Mismatched clinicopathological response after concurrent chemoradiotherapyfor thoracic esophageal cancer

We have been treating patients with operable thoracic esophageal cancer acc ording to our own protocol. It includes the initial concurrent chemoradioth erapy (CRT) followed by continuous CRT or surgery. Patients with good respo nse to initial chemoradiotherapy were allowed to continue chemoradiotherapy , whereas the others were treated with surgery. However, there were two cas es which showed discrepancies in the clinicopathological response. Both pat ients received initial chemoradiotherapy, including two courses of cisplati n (100-120 mg), 5-fluorouracil (750-1000 mg for 4 days) and radiation (44-5 0 Gy). On completion of the initial chemoradiotherapy, all diagnostic imagi ng modalities including barium swallow, esophagoscopy, endoscopic ultrasono graphy and thoracic computed tomography strongly implicated residual tumor with a reduction rate of 40-50%. The patients underwent radical esophagecto my 15-20 days after initial chemoradiotherapy. Pathological specimens only revealed thickening of the esophageal wall due to inflammatory change witho ut residual carcinoma. These facts suggest the current limitations of diagn ostic images in evaluating the response to chemoradiotherapy.