FDG-PET status following chemoradiotherapy provides high management impact and powerful prognostic stratification in oesophageal cancer.
OBJECTIVE
The purpose of this study was to evaluate the impact of FDG-PET following chemoradiotherapy (CRT) on treatment planning and survival in patients with oesophageal cancer (OC).


METHODS
Fifty-three consecutive OC patients had a post-treatment PET scan to evaluate tumour response to CRT prior to possible surgery. Baseline pre-CRT PET was performed in 33 patients. Prospectively recorded post-CRT management plans were compared with post-PET treatment. High impact was defined as a change in treatment intent or modality. Survival was analysed using the Kaplan-Meier product limit method and Cox proportional hazards regression model.


RESULTS
After completion of CRT, 23/53 patients (43%) achieved complete metabolic response (CMR), as compared with only four (8%) with complete response on computed tomography. High PET impact was observed in 19 patients (36%). CMR was strongly predictive of survival (p<0.008) on multivariate analysis. CMR patients in whom resection was not performed had comparable survival to those (CMR and non-CMR) who underwent resection.


CONCLUSIONS
The use of post-treatment FDG-PET for assessment of tumour response after CRT changed the clinical management of more than one-third of OC patients. CMR status as assessed by PET powerfully stratified prognosis. Even in the absence of a baseline study, normalisation of uptake at all sites of known tumoral involvement carries a good medium-term prognosis.
Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Cuong P
CP
Duong
Rodney J
RJ
Hicks
Leann
L
Weih
Elizabeth
E
Drummond
Trevor
T
Leong
Michael
M
Michael
Robert J S
RJ
Thomas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D004358:Drug Therapy / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D049268:Positron-Emission Tomography / Q000379:methods / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D019275:Radiopharmaceuticals; D011878:Radiotherapy / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18