Monitoring of response to pre-operative chemoradiation in combination with hyperthermia in oesophageal cancer by FDG-PET.
OBJECTIVE
To evaluate the use of positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET) to assess early response to pre-operative chemoradiation therapy in combination with external locoregional hyperthermia in patients with oesophageal cancer by correlating the reduction of metabolic activity with histopathologic response.


METHODS
Twenty-six patients with histopathologically proven intra-thoracic oesophageal cancer (with < or =2 cm gastric involvement), scheduled to undergo a 5-week course of pre-operative chemoradiation therapy and hyperthermia, were included. FDG-PET was performed before (n = 26) and 2 weeks after initiation of therapy (n = 17). FDG uptake was quantitatively assessed by standardized uptake values.


RESULTS
After neoadjuvant therapy, 24 of the 26 patients underwent surgery. In 16 patients changes in FDG uptake were correlated to histopathologic response. In these patients, histopathologic evaluation revealed less than 10% viable tumour cells in eight patients (responders) and more than 10% viable tumour cells in eight patients (non-responders). In responders, FDG uptake decreased by a median -44% (-75 to 2); in non-responders, it decreased by a median of -15% (-46 to 40). At a threshold of 31% decrease of FDG uptake compared with baseline, sensitivity to detect response was 75%, with a corresponding specificity of 75%. The positive and negative predictive values were both 75%.


CONCLUSIONS
FDG-PET is a promising tool for early response monitoring in patients undergoing chemoradiation therapy in combination with hyperthermia.
Westerterp
Marinke
M
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.westerterp@amc.uva.nl
Omloo
Jikke M T
JM
Sloof
Gerrit W
GW
Hulshof
Maarten C C M
MC
Hoekstra
Otto S
OS
Crezee
Hans
H
Boellaard
Ronald
R
Vervenne
Walter L
WL
ten Kate
Fiebo J W
FJ
van Lanschot
Jan J B
JJ
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000628:therapy*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D049268:Positron-Emission Tomography / Q000379:methods* / Q000592:standards; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D011878:Radiotherapy; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D019788:Fluorodeoxyglucose F18; D016190:Carboplatin; D017239:Paclitaxel