title: Change in volume parameters induced by neoadjuvant chemotherapy provide accurate prediction of overall survival after resection in patients with oesophageal cancer.
abstract: OBJECTIVE
  To assess the prognostic value of volumetric parameters measured with CT and PET/CT in patients with neoadjuvant chemotherapy (NACT) and resection for oesophageal cancer (EC).
  
  
  METHODS
  Patients with locally advanced EC, who were treated with NACT and resection, were retrospectively analysed. Data from CT volumetry and (18) F-FDG PET/CT (maximum standardized uptake [SUVmax], metabolic tumour volume [MTV], and total lesion glycolysis [TLG]) were recorded before and after NACT. The impact of volumetric parameter changes induced by NACT (MTVRATIO, TLGRATIO, etc.) on overall survival (OS) was assessed using a Cox proportional hazards model.
  
  
  RESULTS
  Eighty-four patients were assessed using CT volumetry; of those, 50 also had PET/CT before and after NACT. Low post-treatment CT volume and thickness, MTV, TLG, and SUVmax were all associated with longer OS (p < 0.05), as were CTthicknessRATIO, MTVRATIO, TLGRATIO, and SUVmaxRATIO (p < 0.05). In the multivariate analysis, only MTVRATIO (Hazard ratio, HR 2.52 [95% Confidence interval, CI 1.33-4.78], p = 0.005), TLGRATIO (HR 3.89 [95%CI 1.46-10.34], p = 0.006), and surgical margin status (p < 0.05), were independent predictors of OS.
  
  
  CONCLUSIONS
  MTVRATIO and TLGRATIO are independent prognostic factors for survival in patients after NACT and resection for EC.
  
  
  CONCLUSIONS
  • Change in PET parameters shows close correlation to survival in oesophageal cancer. • Association with OS is independent of changes in SUVmax and CT volume. • Metabolic parameters after NACT correlate with pathologic response and nodal status. • Metabolic parameters may be better suited than SUVmax for response assessment.
authors.affiliation: Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. dietmar.tamandl@meduniwien.ac.at.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Tamandl
authors.affiliation: Department of Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Gore
authors.affiliation: Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Fueger
authors.affiliation: Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kinsperger
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Hejna
authors.affiliation: Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Paireder
authors.affiliation: Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Haug
authors.affiliation: Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria.
authors.forename: Sebastian F
authors.initials: SF
authors.lastname: Schoppmann
authors.affiliation: Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ba-Ssalamah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006019:Glycolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Metabolic tumour volume; Neoadjuvant chemotherapy; Oesophageal cancer; Overall survival; Response assessment