Response evaluation with endoscopic ultrasound and computed tomography in esophageal squamous cell carcinoma treated by definitive chemoradiotherapy

• Published in: Journal of gastroenterology and hepatology Vol. 30; no. 3; pp. 463 - 469
• Main Authors: Chang, Wei-Lun, Wang, Wen-Lun, Chung, Ta-Jung, Lin, Forn-Chia, Yen, Chia-Jui, Lai, Wu-Wei, Yang, Hsiao-Bai, Sheu, Bor-Shyang
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-03-2015
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy; definitive chemoradiotherapy; Endosonography; Esophageal Neoplasms - diagnosis; Esophageal Neoplasms - mortality; Esophageal Neoplasms - therapy; esophageal squamous cell carcinoma; Esophagus - diagnostic imaging; Feasibility Studies; Female; Humans; Male; Middle Aged; miniprobe endoscopic ultrasound (EUS); Prognosis; prognostic factors; response evaluation; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome; esophageal squamous cell carcinoma; prognostic factors; response evaluation; miniprobe endoscopic ultrasound (EUS); definitive chemoradiotherapy
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.12683

Background and Aim
We assessed the feasibility of combined endoscopic ultrasound and computed tomography on response evaluation in patients with esophageal squamous cell carcinoma treated by definitive chemoradiotherapy, and the impact of response on prognosis.
Methods
Sixty patients treated by definitive chemoradiotherapy were followed by miniprobe endoscopic ultrasound and computed tomography. The post‐treatment esophageal wall thickness was measured by miniprobe endoscopic ultrasound. Metastatic tumors were evaluated by computed tomography. The correlation between post‐treatment image findings and prognosis was evaluated.
Results
Twenty‐four patients (40%) had esophageal stricture after chemoradiotherapy, which limited complete evaluation by endoscopy. Miniprobe successfully penetrated all strictures to measure post‐treatment esophageal wall thickness. Both post‐treatment esophageal wall thickness < 8 mm measured by endoscopic ultrasound and no enlargement of metastatic tumor foci on computed tomography predicted good prognosis (P = 0.001). Combined evaluation with these two modalities improved survival prediction (P < 0.001). Patients who met the above two criteria after chemoradiotherapy had the longest survival compared with those who met only one or none of the criteria. The corresponding median survivals were > 30 months, 16.8 months and 7.1 months, respectively (P < 0.001). On multivariate analysis, treatment response is the strongest independent prognostic factor (hazard ratio 3.65, P = 0.006) regardless of baseline tumor‐node‐metastasis staging and chemoradiation regimen.
Conclusions
Response evaluation by miniprobe endoscopic ultrasound and computed tomography can predict the prognosis of esophageal squamous cell carcinoma patients treated by definitive chemoradiotherapy. Those who were judged as poor responder should receive additional treatment to improve outcome.