Effects of neoadjuvant radio-chemotherapy on 18F-FDG-PET in esophageal carcinoma.
OBJECTIVE
To investigate whether results of [F-18]-fluorodeoxy-d-glucose (FDG) positron emission tomography (PET) of esophageal cancer (EC) before and after neoadjuvant radio-chemotherapy correlate with histopathology after esophageal resection.


METHODS
Twenty consecutive patients with EC without distant metastases were examined twice with 18F-FDG-PET during primary staging and after neoadjuvant radio-chemotherapy. FDG standardised uptake values (SUV) were correlated with the histopathological findings (percentage of viable tumour cells, tumour regression grade 1-5).


RESULTS
Regression analysis revealed a slight (not significant) positive correlation between SUV(pre) (R=0.41, p=0.08) and SUV(post) (R=0.37, p=0.11) and the percentage of viable tumour cells in the resectate. Although all patients showed a significant decrease in SUV after radio-chemotherapy (p < 0.01) the percentual decrease of the SUV after therapy (DeltaSUV%) did not significantly differ between the TRG-groups. In 12 of 20 patients (60%), therapy-induced esophagitis was detected in post-therapeutic PET images.


CONCLUSIONS
In EC, a higher pre-therapeutic SUV might be correlated with a higher fraction of vital tumour cells remaining after radio-chemotherapy. Applying the neoadjuvant therapy protocol and the study design used in this examination, there is no correlation between decrease in SUV and histopathology.
Brink
I
I
Division of Nuclear Medicine, University Hospital Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany. ibrink@ukl.uni-freiburg.de
Hentschel
M
M
Bley
T A
TA
Walch
A
A
Mix
M
M
Kleimaier
M
M
Moser
E
E
Imdahl
A
A
D000230:Adenocarcinoma / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D004941:Esophagitis / Q000139:chemically induced / Q000532:radiotherapy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000627:therapeutic use*; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D013223:Statistics as Topic; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18