title: Results of the baseline positron emission tomography can customize therapy of localized esophageal adenocarcinoma patients who achieve a clinical complete response after chemoradiation.
abstract: BACKGROUND
  Patients with localized esophageal adenocarcinoma (EAC) who achieve a clinical complete response (clinCR) after preoperative chemoradiation (trimodality therapy; TMT) or definitive chemoradiation (bimodality therapy; BMT) live longer than those who achieve a <clinCR (Suzuki A, Xiao LC, Hayashi Y et al. Prognostic significance of baseline positron emission tomography and importance of clinical complete response in patients with esophageal or gastroesophageal junction cancer treated with definitive chemoradiotherapy. Cancer 2011; 117: 4823-4833; Cheedella NK, Suzuki A, Xiao L et al. Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer: analysis in a large cohort. Ann Oncol 2013; 24: 1262-1266; Ajani JA, Correa AM, Hofstetter WL et al. Clinical parameters model for predicting pathologic complete response following preoperative chemoradiation in patients with esophageal cancer. Ann Oncol 2012; 23: 2638-2642). We hypothesized that the initial standardized uptake value (iSUV) of positron emission tomography will define novel subsets of clinCR patients.
  
  
  METHODS
  We analyzed 323 EAC patients, from our prospective database, who achieved a clinCR. Various statistical methods were used to assess the influence of iSUV on patient outcome.
  
  
  RESULTS
  The median follow-up of 323 patients was 40.8 months [95% confidence interval (CI) 35.6-47.3 months]. Two hundred six (63.8%) patients had TMT and 117 (36.2%) had BMT. If iSUV was ≥6, TMT patients had a longer median OS (94.8 months; 95% CI 66.07-NA) than BMT patients (31.4 months; 95% CI 21.7-42.1; P ≤ 0.001). However, if iSUV was <6, the median OS of TMT and BMT patients was similar (P = 0.62). iSVU did not influence the pathologic complete response rate in TMT patients (P = 0.85).
  
  
  CONCLUSIONS
  clinCR patients with iSUV of <6 are identified as a new subset that fared equally well when treated with TMT or BMT. Future esophageal preservation strategy may be best suited for this newly identified subset of EAC patients.
authors.affiliation: Department of Gastrointestinal Medical Oncology.
authors.forename: A
authors.initials: A
authors.lastname: Suzuki
authors.forename: L
authors.initials: L
authors.lastname: Xiao
authors.forename: T
authors.initials: T
authors.lastname: Taketa
authors.forename: K
authors.initials: K
authors.lastname: Sudo
authors.forename: R
authors.initials: R
authors.lastname: Wadhwa
authors.forename: M A
authors.initials: MA
authors.lastname: Blum
authors.forename: H
authors.initials: H
authors.lastname: Skinner
authors.forename: R
authors.initials: R
authors.lastname: Komaki
authors.forename: B
authors.initials: B
authors.lastname: Weston
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: M S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: D C
authors.initials: DC
authors.lastname: Rice
authors.forename: D M
authors.initials: DM
authors.lastname: Maru
authors.forename: J
authors.initials: J
authors.lastname: Erasmus
authors.forename: S G
authors.initials: SG
authors.lastname: Swisher
authors.forename: W L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: J A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D012074:Remission Induction; D016896:Treatment Outcome
keywords: chemoradiation; clinical biology; esophageal cancer; imaging; organ preservation; subpopulations