The center for oesophago-gastric disorders (COGD) specializes in complex and rare diseases of the oesophagus and stomach that need multi-disciplinary expertise.
The aim of COGD is to provide individualized patient care at the highest possible level, to undertake clinical, translational and basic scientific research in a local, regional, national and international network and to enhance the knowledge and skills on the epidemiology, pathogenesis, diagnosis and treatment of oesophago-gastric diseases.
Research Activities
To study the genetics of Barrett's oesophagus/cancer and gastric cancer (including familial Barrett's and adenocarcinoma) and identify biomarkers by using samples form an established tissue bank (incl. liquid biopsies) with the aim to: Establish risk factors for Barrett's cancer, adjust/develop surveillance strategies and screening for cancer (regional and national collaboration; e.g. CyBar, ProBar study) including cost-effectiveness analyses Monitor and/or predict response to treatment (chemotherapy and radiation) and survival and adjust/individualize treatment.
International collaboration with Cambridge University (prof. Fitzgerald) Development of novel targets for drug treatment (center for personalized medicine) Assessment of clinical and pathological response after neoadjuvant chemoradiation (preSANO-study) in order to: Select patients for a non-operative approach who have a complete clinical response (individualization of treatment, development of clinical algorithms).
This diagnostic study is ongoing in six centers in the Netherlands and a new national study (SANO) will start mid-edio 2017 Pharmacokinetics (intratumoral) of oesophageal cancer and pharmacokinetics/genetics of systemic therapy for metastatic oesophageal cancer. National and international collaborative projects (network) on outcomes in oesophago-gastric cancer surgery (ECCG group). Nationwide study among Barrett's expert centers on the development of guidelines for endoscopic treatment of early cancer including the identification of biomarkers.
Collaborations
National and international collaborative projects (network) on outcomes in oesophago-gastric cancer surgery (ECCG group).
Contributions
To improve knowledge on the pathogenesis, epidemiology, diagnosis and treatment of oesophago-gastric diseases to students, residents, fellows, PhD students, postdoctoral workers, general practitioners, gastroenterologists (in training), and surgeons (in training). As part of medical specialty training, the Erasmus MC offers modules in oesophago-gastric diseases for trainees in their differentiation phase.
Education is given locally, regionally, nationally and internationally. International fellows are visiting the Erasmus MC for becoming proficient in advanced endoscopic and surgical techniques. International workshops/congresses are organized in conjunction with a team of renowned international experts inon advanced endoscopic resection techniques using the facilities of the Erasmus MC skillslab.
Future plans: To become a European Upper GI expert center accredited by international bodies e.g. European Digestive Oncology, participation in a European network of specialty training (endoscopic and surgical techniques), regional and national training for pathologists to improve interobserver variability and diagnostic accuracy in premalignant lesions as well as in targeted samples of patients with established malignancy.
Care Activities
The diagnostic, curative and palliative management treatment of upper GI cancer involves neoadjuvant chemotherapy, radiotherapy, surgery, and radiological and endoscopic interventions. The COGD treats patients with rare diseases and is acknowledged as center of excellence for rare diseases by the NFU for oesophageal cancer and Barrett's oesophagus in March 2015.
The central element in the clinical pathway is the weekly multidisciplinary tumour board. For most benign en premalignant conditions (Barrett's oesophagus, gastro-oesophageal reflux, GIST, other rare tumours), two or more disciplines are also involved and work closely together. The outcome measures are recorded in an institutional, international and national database.
The national audit (Dutch Upper GI Cancer Audit) feeds back the levels of performance of the institution including indicators of health care setting (e.g. annual volume, level of expertise, qualifications of staff members), process indicators (e.g. time between diagnosis and treatment) and indicators of performance (outcome data including morbidity and mortality). The Dutch insurance companies have insight in outcomes data and regard the Erasmus MC as a tertiary referral center. Research from the COGD over the past 20 years has had a great impact on the standard of care not only for our patients, but also and internationally based on two papers in the NEJM en two in the Lancet (Oncology).
Societal Relevance to Research, Education and Patient Care
The COGC participates in the EMBRAZE cancer network and acts as the tertiary referral hospital for the Southwest of the Netherlands (Erasmus Mc,BRAbant and Zeeland). COGC coordinates a regional surveillance program for Barrett's oesophagus and looks at cost effectiveness of screening-surveillance programs on a national basis. Members of the COGC participate in national-international guidelines on oesophago-gastric disorders and have contributed to national textbooks for students and international standard works. Members of the COGC organize a master in gastroenterology and oncology for medical students at the EUR and are recognized on a national and international level as experts in the field, given many invitations as invited speakers at meetings. Finally, the COGD is actively seeking the development and early adoption of new techniques including advances in endoscopic and surgical techniques (robotics). A more individualized treatment (patient- and tumour-tailored) e.g. by developing organ-sparing treatments, prediction of treatment response and therapeutic drug monitoring are the core business of this ACE.
Viability of Research, Education and Patient Care
The COGD has managed to attract young investigators (mostly clinicians) that start their career as PhD student before starting their clinical training program. Via educational activities (Master programs) and the visibility of the clinical activities together with the research programs talented people have joined the team. Medical students have been given the opportunity to perform research abroad in one of the collaborating centers.
The ACE is involved in several networks including Barrett's consortia, the Dutch Upper GI Cancer group and the Esophageal Cancer Complications Group. The ACE has hosted international research and clinical fellows over the past years and believes that further international collaboration is of utmost importance for the success of the ACE. The bi-annual international congress of the European Society for Diseases of the Esophagus took place in the Erasmus MC in 2014 with more than 220 participants from around Europe. The strong position of the COGD in the international scientific community is dictated by recent international top publications on neoadjuvant chemoradiation for esophageal cancer, which has indeed changed the world's view on the management of these cancers. This has been picked up by the Dutch newspapers
Key and relevant publications of the last five years
- Preoperative chemoradiotherapy for esophageal or junctional cancer. van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, van der Gaast A; CROSS Group. N Engl J Med. 2012 May 31;366(22):2074-84. IF 59.56
- Three-gene immunohistochemical panel adds to clinical staging algorithms to predict prognosis for patients with esophageal adenocarcinoma. Ong CA, Shapiro J, Nason KS, Davison JM, Liu X, Ross-Innes C, O'Donovan M, Dinjens WN, Biermann K, Shannon N, Worster S, Schulz LK, Luketich JD, Wijnhoven BP, Hardwick RH, Fitzgerald RC. J Clin Oncol. 2013 Apr 20;31(12):1576-82. IF 20,98
- Surgical management of submucosal esophageal cancer: extended or regional lymphadenectomy? Grotenhuis BA, van Heijl M, Zehetner J, Moons J, Wijnhoven BP, van Berge Henegouwen MI, Tilanus HW, DeMeester TR, Lerut T, van Lanschot JJ. Ann Surg. 2010 Nov;252(5):823-30. IF 8,57
- Aberrant p53 protein expression is associated with an increased risk of neoplastic progression in patients with Barrett's oesophagus. Kastelein F, Biermann K, Steyerberg EW, Verheij J, Kalisvaart M, Looijenga LH, Stoop HA, Walter L, Kuipers EJ, Spaander MC, Bruno MJ; ProBar-study group. Gut. 2013 Dec;62(12):1676-83. IF 14.92
- Surveillance in patients with long-segment Barrett's oesophagus: a cost-effectiveness analysis. Kastelein F, van Olphen S, Steyerberg EW, Sikkema M, Spaander MC, Looman CW, Kuipers EJ, Siersema PD, Bruno MJ, de Bekker-Grob EW; on behalf of the ProBar-study group. Gut. 2014 Jul 18. pii: gutjnl-2014-307197. IF 14.92
- Nonsteroidal anti-inflammatory drugs and statins have chemopreventative effects in patients with Barrett's esophagus. Kastelein F, Spaander MC, Biermann K, Steyerberg EW, Kuipers EJ, Bruno MJ; Probar-study Group. Gastroenterology. 2011 Dec;141(6):2000-8. IF 18.19
- Common variants at the MHC locus and at chromosome 16q24.1 predispose to Barrett's esophagus. Su Z, Gay LJ, Strange A, Palles C, Band G, Whiteman DC, Lescai F, Langford C, Nanji M, Edkins S, van der Winkel A, Levine D, Sasieni P, Bellenguez C, Howarth K, Freeman C, Trudgill N, Tucker AT, Pirinen M, Peppelenbosch MP, van der Laan LJ, Kuipers EJ, Drenth JP, Peters WH, Reynolds JV, Kelleher DP, McManus R, Grabsch H, Prenen H, Bisschops R, Krishnadath K, Siersema PD, van Baal JW, Middleton M, Petty R, Gillies R, Burch N, Bhandari P, Paterson S, Edwards C, Penman I, Vaidya K, Ang Y, Murray I, Patel P, Ye W, Mullins P, Wu AH, Bird NC, Dallal H, Shaheen NJ, Murray LJ, Koss K, Bernstein L, Romero Y, Hardie LJ, Zhang R, Winter H, Corley DA, Panter S, Risch HA, Reid BJ, Sargeant I, Gammon MD, Smart H, Dhar A, McMurtry H, Ali H, Liu G, Casson AG, Chow WH, Rutter M, Tawil A, Morris D, Nwokolo C, Isaacs P, Rodgers C, Ragunath K, MacDonald C, Haigh C, Monk D, Davies G, Wajed S, Johnston D, Gibbons M, Cullen S, Church N, Langley R, Griffin M, Alderson D, Deloukas P, Hunt SE, Gray E, Dronov S, Potter SC, Tashakkori-Ghanbaria A, Anderson M, Brooks C, Blackwell JM, Bramon E, Brown MA, Casas JP, Corvin A, Duncanson A, Markus HS, Mathew CG, Palmer CN, Plomin R, Rautanen A, Sawcer SJ, Trembath RC, Viswanathan AC, Wood N, Trynka G, Wijmenga C, Cazier JB, Atherfold P, Nicholson AM, Gellatly NL, Glancy D, Cooper SC, Cunningham D, Lind T, Hapeshi J, Ferry D, Rathbone B, Brown J, Love S, Attwood S, MacGregor S, Watson P, Sanders S, Ek W, Harrison RF, Moayyedi P, de Caestecker J, Barr H, Stupka E, Vaughan TL, Peltonen L, Spencer CC, Tomlinson I, Donnelly P, Jankowski JA; Esophageal Adenocarcinoma Genetics Consortium; Wellcome Trust Case Control Consortium 2. Nat Genet. 2012 Oct;44(10):1131-6. IF 31,61
- Shapiro J, van Lanschot JJ, Hulshof MC, van Hagen P, van Berge Henegouwen MI, Wijnhoven BP, van Laarhoven HW, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, Ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, Steyerberg EW, van der Gaast A; CROSS study group. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol 2015 Sep;16(9): 1090-8. IF 26.50
- van Olphen SH, Biermann K, Shapiro J, Wijnhoven BP, Toxopeus EL, van der Gaast A, Stoop HA, van Lanschot JJ, Spaander MC, Bruno MJ, Looijenga LH. P53 and SOX2 Protein Expression Predicts Esophageal Adenocarcinoma in Response to Neoadjuvant Chemoradiotherapy. Ann Surg. 2016 Jan 15. [Epub ahead of print]. IF 8.57
- SOX2 as a novel marker to predict neoplastic progression in Barrett’s esophagusvan Olphen, S., Biermann K., Kastelein F., Hansen Be., Stoop HA., Spaander MCW., Bruno AJ., Looijenga LHJ. (2015). . Am J Gastroenterol, 2015 Oct;110(10):1420-8.IF 9.21
PhD theses of the last five years
- Dr. R.A.M. Damhuis, October 17th 2013, “Determinants of postoperative mortality after cancer surgery”
- Dr. J.J. Boonstra, 2011 November 2nd, EUR, “Translational research on esophageal cancer- from cell line to clinic
- Dr. A.K. Talsma, EUR, November 18th 2015, “Oesophageal cancer: staging, surgery and survival”
- Dr. P. van Hagen, EUR, May 18th 2016, “Esophageal Cancer: preoperative management and postoperative outcome”
- Dr. J. Shapiro, June 1st 2016, “Prognostication and new treatment strategies for esophageal and junctional cancer”
- Dr. N.C.M. van Heel, December 22nd 2011, “Stenting for benign and malignant oesophageal disease
- Dr. F. Kastelein, September 10 2014, Optimizing Surveillance in Barrett's Esophagus. From chemoprevention and biomarkers to cost-effctiveness and survival
- drs S. van Olphen, 2011-2016 (thesis defence in autumn 2016), “Advances in Barrett’s esophagus surveillance”
- drs A.M. J. van Nistelrooij, October 26 2016,Esophageal adenocarcinoma, more than one entity; a clinical and molecular analysis"
- drs N. Nederlof, 2017 “Complications in Esophageal Surgery”
- drs B. Noordman, Oesophageal cancer: neoadjuvant chemoradiotherapy and surgery, September 2018
Non-scientific publications related to the ACE
- Van den Berg JW, Wijnhoven BPL, van der Gaast A, van Lanschot JJB. Richtlijn is niet altijd heilig. Medisch Contact 2016; 20 oktober.
- Noordman BJ, BPL Wijnhoven, Lagarde SM, Spaander MCW, Valkema R, van Lanschot JJB. Organ-sparing treatment in oesophagus cancer: feasible and safe?].