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. 2021 Jan;48(1):176-185.
doi: 10.1007/s00259-020-04917-5. Epub 2020 Jun 22.

Clinical response assessment on DW-MRI compared with FDG-PET/CT after neoadjuvant chemoradiotherapy in patients with oesophageal cancer

Sophie E Vollenbrock  1   2 , Francine E M Voncken  3 , Doenja M J Lambregts  1 , Monique Maas  1 , Maarten L Donswijk  4 , Erik Vegt  4   5 , Leon C Ter Beek  1 , Jolanda M van Dieren  6 , Johanna W van Sandick  7 , Berthe M P Aleman  3 , Regina G H Beets-Tan  1   2   8 , Annemarieke Bartels-Rutten  9
Affiliations

Clinical response assessment on DW-MRI compared with FDG-PET/CT after neoadjuvant chemoradiotherapy in patients with oesophageal cancer

Sophie E Vollenbrock et al. Eur J Nucl Med Mol Imaging. 2021 Jan.

Abstract

Purpose: In about 30% of patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgical resection for locally advanced oesophageal cancer no vital tumour is found in the resection specimen. Accurate clinical response assessment is critical if deferral from surgery is considered in complete responders. Our study aimed to compare the performance of MRI and of FDG-PET/CT for the detection of residual disease after nCRT.

Methods: Patients with oesophageal cancer eligible for nCRT and oesophagectomy were prospectively included. All patients underwent FDG-PET/CT and MRI before and between 6 and 8 weeks after nCRT. Two radiologists scored the MRI scans, and two nuclear medicine physicians scored the FDG-PET/CT scans using a 5-point score for residual disease. Histopathology after oesophagectomy represented the reference standard. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated for detection of residual tumour (ypT+), residual nodal disease (ypN+), and any residual disease (ypT+Nx/ypT0N+).

Results: Seven out of 33 (21%) patients had a pathological complete response. The AUCs for individual readers to detect ypT+ were 0.71/0.70 on diffusion-weighted (DW)-MRI and 0.54/0.57 on FDG-PET/CT, and to detect ypN+ were 0.89/0.81 on DW-MRI and 0.75/0.71 on FDG-PET/CT. The AUCs/sensitivities/specificities for the individual readers to detect any residual disease were 0.74/92%/57% and 0.70/96%/43% on MRI; these were 0.49/69%/29% and 0.60/69%/43% on FDG-PET/CT, respectively.

Conclusion: MRI reached higher diagnostic accuracies than FDG-PET/CT for the detection of residual tumour in oesophageal cancer patients at 6 to 8 weeks after nCRT.

Trial registration: ClinicalTrials.gov NCT02139488.

Keywords: FDG-PET/CT; MRI; Oesophageal cancer; nCRT.

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