title: Pretreatment metabolic tumor volumes to predict the short-term outcome of unresectable locally advanced squamous cell carcinoma of the esophagus treated with definitive chemoradiotherapy.
abstract: OBJECTIVE
  The aim of the study was to investigate the predictive role of pretreatment metabolic tumor volume (MTV) in patients with squamous cell carcinoma of locally advanced esophageal cancer treated with definitive chemoradiotherapy.
  
  
  METHODS
  Ninety patients received pretreatment with (18)F-fluorodeoxyglucose ((18)F-FDG) PET/CT, and two types of MTVs were measured on the basis of either a maximal standardized uptake value (SUVmax) of 2.5 (MTV2.5) or a fixed threshold of 20% (MTV20%). Overall survival (OS) and disease-free survival (DFS) were examined, and independent prognosticators were identified by Cox regression analysis.
  
  
  RESULTS
  On a median follow-up of 15 months, 51 patients were seen to have died because of tumor recurrence or other illnesses. Multivariate analysis of OS revealed that MTV20%>40 ml was the only predictor of outcome with a lower 1-year OS [P=0.003, hazard ratio (HR)=2.29, 95% confidence interval (CI) 1.36-3.91]. Two independent predictors of DFS were MTV20%>40 ml (P=0.02, HR=1.78, 95% CI 1.09-2.91) and stage IV disease (P=0.01, HR=1.84, 95% CI 1.12-3.03).
  
  
  CONCLUSIONS
  Pretreatment MTV20% is a novel marker for OS and DFS in patients with unresectable locally advanced esophageal cancer treated with definitive chemoradiotherapy. Treatment intensification must be considered for patients with higher MTVs.
authors.affiliation: aDepartment of Radiation Oncology bGraduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine cDepartment of Nuclear Medicine and PET Center dDepartment of Biomedical Imaging and Radiological Science eDivision of Hematology and Oncology, China Medical University Hospital, Taichung fSchool of Medicine, Taipei Medical University, Taipei gDepartment of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Shang-Wen
authors.initials: SW
authors.lastname: Chen
authors.forename: Te-Chun
authors.initials: TC
authors.lastname: Hsieh
authors.forename: Hueisch-Jy
authors.initials: HJ
authors.lastname: Ding
authors.forename: Kuo-Yang
authors.initials: KY
authors.lastname: Yen
authors.forename: Chen-Yuan
authors.initials: CY
authors.lastname: Lin
authors.forename: Ji-An
authors.initials: JA
authors.lastname: Liang
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden / Q000187:drug effects / Q000528:radiation effects
chemical_list: D019788:Fluorodeoxyglucose F18