title: Predicting the effects of chemoradiotherapy for squamous cell carcinoma of the esophagus by induction chemotherapy response assessed by positron emission tomography: toward PET-response-guided selection of chemoradiotherapy or esophagectomy.
abstract: BACKGROUND
  We have developed a treatment protocol for esophageal cancer involving a single course of induction chemotherapy followed by chemoradiotherapy. This study aimed to determine if it was possible to predict the effects of chemoradiotherapy on the basis of the response to induction chemotherapy, assessed by positron emission tomography (PET).
  
  
  METHODS
  Sixteen patients with Stage II-IVA esophageal cancer were treated using this protocol from April 2007 to July 2010. Chemotherapy involved a fluorouracil and platinum-based combination regimen. All patients received PET scans before and 12-24 days after the beginning of induction chemotherapy. Associations between the response to induction chemotherapy assessed by PET and the effects of chemoradiotherapy were evaluated.
  
  
  RESULTS
  Induction chemotherapy followed by chemoradiotherapy resulted in complete response (CR) in 10 of the 16 patients. The reduction in maximum standardized uptake value (SUV(max)) was 58 ± 12% in patients with CR (n = 10), compared with 14 ± 16% in patients without CR (n = 6) (P < 0.0001). Using a cut-off value of 55% for SUV(max) reduction rate, eight of 10 cancers with CR and six of six cancers without CR were correctly identified, providing a sensitivity and specificity of 80 and 100%, respectively. The overall 1-year survival rates for patients with an SUV(max) reduction rate >55% (responders) were 100%, compared with 60% for patients with an SUV(max) reduction rate ≤55% (non-responders), respectively.
  
  
  CONCLUSIONS
  The response to a single course of induction therapy assessed by PET was significantly associated with the effects of chemoradiotherapy.
authors: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3 Nakamichi 1-chome, Higashinari-ku, Osaka, 537-8511, Japan. isihara-ry@mc.pref.osaka.jp
authors: Ryu
authors: R
authors: Ishihara
authors: Sachiko
authors: S
authors: Yamamoto
authors: Hiroyasu
authors: H
authors: Iishi
authors: Kengo
authors: K
authors: Nagai
authors: Fumi
authors: F
authors: Matui
authors: Natsuko
authors: N
authors: Kawada
authors: Takashi
authors: T
authors: Ohta
authors: Hiromitsu
authors: H
authors: Kanzaki
authors: Masao
authors: M
authors: Hanafusa
authors: Noboru
authors: N
authors: Hanaoka
authors: Yoji
authors: Y
authors: Takeuchi
authors: Koji
authors: K
authors: Higashino
authors: Noriya
authors: N
authors: Uedo
authors: Naotoshi
authors: N
authors: Sugimoto
authors: Yoshifumi
authors: Y
authors: Kawaguchi
authors: Kinji
authors: K
authors: Nishiyama
authors: Masaaki
authors: M
authors: Motoori
authors: Masahiko
authors: M
authors: Yano
authors: Takuya
authors: T
authors: Hosoki
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000628:therapy*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography