Tumor texture analysis, determined by computed tomography (CT), holds promise as a prognostic biomarker in patients with esophageal cancer, research indicates.
The study, which was presented at the 2013 Cancer Imaging and Radiation Therapy Symposium, also found that texture parameters altered following neoadjuvant therapy in esophageal cancer.
"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," said Connie Yip (King's College London, UK), the study's lead study author, in a press statement.
Yip and team evaluated textural features of tumors on baseline and post-chemotherapy CT scans of 31 patients with localized resectable esophageal cancer. The patients' mean age was 63 years and all received platinum and fluorouracil-based chemotherapy followed by surgery.
Texture parameters derived from the CT scans included mean-gray level intensity (MGI), entropy, uniformity, kurtosis, skewness, and standard deviation of histogram. Each feature was derived for four filter values to highlight structures of different spatial width (ie, fine, medium, and coarse).
"Texture analysis of the CT scans is a post-processing step, which was done utilizing proprietary software that enhances the images in ultra-fine detail not visible to the human eye," the investigators explain.
The median follow-up duration was 21.9 months, during which 11 patients responded to chemotherapy either completely or partially.
Following chemotherapy, the texture of primary esophageal tumors typically became more homogenous, as entropy decreased and uniformity increased, Yip et al report.
Multivariate analysis identified several prognostic factors for survival: a lower baseline entropy, smaller change in skewness following chemotherapy, and lower posttreatment MGI. Baseline and posttreatment standard deviation of histogram - analyzed as continuous variables - were also significantly associated with pathologic tumor response.
Taken together, these preliminary results support CT analysis of tumor texture to provide prognostic information in esophageal cancer, say Yip et al, who call for their hypothesis to be tested in a prospective study.
They add: "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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