Ct staging of esophageal carcinoma in patients treated by primary radiation therapy and chemotherapy

Primary radiation therapy with concurrent chemotherapy is under study as definitive and palliative therapy for patients with esophageal carcinoma. To evaluate the correlation between CT staging and outcome, we retrospectively reviewed the CT scans of 48 patients treated with primary radiation therapy and concurrent chemotherapy and correlated CT staging with disease-free survival, overall survival, and site of relapse. Excluding one patient who was understaged and six patients who died of problems unrelated to esophageal carcinoma, mean survival of CT stage I, II, and III patients was 14.7, 21.3, and 5.2 months, respectively. When the CT stage is modified by the presence of nodal involvement on CT, the mean survival of stage Iln and Illn (nodes >1.5 cm in diameter) and stage IV patients (distant metastases) was 16.4, 19.2, and 10.6 months, respectively. Despite thickening of the esophageal wall >3.0 cm in five patients with stage Iln cancer, mean survival was still 19.2 months. Patients with pericardial effusion had the worst survival of only 4.3 months. Stage II patients had a significantly longer (p < 0.05) disease-free period than all other groups and the difference between stage II and III patients was highly significant (p < 0.01). Stage II patients were also more likely to be disease-free at the time of death or last follow-up (p < 0.05). Computed tomographic staging of esophageal carcinoma is useful in radiation therapy treatment planning and predicting outcome of patients managed with a nonsurgical technique of concurrent radiation and chemotherapy.