Combined modalities of magnetic resonance imaging, endoscopy and computed tomography in the evaluation of tumor responses to definitive chemoradiotherapy in esophageal squamous cell carcinoma.

PURPOSE:To explore the value of combined modalities, including anatomical and functional magnetic resonance imaging (MRI), endoscopy and computed tomography (CT), for the assessment of tumor responses to definitive chemoradiotherapy (dCRT) in esophageal squamous cell carcinoma (ESCC). METHODS:Sixty-seven patients with locally advanced ESCC were enrolled. Tumor response (TR) was assessed two months after the completion of dCRT. Evaluation criteria according to combined modalities, including MRI, endoscopy and CT, were established and compared with traditional criteria based on CT and endoscopy. Progression-free survival (PFS)⩾12months was used as the reference standard, and the accuracy of the two criteria in response assessment was analyzed. RESULTS:Thirty-seven (55.2%) and 10 (14.9%) patients were considered to exhibit CR, as assessed by combined modalities and the traditional criteria, respectively. Using PFS⩾12months as a surrogate for CR, the sensitivity and specificity of the combined modalities were 82.4% and 88.9%, respectively, compared with 20.6% and 92.6% for the traditional criteria. TR assessed by combined modalities (CR vs. non-CR) was prognostic of PFS in univariate and multivariate analyses (Log-rank, P<0.0001; Cox regression, HR=0.114, 95% CI 0.048-0.272). CONCLUSIONS:Tumor responses assessed by the combined modalities of MR, endoscopy and CT seemed highly predictive of prognosis after dCRT in ESCC patients.