Correlation between tumor blood flow assessed by perfusion CT and effect of neoadjuvant therapy in advanced...

Redundant blood supply by angiogenesis is a great advantage for the continuous growth of solid tumors. However, with chemotherapy (ChT), it can be disadvantageous due to increased drug delivery. An objective, reproducible, and non-invasive method for evaluating tumor blood supply is offered by perfusion CT.

Fifty-five advanced esophageal cancers (95% squamous cell carcinomas) were evaluated for hemodynamic parameters, including blood flow (BF), blood volume (BV), and mean transit time (MTT) of primary tumor by perfusion CT scan. Forty-six underwent neoadjuvant therapy (36 ChT and 10 chemoradiotherapy (CRT)) as primary treatment of the cancer and 36 underwent esophagectomy.

Clinicopathological parameters were not significantly associated with hemodynamic parameters, except for hematogenic metastasis, which was not frequent (seven patients), but significantly associated with high BF (P = 0.0165). High BF and low MTT correlated significantly with a good response by neoadjuvant therapies (P = 0.0004 and P = 0.0124), while BV did not. The patients with high BF more frequently underwent esophagectomy and displayed better prognosis than those with lower values, while neither BV nor MTT was associated with patient survival.

Tumor BF by perfusion CT can partly predict the effect of ChT and CRT and survival. Further large cohort studies in homogeneous patient groups will reveal its clinical usefulness.