Clinical application of barium radiography and computed tomography-based short-term outcome evaluation criteria in esophageal cancer

Objective To explore and improve the feasibility and prognostic value of barium radiography and computed tomography (CT)-based evaluation criteria in evaluation of the short-term efficacy of radiotherapy for esophageal cancer, and to provide a basis for clinical application. Methods The short-term treatment outcomes of 529 patients with esophageal carcinoma receiving three-dimensional radiotherapy from 2004 to 2015 were evaluated by the 2013 version of barium radiography and CT-based evaluation criteria. The local control (LC) and survival rates were calculated using the Kaplan-Meier method. The log-rank test was used for data analysis and univariate prognostic analysis. The agreement between two evaluation criteria was measured by the Kappa coefficient. Results According to the results of the survival analysis in all the patients using the evaluation criteria for short-term treatment outcomes, the 3-, 5-, 7-, and 9-year LC rates were 78.6%, 69.8%, 69.8%, and 63.4% in the complete response (CR) group (n=52), and 56.4%, 47.9%, 46.2%, and 42.4% in the partial response (PR) group (n=409), respectively; the 3-, 5-, 7-, and 9-year overall survival (OS) rates were 62.7%, 49.1%, 39.8%, and 39.8% in the CR group, and 29.5%, 21.6%, 20.6%, and 19.5% in the PR group, respectively; the median OS time was 50, 17, and 5 months in the CR group, PR group, and non-response group (n=12), respectively (P=0.000). According to CT measurements, the short diameter of residual metastatic lymph node after radiotherapy was between 0.37-3.40 cm (median value=0.82 cm). All patients were divided into groups based on the short diameter of residual metastatic lymph node after radiotherapy with a gradient of 0.5 cm. Patients with short diameters of residual metastatic lymph node of ≤1.00 cm had a significantly higher OS rate than those with short diameters of residual metastatic lymph node of>1.00 cm (P=0.000). The lymph node volume of 1.00 cm3 in the original criteria was replaced by the short diameter of residual metastatic lymph node of 1.00 cm after radiotherapy and treatment outcomes were re-evaluated using the new criteria. The CR group still had significantly higher LC and OS rates than the PR group (P=0.000). There was a good agreement between the two evaluation criteria (Kappa=0.863). Conclusions The barium radiography and CT-based evaluation criteria for short-term treatment outcomes can accurately evaluate the short-term outcomes and predict prognosis in patients with esophageal carcinoma. Replacing the volume in the original criteria with the short diameter of residual metastatic lymph node after radiotherapy achieves similar results in prognostic prediction. Key words: Esophageal neoplasms/radiotherapy; Treatment outcome; Prognosis