title: Are patients with esophageal cancer who become PET negative after neoadjuvant chemoradiation free of cancer?
abstract: BACKGROUND
  Esophageal cancer continues to increase in incidence. Many patients are presenting with stage II or greater disease and proceeding to neoadjuvant chemoradiation therapy before resection. Approximately 30% of patients will achieve a complete response and might not benefit from proceeding to resection. This study will examine the ability of PET to predict patients with a complete pathologic response.
  
  
  METHODS
  A query of our IRB-approved esophageal database revealed 81 patients who underwent a pre- and postchemoradiation PET scan and then proceeded to esophageal resection. Statistical analysis was performed to determine the ability of PET to predict a complete pathologic response.
  
  
  RESULTS
  When comparing posttherapy PET with final pathology, it was determined that PET could not consistently differentiate a complete pathologic response from patients who still had persistent disease. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 61.8%, 43.8%, 70%, 35%, and 56%, respectively, for patients with a complete PET response after neoadjuvant therapy.
  
  
  CONCLUSIONS
  A complete PET response after neoadjuvant chemoradiation is not substantially predictive of a complete pathologic response. Patients should still be referred for resection unless distant metastases are identified.
authors.affiliation: Department of Surgery, Medical College of Georgia, Augusta, GA, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: McLoughlin
authors.forename: Marcovalerio
authors.initials: M
authors.lastname: Melis
authors.forename: Erin M
authors.initials: EM
authors.lastname: Siegel
authors.forename: E Michelle
authors.initials: EM
authors.lastname: Dean
authors.forename: Jill M
authors.initials: JM
authors.lastname: Weber
authors.forename: Jeannie
authors.initials: J
authors.lastname: Chern
authors.forename: Melanie
authors.initials: M
authors.lastname: Elliott
authors.forename: Scott T
authors.initials: ST
authors.lastname: Kelley
authors.forename: Richard C
authors.initials: RC
authors.lastname: Karl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011878:Radiotherapy; D012074:Remission Induction
chemical_list: D000970:Antineoplastic Agents