title: Early repeated 18F-FDG PET scans during neoadjuvant chemoradiation fail to predict histopathologic response or survival benefit in adenocarcinoma of the esophagus.
abstract: This study evaluated the role of (18)F-FDG PET as an early predictor of histopathologic response to neoadjuvant chemoradiotherapy and overall survival in patients with adenocarcinoma of the esophagus undergoing multimodal therapy.
  
  
  METHODS
  Thirty-seven patients with locally advanced adenocarcinoma of the esophagus underwent pretreatment and an intratreatment (18)F-FDG PET scan in the second week of a 6-wk regimen of neoadjuvant chemoradiotherapy. Histopathologic response and overall survival were correlated with percentage change in (18)F-FDG uptake (%Δmaximum standardized uptake value [%ΔSUVmax]).
  
  
  RESULTS
  In 16 patients (43%), treatment induced a histopathologic response (<10% viable tumor cells), which was associated with a significant (P < 0.05) survival benefit. The optimal reduction in (18)F-FDG uptake, which separated histopathologic responders and nonresponders, was a -26.4% ΔSUVmax (receiver-operating-characteristic curve analysis). At this separation, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy (area under the receiver operating characteristic curve) were 62.5%, 71.4%, 62.5%, 71.4%, and 67.4%, respectively, for intratreatment (18)F-FDG PET scans. Kaplan-Meier survival analysis of (18)F-FDG PET responders (>26.4% reduction in SUVmax), compared with (18)F-FDG PET nonresponders (<26.4% reduction in SUVmax), revealed no survival benefit for responders (P = 0.6812).
  
  
  CONCLUSIONS
  The %ΔSUVmax during the second week of induction chemoradiation did not correlate either with histopathologic response or with survival. Our results show that, in contrast to published reports on neoadjuvant chemotherapy, combined chemoradiotherapy in patients with adenocarcinoma of the esophagus lowers the predictive accuracy of early repeated (18)F-FDG PET in identifying histopathologic responders and those with chances for increased survival below clinically applicable levels.
authors.affiliation: Department of Clinical Surgery, Trinity Centre for Health Science, Trinity College Dublin, St James's Hospital, Dublin, Ireland.
authors.forename: Vinod
authors.initials: V
authors.lastname: Malik
authors.forename: Julie A
authors.initials: JA
authors.lastname: Lucey
authors.forename: George J
authors.initials: GJ
authors.lastname: Duffy
authors.forename: Lorraine
authors.initials: L
authors.lastname: Wilson
authors.forename: Leanne
authors.initials: L
authors.lastname: McNamara
authors.forename: Mary
authors.initials: M
authors.lastname: Keogan
authors.forename: Charles
authors.initials: C
authors.lastname: Gillham
authors.forename: John V
authors.initials: JV
authors.lastname: Reynolds
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012372:ROC Curve; D019275:Radiopharmaceuticals; D016019:Survival Analysis; D051598:Whole Body Imaging
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18