Computed tomography (CT) texture analysis of primary tumors may become a helpful imaging biomarker in localized esophageal cancer after administering neoadjuvant chemotherapy, according to recent research.

The study’s findings were presented February 9, 2013, at the 2013 Cancer Imaging and Radiation Therapy Symposium, held in Orlando (FL, USA). This symposium is sponsored by the American Society for Radiation Oncology (ASTRO) and the Radiological Society of North American (RSNA).

This study assessed the tumoral texture analysis on baseline and post-treatment CT scans of 31 patients with localized resectable esophageal cancer, with a median age of 63, and who received neoadjuvant chemotherapy between 2007 and 2010. CT scans were performed before and after the use of chemotherapy and before surgery. All patients received fluorouracil-based and platinum chemotherapy followed by surgery. Texture parameters (mean-gray level intensity [MGI], entropy, uniformity, skewness, kurtosis, and standard deviation of histogram [SDH]) were derived for four filter values to highlight structures of different spatial width: 1.0 (fine texture), 1.5–2.0 (medium), and 2.5 (coarse). Median follow-up was 21.9 months. Primary tumors became more homogenous following chemotherapy because entropy decreased and uniformity increased. Smaller change in skewness following chemotherapy was a key prognostic factor—median overall survival was 36.1 months vs. 11.1 months. Lower baseline entropy and lower post-treatment MGI were also tied with increased survival, although they demonstrated only a trend toward significance.

Texture analysis of the CT scans is a post-processing step, which was performed using exclusive software (TexRAD) that enriches the images in ultrafine clarity not visible to the human eye. Specific tumoral characteristics changed consistently following chemotherapy, and some features were linked with overall survival.

“Though these results are for a very small number of patients, they suggest that the tumoral texture features may provide valuable information that could help us to distinguish which patients will do well following chemotherapy and which ones will do poorly,” concluded Connie Yip, MD, the lead study author, a clinical research fellow at King’s College London (UK), and an associate consultant in radiation oncology at the National Cancer Center, Singapore. “As a biomarker for treatment efficacy, this technique could save patients from unnecessary surgery and provide more definitive guidance in developing patient treatment plans with improved outcomes.”

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King’s College London