Esophageal cancer (EC) is the seventh most frequently diagnosed cancers and the sixth leading causes of cancer death worldwide . It is one of the most common malignancy in China, with the third highest morbidity and mortality rate. More than 90% of patients with EC in China have esophageal squamous cell carcinoma (ESCC). Neoadjuvant chemoradiotherapy (nCRT) followed by surgery is currently widely used strategy for locally advanced surgical EC. At present, conventional imaging methods have certain defects (focus only on the volume change) in the evaluation of the efficacy of nCRT. Whereas functional imaging can more comprehensively reflect the biological and microstructural characterization of tumors. The changes of these aspects of tumors can be observed earlier than volumetric changes of tumors. The normal metabolism of the body is the basis for ensuring life activities. Due to the increased energy demand and proliferation of tumor tissue in patients with cancer, the metabolism of patients is different from that of normal person. Thus, the metabolic alterations seen in cancer cells have emerged as one of the hallmarks of cancer. Previous metabolomic studies have demonstrated various metabolic alterations in patients with ESCC. Many metabolites have been found to be promising diagnostic, staging or prognostic biomarkers for ESCC. However, there are few studies on metabolic markers on the chemoradiation sensitivity of esophageal cancer. Therefore, the aim of the present study is to evaluate the value of functional imaging parameters and metabolic markers in assessing and predicting pathological response in patients who underwent nCRT for ESCC.
Study Type
OBSERVATIONAL
Enrollment
118
Anatomical (T2W) and functional MRI (DWI) at a 3.0T Siemens or Philips scanner Three MRI scan series (before, during, after nCRT) Measurements: change in apparent diffusion coefficient (ADC)
PET-CT scan at diagnosis and 4-6 weeks after nCRT before operation Measurements: change in TLG (Total Lesion Glycolysis), SUVmax (Standardized Uptake Value),MTV(Metabolic tumor volume)
Blood and urine specimens are collected before radiotherapy, the third week of radiotherapy, and at the end of radiotherapy.
Renji Hospital
Shanghai, Shanghai Municipality, China
RECRUITINGHistopathologic response
Histopathologic response of the primary tumor to nCRT according to the tumor regression grade (TRG) scale as determined by expert pathologist. TRG 1(pCR): no residual viable tumor cells, pathologic complete response TRG 2: rare residual cancer cells TRG 3: predominant fibrosis with increased number of residual cancer cells TRG 4: residual cancer outgrowing fibrosis or no regressive change
Time frame: Based on resection specimen (surgery 6-8 weeks after finishing nCRT)
∆ADC
change of apparent diffusion coefficient in DW-MRI and difference between pCR group and non-pCR group
Time frame: within 2 weeks before the start of nCRT,2 weeks after the start of nCRT and 4-6 weeks after the completion of nCRT
∆TLG
change of total lesion glycolysis in PET/CT and difference between pCR group and non-pCR group
Time frame: within 2 weeks before the start of nCRT,2 weeks after the start of nCRT and 4-6 weeks after the completion of nCRT
change of metabolites
change of metabolites after chemoradiotherapy and differences between pCR group and non-pCR group
Time frame: within 2 weeks before the start of nCRT and 4-6 weeks after the completion of nCRT
Disease-free survival
time to locoregional or distal recurrence
Time frame: Up to 5-year follow-up
Overall survival
time to die or follow-up deadline
Time frame: Up to 5-year follow-up
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