Prediction of response to definitive chemoradiotherapy in esophageal cancer using positron emission tomography.
BACKGROUND
Positron emission tomography (PET) with 18-F-fluorodeoxyglucose (FDG) has already proven useful in assessing the extension of esophageal carcinomas, detecting tumor recurrence and monitoring responses to therapy. The current study aims to assess the potential role of FDG-PET in predicting the response of esophageal squamous cell carcinoma (SCC) to definitive chemoradiotherapy (CRT).


METHODS
Twenty-seven patients with thoracic esophageal SCC who received definitive CRT between January 2001 and December 2005 underwent PET before and after CRT. The clinical evaluation of the primary tumor response to treatment was classified as either complete response (CR) or non-CR.


RESULTS
All patients had intensive FDG uptake in the primary tumor prior to CRT. The standardized uptake value (SUV) averaged 8.2+/-4.7 before CRT and decreased significantly to 2.8+/-1.8 after CRT (p<0.0001). The SUV before CRT averaged 10.2 in the non-CR group (n=17) and 4.9 in the CR group (n= 10). The SUV after CRT averaged 3.7 in the non-CR group and 1.4 in the CR group. The change in SUV for the CR group was higher than that in the non-CR group (p<0.05). The relationship between clinical features and clinical CR was analyzed using logistic regression analysis which revealed significant correlations between clinical CR and the longitudinal dimension of the tumor (p <0.05), SUV before CRT (p<0.05), SUV after CRT (p<0.01) and tumor classification (p <0.05). If the clinical features before CRT were limited, multivariate analysis revealed that the SUV before CRT was an independent predictor for clinical CR (p<0.05).


CONCLUSIONS
In predicting clinical evaluation of therapy prior to CRT, we suggest that SUV prior to definitive CRT is one of the most reliable predictors of response, along with tumor dimensions and classification.
Kato
Hiroyuki
H
Departments of General Surgical Science (Surgery I), Gunma University, Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi 371-8511, Japan. hiroyuki@po.wind.ne.jp
Fukuchi
Minoru
M
Miyazaki
Tatsuya
T
Nakajima
Masanobu
M
Tanaka
Naritaka
N
Inose
Takanori
T
Kimura
Hitoshi
H
Faried
Ahmad
A
Saito
Kana
K
Sohda
Makoto
M
Fukai
Yasuyuki
Y
Masuda
Norihiro
N
Manda
Ryokuhei
R
Ojima
Hitoshi
H
Tsukada
Katsuhiko
K
Oriuchi
Noboru
N
Endo
Keigo
K
Nonaka
Tetsuo
T
Shioya
Mariko
M
Ishikawa
Hitoshi
H
Sakurai
Hideyuki
H
Nakano
Takashi
T
Kuwano
Hiroyuki
H
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies
D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18