title: Prediction of the outcome of definitive chemoradiation by decrease in F-18 FDG uptake in nonsurgical esophageal squamous cell cancer.
abstract: OBJECTIVE
  To analyze the predictive value of fluorine-18 fluorodeoxyglucose (F-18 FDG) uptake using positron emission tomography and computed tomography to assess the outcome of definitive chemoradiation in nonsurgical esophageal squamous cell carcinoma.
  
  
  METHODS
  A retrospective review of 61 patients with clinical stage T1-4, N0/1, and M0 was performed. Chemoradiation included chemotherapy with fluorouracil plus cisplatin and irradiation with a total dose of 5600 to 6400 centigray (cGy). Positron emission tomography combined with computed tomography scans were acquired before and during the therapy. The correlation between a decrease in FDG uptake and 5-year progression-free survival (PFS) was analyzed by a receiver operating characteristic curve method to determine a cutoff value. A 5-year overall survival (OS), PFS, and cancer-specific survival (CSS) were evaluated by Kaplan-Meier method.
  
  
  RESULTS
  The mean of standardized uptake value decreased significantly during chemoradiation (P = 0.001). Using 51% reduction of FDG uptake as a cutoff value provided a sensitivity of 76.9% and a specificity of 79.2% in predicting PFS (P = 0.000). The positive predictive value and negative predictive value were 50% and 95%, respectively. PFS, CSS, and OS were significantly different when grouped by this cutoff value (P < 0.05), and when dichotomized by stage T1-2 and T3-4 (P < 0.05), simultaneously with a decrease of 51% or more in FDG uptake.
  
  
  CONCLUSIONS
  This study showed that a 51% decrease in FDG uptake during chemoradiation was a sensitive and accurate cut-point for predicting PFS. Stage T and decrease in FDG uptake were 2 independent predictive factors for 5-year PFS, CSS, and OS.
authors: Division of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.
authors: Yanqin
authors: Y
authors: Yang
authors: Zhiqiang
authors: Z
authors: Yang
authors: Anqin
authors: A
authors: Han
authors: Rui
authors: R
authors: Feng
authors: Yidong
authors: Y
authors: Ma
authors: Li
authors: L
authors: Kong
authors: Xindong
authors: X
authors: Sun
authors: Jingsong
authors: J
authors: Zheng
authors: Jinming
authors: J
authors: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000628:therapy*; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D016016:Proportional Hazards Models; D012372:ROC Curve; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18