Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer.
BACKGROUND
This study evaluates the utility of positron emission tomography (PET), endoscopic ultrasonography (EUS), and computed tomographic (CT) scans to predict pathologic response and survival following preoperative chemoradiation (CRT) in esophageal cancer.


METHODS
One hundred three sequential patients with locoregionally advanced esophageal cancer, who were treated with CRT and esophageal resection between May 2001 and November 2003 at the University of Texas M.D. Anderson Cancer Center, were retrospectively reviewed. PET, EUS, and CT were performed before (pre) or after (post) CRT and before surgical resection. PET standardized uptake value (SUV) was defined as maximal uptake in primary tumor.


RESULTS
Most patients were male (91 [88%]) with adenocarcinoma (90 [87%]). Pretreatment clinical stages were: IIA (42 [41%]), IIB (5 [5%]), III (50 [49%]), and IVA (6 [6%]). At the time of surgery, 58 patients (56%) had a pathologic response to CRT (< or =10% viable cells). Post-CRT measurements that correlated with pathologic response were: CT esophageal wall thickness (13.3 vs 15.3 mm, p = 0.04), EUS mass size (0.7 vs 1.7 cm, p = 0.01) and PET SUV (3.1 vs 5.8, p = 0.01). Post-CRT PET SUV equal to or greater than 4 had the highest accuracy for pathologic response (76%). Univariate and multivariate Cox regression analysis demonstrated that a post-CRT PET SUV equal to or greater than 4 was an independent predictor of survival (HR, 3.5, p = 0.04).


CONCLUSIONS
The FDG-PET SUV is the most accurate noninvasive test to predict long-term survival after preoperative CRT and before surgical resection. Post-CRT FDG-PET cannot, however, rule out residual microscopic disease so esophagectomy should remain a therapeutic option even if the post-CRT imaging modalities are normal.
Department of Thoracic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. sswisher@mdanderson.org
Stephen G
SG
Swisher
Mary
M
Maish
Jeremy J
JJ
Erasmus
Arlene M
AM
Correa
Jaffer A
JA
Ajani
Robert
R
Bresalier
Ritsuko
R
Komaki
Homer
H
Macapinlac
Reginald F
RF
Munden
Joe B
JB
Putnam
David
D
Rice
W Roy
WR
Smythe
Ara A
AA
Vaporciyan
Garrett L
GL
Walsh
Tsung T
TT
Wu
Jack A
JA
Roth
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D000077143:Docetaxel; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D019788:Fluorodeoxyglucose F18; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D000077146:Irinotecan; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D011379:Prognosis; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D043823:Taxoids; D019788:Fluorodeoxyglucose F18; D000077143:Docetaxel; D000077146:Irinotecan; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin; D005472:Fluorouracil; D002166:Camptothecin