Correlation between tumor blood flow assessed by perfusion CT and effect of neoadjuvant therapy in advanced esophageal cancers.
BACKGROUND
Redundant blood supply by angiogenesis is a great advantage for the continuous growth of solid tumors. However, with chemotherapy (ChT), it can be disadvantageous due to increased drug delivery. An objective, reproducible, and non-invasive method for evaluating tumor blood supply is offered by perfusion CT.


METHODS
Fifty-five advanced esophageal cancers (95% squamous cell carcinomas) were evaluated for hemodynamic parameters, including blood flow (BF), blood volume (BV), and mean transit time (MTT) of primary tumor by perfusion CT scan. Forty-six underwent neoadjuvant therapy (36 ChT and 10 chemoradiotherapy (CRT)) as primary treatment of the cancer and 36 underwent esophagectomy.


RESULTS
Clinicopathological parameters were not significantly associated with hemodynamic parameters, except for hematogenic metastasis, which was not frequent (seven patients), but significantly associated with high BF (P = 0.0165). High BF and low MTT correlated significantly with a good response by neoadjuvant therapies (P = 0.0004 and P = 0.0124), while BV did not. The patients with high BF more frequently underwent esophagectomy and displayed better prognosis than those with lower values, while neither BV nor MTT was associated with patient survival.


CONCLUSIONS
Tumor BF by perfusion CT can partly predict the effect of ChT and CRT and survival. Further large cohort studies in homogeneous patient groups will reveal its clinical usefulness.
Makari
Yoichi
Y
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Yasuda
Takushi
T
Doki
Yuichiro
Y
Miyata
Hiroshi
H
Fujiwara
Yoshiyuki
Y
Takiguchi
Shuji
S
Matsuyama
Jin
J
Yamasaki
Makoto
M
Hirao
Takafumi
T
Koyama
Mitsuhiro Koyama
MK
Nakamuara
Hironobu
H
Monden
Morito
M
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D011379:Prognosis; D016016:Proportional Hazards Models; D012039:Regional Blood Flow; D014057:Tomography, X-Ray Computed