Investigation of Using Diffusion-Weighted Magnetic Resonance Imaging (DWI) Combined with CT and Esophagogram to Evaluate the Therapeutic Effect of Esophageal Squamous Cell Carcinoma (ESCC) Treated with Chemoradiotherapy

Abstract

To investigate the application value of using DWI combined with CT and esophagogram evaluating the therapeutic effect of ESCC treated with chemoradiotherapy (CCRT). From January 2004 to December 2015, 529 patients with ESCC underwent CCRT were enrolled. Therapeutic effect was evaluated based on the maximal esophageal wall thickness measured by CT, hyperintense expression in DWI and tumor shape changes in esophagogram. Prognosis analysis was also performed. A total of 529 patients were evaluated by esophagogram and CT -based evaluation criteria, 132 patients were in complete response (CR) and 385 in partial response (PR) after CCRT. Overall survival (OS) and local control (LC) rates of patients in CR were significantly higher than those in PR, with the 5-, 10-year OS at 37%, 30% versus 21%, 19%, respectively (P<0.001). The median survival time was 5 months for 12 patients in none response (NR). Of all enrolled patients, 83 patients received DWI examination before and after CCRT. A total of 48 patients had no hyperintense expression in DWI (defined as CR) after CCRT and 35 still had hyperintense expression (defined as PR). OS and LC rates of patients received DWI examination in CR were significantly higher than those in PR (P=0.013, 0.001). In contrast, there was a trend towards increased uncontrolled and recurrent rate of patients in PR versus CR (P<0.05). According to the evaluation criteria based on DWI combined with CT and esophagogram, OS and LC rates of patients in CR were significantly higher than those in PR, with the 5-year LC at 62% versus 33% and 5-year OS at 48% versus 16%, respectively (P=0.018, 0.002). The esophagogram and CT -based evaluation criteria can accurately evaluate the therapeutic effect and predict prognosis in patients with ESCC. The expression of hyperintense in DWI at the end of treatment may indicate a high risk of recurrence. The therapeutic effect evaluated by DWI combined with CT and esophagogram maybe more objective and more accurate.