Esophageal carcinoma response to neoadjuvant chemotherapy in CT examination

Neoadjuvant treatment of esophageal cancer prior to surgery was thought to improve survival by reducing the primary tumor lesion as well as regional and systemic tumor spread. However,until now, prospective randomized trials could not prove the effectiveness of chemotherapy in terms of prolonged survival or higher rate of cure. Both chemo- and radiotherapy may be used as pre- or postoperative treatment. The evaluation of changes in neoplastic lesions in response to pharmacological treatment is an increasingly important task for radiologists. The aim of the study was to assess patient survival depending on the degree of response to neoadjuvant chemotherapy. The material comprised a group of 47 men and 5 women (aged 40-54 years) with diagnosed esophageal carcinoma. In all patients, CT examination of the esophagus was performed using a CT scanner Somatom AR T by Siemens in 5-mm-thick axial sections before and after administering contrast agent intravenously and orally. A control CT examination was performed in each patient after the proper course of neoadjuvant chemotherapy using the same scanning protocol. After chemotherapy, complete CT response (CR) was found in 6 patients (11.54%), and in 3 of these there was complete histopathological response. In 15 patients, partial response (PR) was found. In 21 patients there was no change (SD) after chemotherapy, and in 10 progression was found (PD). The mean survival period was 31.33 months in the CR group, 39.0 months in the PR group, 16.63 months in the SD group, and 10.56 months in the PD group. Analysis of variance showed statistically significant differences between mean survival periods in the group with partial response and groups with stable disease and progression. CT enables precise assessment of esophageal carcinoma response to neoadjuvant chemotherapy. The WHO criteria of tumor response are the most widely used. The CT assessment provides precise evaluation of the diameters of the tumor and the presence of local and distal lymph node enlargement and metastases. The survival period depends directly on the degree of response to neoadjuvant chemotherapy, and is longer in patients with partial or complete regression of the disease. (author)