Value of complete metabolic response by (18)F-fluorodeoxyglucose-positron emission tomography in oesophageal cancer for prediction of pathologic response and survival after preoperative chemoradiotherapy.
We aimed to assess the ability of (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan to predict pathologic complete response (CR) and survival in patients with oesophageal cancer treated with preoperative chemoradiotherapy (CRT). The study cohort consisted of 62 consecutive patients with operable oesophageal cancer who were treated with preoperative CRT followed by oesophagectomy. Endoscopy, computed tomography (CT) and PET were performed before and after CRT. Of the 62 patients, 56 (90%) patients responded to preoperative CRT. FDG-PET-determined complete metabolic response (CMR) was achieved by 33 patients (54.1%), whereas pathologic CR was achieved by 28 patients (45.2%). Compared with endoscopic biopsy or CT scan, CMR by FDG-PET showed the highest correlation with pathologic CR (concordance, 71%). At a median follow-up of 19.3 months (range, 3.9-57.1 months), median overall survival (OS) was not reached in patients with CMR compared to 22.4 months in patients who did not achieve CMR. Median disease free survival (DFS) was not reached in patients with CMR compared to 17.4 months in patients who did not achieve CMR. By multivariate analysis, CMR by FDG-PET was significantly associated with better DFS and OS (P=0.006, P=0.033, respectively). The variables associated with pre-CRT PET scan were not predictive of survival. In conclusion, CMR by FDG-PET has a significant correlation with pathologic CR and can predict the long-term outcome in oesophageal cancer patients undergoing CRT. Although surgery is standard treatment for respectable oesophageal cancer, currently even in patients with CMR, the addition of (18)F-FDG-PET could be used to select the patient subgroup not requiring surgery.
Kim
Min Kyoung
MK
Division of Oncology, Department of Medicine, University of Ulsan College of Medicine, Asan Medical Centre, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Ryu
Jin-Sook
JS
Kim
Sung-Bae
SB
Ahn
Jin Hee
JH
Kim
Soo Young
SY
Park
Seung-Ii
SI
Kim
Yong Hee
YH
Song
Ho Yong
HY
Shin
Ji Hoon
JH
Jung
Hwoon Yong
HY
Lee
Gin Hyug
GH
Choi
Kee Don
KD
Cho
Kyung-Ja
KJ
Kim
Jong Hoon
JH
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D016019:Survival Analysis
D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18