Adenocarcinoma of the gastro-esophageal junction: CT for monitoring during neoadjuvant chemotherapy.
OBJECTIVE
A clinical study was performed to assess the diagnostic value of spiral CT for evaluation of response during neoadjuvant chemotherapy (CTx) in patients with adenocarcinoma of the gastro-esophageal-junction (GEJ). Results were compared to those of endoscopy.


METHODS
Twenty-five patients with histologically proven adenocarcinoma of the GEJ scheduled to undergo neoadjuvant CTx were studied. Before CT examination, 1200 ml of a vanilla flavoured paraffin emulsion were applied orally to the fasting patients and 40 mg BuscopanR or 2 mg glucagon were injected i.v. for hypotonia. Iodine (100 ml) was injected automatically (3 ml/s) and the CT scan was started 10 s after complete administration of CM. For response evaluation to CTx, four standardized parameters were measured by two experienced, blinded radiologists. The results were categorized according to the WHO classification of 1981 and compared to those of endoscopy.


RESULTS
In 24 of 25 patients endoscopic and computed tomographic response evaluation showed a close correlation (r = 0.96).


CONCLUSIONS
Spiral CT with negative oral contrast agent is a suitable technique for monitoring of GEJ masses. In combination with standardized metric parameters it offers a quantitative response evaluation in patients with GEJ masses during neoadjuvant CTx.
Helmberger
H
H
Department of Diagnostic Radiology, Technische Universität of Munich, Germany.
Baum
U
U
Dittler
H J
HJ
Sendler
A
A
Schulte
B
B
Herter
B
B
Fink
U
U
Gerhardt
P
P
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002086:Butylscopolammonium Bromide / Q000008:administration & dosage / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003287:Contrast Media; D004655:Emulsions; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000187:drug effects; D004945:Esophagoscopy; D005215:Fasting; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005773:Gastroscopy; D005934:Glucagon / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D010232:Paraffin; D010592:Pharmaceutic Aids; D015641:Radiography, Interventional; D016037:Single-Blind Method; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D014283:Triiodobenzoic Acids
D000970:Antineoplastic Agents; D003287:Contrast Media; D004655:Emulsions; D005765:Gastrointestinal Agents; D018727:Muscarinic Antagonists; D010592:Pharmaceutic Aids; D014283:Triiodobenzoic Acids; D002086:Butylscopolammonium Bromide; C053571:iopentol; D010232:Paraffin; D005934:Glucagon