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. 2023 Oct;49(10):106934.
doi: 10.1016/j.ejso.2023.05.009. Epub 2023 May 10.

Association of dynamic contrast-enhanced MRI and 18F-Fluorodeoxyglucose PET/CT parameters with neoadjuvant therapy response and survival in esophagogastric cancer

Samuel J Withey  1 , Kasia Owczarczyk  2 , Mariusz T Grzeda  3 , Connie Yip  4 , Harriet Deere  5 , Mike Green  5 , Nick Maisey  6 , Andrew R Davies  7 , Gary J Cook  8 , Vicky Goh  9 ; Guy's & St Thomas' Esophagogastric Research Group
Collaborators, Affiliations

Association of dynamic contrast-enhanced MRI and 18F-Fluorodeoxyglucose PET/CT parameters with neoadjuvant therapy response and survival in esophagogastric cancer

Samuel J Withey et al. Eur J Surg Oncol. 2023 Oct.

Abstract

Introduction: Better predictive markers are needed to deliver individualized care for patients with primary esophagogastric cancer. This exploratory study aimed to assess whether pre-treatment imaging parameters from dynamic contrast-enhanced MRI and 18F-fluorodeoxyglucose (18F-FDG) PET/CT are associated with response to neoadjuvant therapy or outcome.

Materials and methods: Following ethical approval and informed consent, prospective participants underwent dynamic contrast-enhanced MRI and 18F-FDG PET/CT prior to neoadjuvant chemotherapy/chemoradiotherapy ± surgery. Vascular dynamic contrast-enhanced MRI and metabolic 18F-FDG PET parameters were compared by tumor characteristics using Mann Whitney U test and with pathological response (Mandard tumor regression grade), recurrence-free and overall survival using logistic regression modelling, adjusting for predefined clinical variables.

Results: 39 of 47 recruited participants (30 males; median age 65 years, IQR: 54, 72 years) were included in the final analysis. The tumor vascular-metabolic ratio was higher in patients remaining node positive following neoadjuvant therapy (median tumor peak enhancement/SUVmax ratio: 0.052 vs. 0.023, p = 0.02). In multivariable analysis adjusted for age, gender, pre-treatment tumor and nodal stage, peak enhancement (highest gadolinium concentration value prior to contrast washout) was associated with pathological tumor regression grade. The odds of response decreased by 5% for each 0.01 unit increase (OR 0.95; 95% CI: 0.90, 1.00, p = 0.04). No 18F-FDG PET/CT parameters were predictive of pathological tumor response. No relationships between pre-treatment imaging and survival were identified.

Conclusion: Pre-treatment esophagogastric tumor vascular and metabolic parameters may provide additional information in assessing response to neoadjuvant therapy.

Keywords: Esophageal cancer; Fluorodexoyglucose F18; Magnetic resonance imaging; Perfusion imaging; Positron emission tomography computed tomography.

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Figures

Fig. 1
Fig. 1
Participant flow through the study.
Fig. 2
Fig. 2
59-year-old with an esophagogastric adenocarcinoma responding to neoadjuvant therapy (TRG 2). Axial T2-weighted MRI (A) demonstrates the primary tumor. Axial pre-contrast T1-weighted MRI (B), arterial phase T1-weighted MRI (C) and portal-venous phase T1-weighted MRI (D) show early tumor enhancement with washout. Corresponding peak enhancement map (E) and 18F-FDG PET/CT (F) show lower tumor peak enhancement of 0.17 mmol.L−1 and metabolic activity, SUVmax of 29.8, respectively.
Fig. 3
Fig. 3
75-year-old with a lower esophageal adenocarcinoma who had a poor response to neoadjuvant therapy (TRG 4). Axial T2-weighted MRI image (A) demonstrates the primary tumor. Axial pre-contrast T1-weighted MRI image (B), axial arterial phase T1-weighted MRI image (C) and axial portal-venous phase T1-weighted MRI image (D) show early tumor enhancement with washout. Corresponding peak enhancement map (E) and 18F-FDG PET/CT (F) shows higher peak enhancement of 0.33 mmol L−1 and lower tumor metabolic activity, SUVmax of 5.7, respectively.
See this image and copyright information in PMC

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