The value of ¹⁸F-FDG PET/CT in assessment of metabolic response in esophageal cancer for prediction of histopathological response and survival after preoperative chemoradiotherapy.
OBJECTIVE
To evaluate the ability of hybrid 18F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) to predict histopathological response and overall survival (OS) after preoperative neoadjuvant chemoradiotherapy (CRT) in patients with the esophageal carcinoma.


METHODS
73 patients with locally advanced esophageal carcinoma were included in the study. All were treated with CRT and 34 subsequently underwent surgical resection of the esophagus. (18)F-FDG PET/CT was carried out prior to (PET/ CT1) and 6 weeks after (PET/CT2) completion of the CRT.


RESULTS
PET/CT2-determined complete metabolic response (CMR) was achieved in 6 (17.6%) out of 34 operated patients, the metabolic response was incomplete (NCMR) in 28 (82.4%) patients. A histopathological complete response (CR) to CRT was discovered in 7 patients (20.6%). The median OS in operated patients was 17.1 months, 95% CI:12.9-23.3 months. In a group of 39 non-operated patients, CMR after neoadjuvant CRT was achieved in 12 patients (30.8%), while NCMR was found in 28 (82.4%). The median OS was 13.5 months in this group, 95% CI: 4.4-22.7 months.


CONCLUSIONS
No statistically significant correlation was found between the (18)F-FDG metabolic response after the neoadjuvant CRT and histopathological response. Presently, the contribution of (18)F-FDG PET/CT as a marker of the potential result of CRT cannot be considered definite. Another study with a larger sample of patients and standardized algorithms for the examining protocols would be necessary for reaching definitive conclusions.
Department of Nuclear Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
Miroslav
M
Myslivecek
Cestmir
C
Neoral
Radek
R
Vrba
Katherine
K
Vomackova
Jan
J
Cincibuch
Radim
R
Formanek
Pavel
P
Koranda
Jana
J
Zapletalova
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18