Purpose. This retrospective study examined the usefulness of barium esophagography, focusing on the luminal stenosis, in the response evaluation of neoadjuvant chemoradiotherapy (NACRT) in patients with esophageal cancer. Materials and Methods. Thirty-four patients with primary advanced esophageal cancer (≥T2) who were treated with NACRT before surgical resection were analyzed. All patients underwent barium esophagography before and after NACRT. The tumor length, volume, and percent esophageal stenosis (PES) before and after NACRT were measured. These values and their changes were compared between histopathologic responders ( ) and nonresponders ( ). Results. Posttreatment tumor length and PES in responders (4.5？cm ± 1.1 and 33.0% ± 18.5) were significantly smaller than those in nonresponders (5.8？cm ± 1.9 and 48.0% ± 12.9) ( ). Regarding posttherapeutic changes, the decrease in PES in responders (31.5% ± 13.9) was significantly greater than that in nonresponders (14.4% ± 10.7) ( ). The best decrease in PES cutoff with which to differentiate between responders and nonresponders was 18.8%, which yielded a sensitivity of 91% and a specificity of 75%. Conclusions. Decrease in PES is a good parameter to differentiate responders from nonresponders for NACRT. Barium esophagography is useful in response evaluation to NACRT in patients with locally advanced esophageal cancer. 1. Introduction In the treatment evaluation of chemoradiotherapy in patients with esophageal cancer, new guidelines published in 1999, known as the “Response Evaluation Criteria in Solid Tumors (RECIST),” have been commonly used [1]. RECIST gives specific size requirements for measurable lesions at baseline to distinguish target from nontarget lesions. It is difficult to measure accurately the primary site of esophageal cancer as distinct from the normal esophageal wall in one dimension, because a computed tomography (CT) scan detects a primary lesion of esophageal cancer according to wall thickness of the esophagus. Therefore, the primary site of esophageal cancer is often identified as a “nontarget lesion” [2]. Accordingly, in the case of patient who has no target lesion (i.e., nodal involvement), evaluation of response to chemoradiotherapy is not clinically available. The only way to verify the response is to pathologically evaluate the resected specimen after the treatment, neoadjuvant chemoradiotherapy (NACRT). NACRT is a treatment option for advanced esophageal cancer which main aim is downstaging before surgery to increase rates of curative resection [3, 4]. Barium esophagography
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