[Clinical value of barium swallow in observing esophageal tumor regression during radiotherapy].

BACKGROUND & OBJECTIVE: Barium swallow is widely used to observe the treatment response of esophageal squamous cell carcinoma (ESCC) and as a routine examination for long-term follow-up in China because of its convenience and inexpensiveness. This study was to observe esophageal tumor regression by barium swallow during radiotherapy, analyze the correlations of tumor regression speed to short-term response and long-term survival, and evaluate the clinical value of barium swallow during radiotherapy for ESCC.

METHODS

Clinical data from 94 patients with ESCC, treated with radiotherapy (39 patients) or chemoradiotherapy (55 patients) from Jan. 2001 to Jun. 2003 at Cancer Center of Sun Yat-sen University, were retrospectively reviewed. Of the 94 patients, 18 (19.1%) were at stage II, 36 (36.3%) at stage III, and 42 (44.6%) at stage IV. Barium swallow was performed at the radiation dose of 40 Gy and the radiation end, and the X-ray appearance was classified according to Zhengzhou Meeting criteria. The patients were divided into 3 groups according to their tumor regression speed: Group A had rapid regression, with the X-ray appearance classified as grade I or II at 40 Gy, Group B had slow regression, with the X-ray appearance classified as grade III or IV at 40 Gy, but as grade I or II at the radiation end, Group C had obvious residual tumors, with the X-ray appearance kept being classified as grade III or IV till radiation end. The correlations of tumor regression speed to short-term response and long-term survival were analyzed.

RESULTS

The complete response (CR) rates were 100.0% in Group A, 65.2% in Group B, and 28.3% in Group C (P<0.001), the 3-year survival rates were 44.0%, 24.2%, and 17.3%, respectively (P<0.001). Multivariate Cox regression analysis showed that short-term response and M stage were independent prognostic factors. The 3-year survival rates of CR patients were 44.0% in Group A, 32.6% in Group B, and 42.2% in Group C (P=0.814). The locoregional failure rates were 50% in Group A, 88% in Group B, and 81% in Group C, and the occurrence rates of severe radiation-related complications were 19%, 0%, and 6%, respectively.

CONCLUSIONS

Barium swallow during radiotherapy for ESCC could be used to judge tumor regression speed, which is closely related to short-term response. Short-term response is an important prognostic factor of ESCC.