title: Potential values of metabolic tumor volume and heterogeneity measured with ¹⁸F-FDG PET/CT pretreatment to evaluate local control for esophageal squamous cell carcinoma treated with nonsurgical therapy.
abstract: OBJECTIVE
  The aim of the study was to evaluate the predictive value of fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) pretreatment on local control (LC) and survival after radical radiotherapy or chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma (SCC) and to discuss its potential value for establishing optimal radiation treatment plans.
  
  
  METHODS
  Fifty-eight patients with pathologically proven esophageal SCC who underwent ¹⁸F-FDG PET/CT pretreatment in our center were retrospectively reviewed. We examined the correlation between the PET parameters of primary tumors and LC and overall survival. The coefficient of variation was used to estimate the ¹⁸F-FDG uptake in heterogeneity.
  
  
  RESULTS
  The mean duration of follow-up for surviving patients was 38 months, and 36 patients died because of tumor recurrence or other diseases. The rates of 3-year overall survival and LC were 40.4 and 50.4%, respectively. Multivariate analysis of LC revealed that metabolic tumor volume (MTV) greater than 16.08 ml was the only predictor of outcome, with a lower 3-year LC (P=0.017, hazard ratio: 1.608, 95% confidence interval: 1.090-2.371). The coefficient of variations of their primary lesion were higher compared with those of patients who had smaller MTVs.
  
  
  CONCLUSIONS
  In this study, MTV assessed by PET/CT might be an adverse factor for predicting LC in esophageal SCC. For those with higher MTVs, higher intratumor heterogeneity suggests that irradiation may need to be boosted in stable high-uptake regions to improve LC. These results need to be prospectively validated in larger cohorts.
authors.affiliation: Departments of aRadiation Oncology bNuclear Medicine, Fudan University Shanghai Cancer Center cDepartment of Oncology, Shanghai Medical College, Fudan University dDepartment of Radiation Oncology, Shanghai Chest Hospital, Shanghai, People's Republic of China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
authors.forename: Xiao-Long
authors.initials: XL
authors.lastname: Fu
authors.forename: Wen
authors.initials: W
authors.lastname: Yu
authors.forename: Zheng-Fei
authors.initials: ZF
authors.lastname: Zhu
authors.forename: Ying-Jian
authors.initials: YJ
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011829:Radiation Dosage; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
chemical_list: D019788:Fluorodeoxyglucose F18