[18F]-Fluorodeoxyglucose-positron emission tomography for the assessment of histopathologic response and prognosis after completion of neoadjuvant chemoradiation in esophageal cancer
- PMID: 19953708
- DOI: 10.1097/sla.0b013e3181bc9c0d
[18F]-Fluorodeoxyglucose-positron emission tomography for the assessment of histopathologic response and prognosis after completion of neoadjuvant chemoradiation in esophageal cancer
Abstract
Objective: To evaluate the potential of [(18)F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) after the completion of neoadjuvant chemoradiation for the assessment of histopathologic response and prognosis in the multimodality treatment of patients with esophageal cancer.
Background: Combined chemoradiation with and without surgery are widely accepted treatment options for patients with locally advanced esophageal cancer. Evidence suggests that patients with response to chemoradiation have no additional benefit from surgery compared with definitive chemoradiation. However, there is still a great lack in noninvasive markers for response assessment in patients with esophageal cancer undergoing multimodality treatment. Interestingly, recent studies imply that FDG-PET significantly correlates with histopathologic response and survival in patients with esophageal cancer undergoing neoadjuvant chemotherapy followed by surgical resection.
Methods: Study patients were recruited from a prospective clinical observation trial on neoadjuvant chemoradiation for esophageal cancer between 1997 and 2006. The study included 119 (98 men, 21 women; median age, 59.4 years; squamous cell cancer: 66; adenocarcinoma: 53) patients with locally advanced esophageal cancer (cT2- 4, N(x), M(0)). All patients received neoadjuvant chemoradiation (cisplatin, 5-FU, 36 Gy) and subsequently underwent transthoracic en bloc esophagectomy. Histomorphologic regression was defined as major histopathologic response when resected specimens contained less than 10% vital residual tumor cells (major response: 47 patients [39.5%]; minor response: 72 patients [60.5%]). FDG-PET was performed before and 2 to 3 weeks after the end of chemoradiation with assessment of the intratumoral FDG-uptake (pretreatment standardized uptake value; post-treatment standardized uptake value; percentage change). These variables were correlated with histopathologic response and survival.
Results: Major histomorphologic response was confirmed as an important prognostic factor (P = 0.005; log-rank test). Neoadjuvant chemoradiation led to a significant reduction of intratumoral FDG-uptake (P = 0.0001). A nonsignificant association was seen between major responders and FDG-PET results (P = 0.056). However, the receiver operating characteristic analysis could not identify a standardized uptake value threshold with a relevant predictive value for histomorphologic response. No significant association between metabolic imaging and prognosis was found.
Conclusion: FDG-PET seems not to be an imaging system that effectively characterizes the groups of major and minor response as well as survival in patients with esophageal cancer after multimodality treatment.
Similar articles
-
Ineffectiveness of ¹⁸F-fluorodeoxyglucose positron emission tomography in the evaluation of tumor response after completion of neoadjuvant chemoradiation in esophageal cancer.Ann Surg. 2013 Jul;258(1):66-76. doi: 10.1097/SLA.0b013e31828676c4. Ann Surg. 2013. PMID: 23470576
-
[18F]-fluorodeoxyglucose-positron emission tomography for the assessment of histopathologic response and prognosis after completion of neoadjuvant chemotherapy in gastric cancer.J Surg Oncol. 2010 Aug 1;102(2):135-40. doi: 10.1002/jso.21592. J Surg Oncol. 2010. PMID: 20648583 Clinical Trial.
-
Predictive value of 18-fluoro-deoxy-glucose-positron emission tomography (18F-FDG-PET) in the identification of responders to chemoradiation therapy for the treatment of locally advanced esophageal cancer.Ann Surg. 2006 Apr;243(4):472-8. doi: 10.1097/01.sla.0000208430.07050.61. Ann Surg. 2006. PMID: 16552197 Free PMC article. Clinical Trial.
-
Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer.Ann Thorac Surg. 2004 Oct;78(4):1152-60; discussion 1152-60. doi: 10.1016/j.athoracsur.2004.04.046. Ann Thorac Surg. 2004. PMID: 15464463 Review.
-
Optimizing neoadjuvant chemotherapy through the use of early response evaluation by positron emission tomography.Recent Results Cancer Res. 2012;196:201-11. doi: 10.1007/978-3-642-31629-6_14. Recent Results Cancer Res. 2012. PMID: 23129376 Review.
Cited by
-
Oesophageal cancer--an overview.Nat Rev Gastroenterol Hepatol. 2013 Apr;10(4):230-44. doi: 10.1038/nrgastro.2012.236. Epub 2013 Jan 8. Nat Rev Gastroenterol Hepatol. 2013. PMID: 23296250 Review.
-
Personalized therapy based on image for esophageal or gastroesophageal junction adenocarcinoma.Ann Transl Med. 2018 Feb;6(4):80. doi: 10.21037/atm.2017.10.28. Ann Transl Med. 2018. PMID: 29666803 Free PMC article. Review.
-
Early post-treatment FDG PET predicts survival after 90Y microsphere radioembolization in liver-dominant metastatic colorectal cancer.Eur J Nucl Med Mol Imaging. 2015 Mar;42(3):370-6. doi: 10.1007/s00259-014-2935-z. Epub 2014 Oct 29. Eur J Nucl Med Mol Imaging. 2015. PMID: 25351506
-
Interim position emission tomography-computed tomography during multimodality treatment of locally advanced esophageal cancer: a scoping review.Quant Imaging Med Surg. 2023 Sep 1;13(9):6280-6295. doi: 10.21037/qims-22-1306. Epub 2023 Jul 17. Quant Imaging Med Surg. 2023. PMID: 37711778 Free PMC article.
-
State-of-the-art molecular imaging in esophageal cancer management: implications for diagnosis, prognosis, and treatment.J Gastrointest Oncol. 2015 Feb;6(1):3-19. doi: 10.3978/j.issn.2078-6891.2014.062. J Gastrointest Oncol. 2015. PMID: 25642333 Free PMC article. Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Research Materials