Mean and maximum standardized uptake values in [18F]FDG-PET for assessment of histopathological response in oesophageal squamous cell carcinoma or adenocarcinoma after radiochemotherapy.
OBJECTIVE
To evaluate the potential of [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) for the assessment of histopathological response and survival after neoadjuvant radiochemotherapy in patients with oesophageal cancer.


METHODS
In 2005 and 2006, 55 patients (43 men, 12 women; median age 60 years) with locally advanced oesophageal cancer (cT3-4 Nx M0; 24 with squamous cell carcinoma, 31 with adenocarcinoma) underwent transthoracic en bloc oesophagectomy after completion of treatment with cisplatin, 5-fluorouracil, and radiotherapy ad 36 Gy in a prospective clinical trial. Of the 55 patients, 21 (38%) were classified as histopathological responders (<10% vital residual tumour cells) and 34 (62%) as nonresponders. FDG-PET was performed before (PET 1) and 3-4 weeks after the end (PET 2) of radiochemotherapy with assessment of maximum and average standardized uptake values (SUV) for correlation with histopathological response and survival.


RESULTS
Histopathological responders had a slightly higher baseline SUV than nonresponders (p<0.0001 between PET 1 and PET 2 for responders and nonresponders) and the decrease was more prominent in responders. Except for SUVmax in patients with squamous cell carcinoma neither baseline nor preoperative SUV nor percent SUV reduction correlated significantly with histopathological response. Histopathological responders had a 2-year overall survival of 91 +/- 9% and nonresponders a survival of 53 +/- 10% (p = 0.007).


CONCLUSIONS
Our study does not support recent reports that FDG-PET predicts histopathological response and survival in patients with locally advanced oesophageal cancer treated by neoadjuvant radiochemotherapy.
Schmidt
Matthias
M
Department of Nuclear Medicine, University of Cologne, Cologne, Germany. Matthias.Schmidt@uni-koeln.de
Bollschweiler
Elfriede
E
Dietlein
Markus
M
Mönig
Stefan P
SP
Kobe
Carsten
C
Vallböhmer
Daniel
D
Vallboehmer
Daniel
D
Eschner
Wolfgang
W
Hölscher
Arnulf
A
Schicha
Harald
H
D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology*; D003131:Combined Modality Therapy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D012372:ROC Curve; D016896:Treatment Outcome
D019788:Fluorodeoxyglucose F18