The standardized uptake value of 18-fluorodeoxyglucose positron emission tomography after chemoradiation and clinical outcome in patients with localized gastroesophageal carcinoma.
BACKGROUND
Empirical trimodality (TM) or bimodality (BM) approaches lead to unpredictable outcomes in patients with localized gastroesophageal carcinoma (LGC). We hypothesized that the standardized uptake value (SUV) of positron emission tomography (PET) after chemoradiation would define the clinical outcome in patients.


METHODS
We analyzed 272 (TM = 155 and BM = 117) LGC patients after chemoradiation PET and studied its association with overall survival (OS) and disease-free survival (DFS). The log-rank test, multivariate Cox proportional hazards model, and Kaplan-Meier survival plots were used to analyze the dichotomized data (using the median as a cutoff).


RESULTS
The median survival of TM patients was 49 months (95% CI: 36 to not reached) and that of BM patients was 20 months (95% CI: 15-34; p < 0.0001); however, if the postchemoradiation SUV was <4.6 (4.6 = median SUV), the OS of TM and BM patients was not significantly different (p = 0.22). In the multivariate Cox model, postchemoradiation SUV (p = 0.02), baseline stage (p = 0.03), histology grade (p = 0.01), and having surgery (p = 0.004) were independent prognosticators for OS and DFS.


CONCLUSIONS
These data document that the low postchemoradiation SUV in both TM and BM patients defines clinical aggression and has a similar clinical outcome. Systematic validation of PET changes, in this setting, can facilitate individualization of therapy of LGC patients.
Murthy
Santosh B
SB
Department of Gastrointestinal Medical Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA.
Patnana
Srikrishna V
SV
Xiao
Lianchun
L
Rohren
Eric
E
Hofstetter
Wayne L
WL
Swisher
Stephen G
SG
Liao
Zhongxing
Z
Lee
Jeffrey H
JH
Bhutani
Manoop S
MS
Macapinlac
Homer A
HA
Wang
Xuemei
X
Ajani
Jaffer A
JA
D000230:Adenocarcinoma / Q000378:metabolism / Q000473:pathology / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000378:metabolism / Q000473:pathology / Q000532:radiotherapy; D004938:Esophageal Neoplasms / Q000378:metabolism / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000378:metabolism / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery
D019788:Fluorodeoxyglucose F18