Evaluation of progression prior to surgery after neoadjuvant chemoradiotherapy with computed tomography in esophageal cancer patients.
BACKGROUND
The risk of tumor progression during neoadjuvant chemoradiotherapy (CRT) in esophageal cancer (EC) is around 8% to 17%. We assessed the efficacy of computed tomography (CT) to identify these patients before esophagectomy.


METHODS
Ninety-seven patients with locally advanced EC treated with Carboplatin/Paclitaxel and 41.4 Gy neoadjuvantly were restaged with CT. Two radiologists reviewed pre- and post-CRT CT images. The primary outcome was detection of clinically relevant progressive disease. Missed metastases were defined as metastatic disease found during surgery or within 3 months after post-CRT CT.


RESULTS
Progressive disease was detected in 9 patients (9%). Both radiologists detected 5 patients with distant metastases (liver, n = 4; lung metastasis, n = 1), but missed progressive disease in 4 cases. One radiologist falsely assessed 2 metastatic lesions, but after agreement progressive disease was detected with sensitivity and specificity of 56% and 100%, respectively.


CONCLUSIONS
CT is effective in detecting clinically relevant progressive disease in EC patients, after neoadjuvant treatment.
Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands.
Jan B
JB
Hulshoff
Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands.
Justin K
JK
Smit
Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands.
Eric J
EJ
van der Jagt
Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: j.t.m.plukker@umcg.nl.
John T
JT
Plukker
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000628:therapy; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary / Q000628:therapy; D018196:Carcinoma, Adenosquamous / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D016190:Carboplatin; D017239:Paclitaxel
Computed tomography; Neoadjuvant CRT; Progression esophageal cancer