title: Role of surgical resection in complete responders on FDG-PET after chemoradiotherapy for locally advanced esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  To determine the role of surgery in complete responders on FDG-PET after CRT and the prognostic significance of metabolic response in locally advanced esophageal squamous cell carcinoma.
  
  
  METHODS
  We retrospectively reviewed 154 patients with locally advanced esophageal cancer with increased uptake on FDG-PET. Eighty-one patients received definitive CRT and 73 received trimodality therapy. We defined metabolic complete remission (PET-CR) when FDG uptake of the primary tumor and lymph nodes were decreased and was indistinguishable from surrounding normal tissue. Oncologic outcomes were compared between trimodality group, definitive CRT group, and PET-CR subgroup of definitive CRT.
  
  
  RESULTS
  Thirty-one (38.3%) of the definitive CRT patients and 39 (53.4%) of the trimodality therapy patients achieved PET-CR after CRT. The 2-year OS of the trimodality group was higher than that of the definitive CRT group, but equivalent to that of the PET-CR subgroup of definitive CRT. The 2-year LRFS and DFS of the trimodality group were higher than that of the PET-CR subgroup or the entire of definitive CRT group.
  
  
  CONCLUSIONS
  The addition of surgery showed higher DFS and LRFS rates than those of the PET-CR subgroup of definitive CRT. Despite achieving PET-CR, surgery still seems to improve local tumor control.
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Jeong
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Sung-Bae
authors.initials: SB
authors.lastname: Kim
authors.forename: Dok Hyun
authors.initials: DH
authors.lastname: Yoon
authors.forename: Seung Il
authors.initials: SI
authors.lastname: Park
authors.forename: Yong Hee
authors.initials: YH
authors.lastname: Kim
authors.forename: Hyeong Ryul
authors.initials: HR
authors.lastname: Kim
authors.forename: Hwoon Yong
authors.initials: HY
authors.lastname: Jung
authors.forename: Gin Hyug
authors.initials: GH
authors.lastname: Lee
authors.forename: Jin-Sook
authors.initials: JS
authors.lastname: Ryu
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*; D016629:Esophagectomy; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D016017:Odds Ratio; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals; D012074:Remission Induction; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: PET; chemotherapy; esophageal cancer; esophageal surgery; operation; radiation therapy