Evaluation of response to induction chemotherapy in esophageal cancer: is barium esophagography or PET-CT useful?

Abstract

Objective: To determine whether sequential barium esophagograms can predict histopathological response to treatment in esophageal cancer.

Materials and methods: Two radiologists retrospectively reviewed esophagograms pre- and post- chemotherapy in 32 patients for tumor length decrease of at least 15% and luminal width increase of at least 15%. Positron emission tomography-computed tomography (PET-CT) was reviewed for tumor maximum standardized uptake value (SUVmax) decrease of at least 35%. The reference standard was 90% or more tumor necrosis at histopathologic examination of the excised specimen.

Results: Pathologic response ranged from 10% to 100% necrosis. For prediction of tumor response, the sensitivity, specificity, positive and negative predictive values for length ranged from 43.8 to 56.3% and for width from 41.2% to 66.7% and for SUVmax from 47.1% to 53.3%.

Conclusion: Performance characteristics for barium esophagograms in our group of patients were similar to PET-CT in predicting tumor response. Both tests were inadequate in predicting tumor response.