Vrednost multidetektorske kompjuterizovane tomografije u proceni i predviđanju odgovora karcinoma jednjaka na neoadjuvantnu hemoradioterapiju

Abstract

Cilj: Neoadjuvantna (preoperativna) hemoradioterapija (HRT) je široko prihvaćena terapijska opcija u multimodalnom tretmanu uznapredovalog, lokorgionalno ograničenog karcinoma jednjaka, a multidetektorska kompjuterizovana tomografija (MDCT) danas predstavlja standard u radiološkom dijagnostičkom algoritmu bolesnika sa karcinomom jednjaka, jer omogućava istovremenu procenu lokoregionalne proširenosti maligne bolesti (T i N stadijum) i detekciju udaljenih metastaza (M stadijum). Glavni ciljevi rada su: 1) utvrđivanje dijagnostičke pouzdanosti MDCT sa CT perfuzijom u proceni odgovora karcinoma jednjaka na neoadjuvantnu HRT i 2) identifikacija morfoloških i perfuzionih karakteristika karcinoma jednjaka koje mogu da predstavljaju prediktivne markere potencijalnog odgovora na HRT, a koje je moguće detektovati inicijalnim MDCT pregledom sa CT perfuzijom. Metodologija: Prospektivnom kohortnom kliničkom studijom obuhvaćeno je 65 bolesnika sa lokalno uznapredovalim skvamocelularnim karcinomom jednjaka, lečenih neoadjuvantnom HRT, kojima je u inicijalnoj dijagnostičkoj obradi, kao i 4-8 nedelja po sprovedenoj HRT, urađen MDCT pregled vrata, grudnog koša i abdomena sa CT perfuzionom studijom, radi (inicijalne i post-HRT) procene stadijuma maligne bolesti jednjaka. Istraživanje je sprovedeno u Centru za radiologiju i magnetnu rezonancu Kliničkog centra Srbije (Odsek digestivne radiologije- Prva hirurška klinika i Odsek za multidetektorsku kompjuterizovanu tomografiju) i Centru za hirurgiju jednjaka Prve hirurške klinike Kliničkog centra Srbije, u periodu od januara 2007. do jula 2013. Patološka analiza je rađena u Službi za patohistologiju Kliničkog centra Srbije (Odeljenje za digestivnu patologiju)...

Objective: Neoadjuvant (preoperative) chemo radiotherapy (CRT) is widely accepted therapeutic option in the multimodal treatment of loco regional advanced esophageal cancer, while multidetector-computed tomography (MDCT) is now the standard in diagnostic algorithm of patients with esophageal cancer, because it allows the simultaneous assessment of loco regional spread of malignancy (T and N stage) and the detection of distant metastases (M stage). The main objectives of this study were: 1) to estimate the diagnostic accuracy of MDCT together with the CT perfusion study in assessment of response of esophageal cancer to the neoadjuvant CRT, and 2) to identify the morphological and perfusion characteristics of the esophageal carcinoma, which could be the potential predictive markers of response to CRT, and those could be detected by initial MDCT examination with CT perfusion study. Methodology: 65 patients with loco regional advanced squamous cell carcinoma of the esophagus, who were treated with neoadjuvant CRT, were included in this prospective cohort clinical study. In all patients, MDCT examination of the neck, thorax and abdomen with CT perfusion study was performed in the initial diagnostic process, and repeated on the same way 4-8 weeks after completion of the CRT, due to staging and restaging purposes. The research was performed at the Center of Radiology and MRI of Clinical Center of Serbia (Unit of Digestive Radiology - First Surgical Clinic and Department of Multidetector Computed Tomography), and the Center of Esophageal Surgery, First Surgical Clinic, Clinical Center of Serbia, from January 2007 until July 2013. Pathological analysis was performed in the Department of histopathology (Department of Digestive Pathology), Clinical Center of Serbia. The study was approved by the Ethics Committee of the Medical Faculty in Belgrade...