy proven esophageal carcinoma staged ≥cT2 and eligible for treatment with curative intent, including neoadjuvant chemoradiotherapy (nCRT) or definitive chemoradiotherapy (dCRT) were included. After March 2018, patients who were scheduled for dCRT or ASA 3 were excluded from routine EUS-FNA. The primary outcome was the impact of EUS-FNA after 18FDG-PET-CT on radiotherapy target volume delineation. Subsequently, radiotherapy field modifications were compared with surgical pathology when available. Results Between 2018 and 2023, 179 patients were included. In 61 patients (34%), the EUS scope was unable to pass through the tumor, limiting lymph node assessment. EUS-FNA altered radiotherapy treatment plans in 24 patients (13%) resulting in a number needed to treat of 7.5. Modifications included expansion of the radiation field in 17 cases, reduction in 6 cases, and both 1 case. Among surgically resected patient, 10 lymph node stations were added to the radiation field based on EUS-FUNA results.Two patients were readmitted post-procedure, including one fatal case of mediastinitis potentially linked to EUS-FNA. Conclusion Routine EUS-FNA after 18FDG-PET-CT altered radiotherapy plans in only 13% of patients, with limited and uncertain impact on clinical outcomes, especially for those undergoing planned neoadjuvant therapy and surgery. These findings suggest that EUS-FNA may be best avoided in routine practice for such patients.

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