Hulshoff Jan B, Smit Justin K, van der Jagt Eric J, Plukker John T
Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands.
Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands.
Am J Surg. 2014 Jul;208(1):73-9. doi: 10.1016/j.amjsurg.2013.08.048. Epub 2014 Jan 4.
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.
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.
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.
CT is effective in detecting clinically relevant progressive disease in EC patients, after neoadjuvant treatment.
食管癌（EC）新辅助放化疗（CRT）期间肿瘤进展的风险约为8%至17%。我们评估了计算机断层扫描（CT）在食管切除术前行识别这些患者的有效性。
97例接受卡铂/紫杉醇新辅助治疗及41.4 Gy放疗的局部晚期EC患者接受CT重新分期。两名放射科医生对CRT前后的CT图像进行了评估。主要结局是检测出临床相关的疾病进展。漏诊转移灶定义为在手术期间或CRT后CT检查后3个月内发现的转移性疾病。
9例患者（9%）检测出疾病进展。两名放射科医生均检测出5例远处转移患者（肝脏转移4例；肺转移1例），但漏诊了4例疾病进展。一名放射科医生错误评估了2个转移灶，但经会诊后检测出疾病进展，敏感性和特异性分别为56%和100%。
新辅助治疗后，CT在检测EC患者临床相关的疾病进展方面有效。
