title: Correlation Between Standardized Uptake Value in Preneoadjuvant and Postneoadjuvant Chemoradiotherapy and Tumor Regression Grade in Patients With Locally Advanced Esophageal Cancer.
abstract: To investigate whether positron emission tomography/computed tomography (PET/CT) initial and restaging imaging predicts for pathologic response measured by tumor regression grade (TRG) after preoperative chemoradiotherapy (CRT) in patients with locally advanced esophageal cancer.
  
  
  
  A retrospective review of 220 patients with stage II-III esophageal cancer treated with neoadjuvant CRT followed by surgery was performed. In total, 187 patients were eligible for statistical analysis. Pretreatment and posttreatment PET/CT scans were reviewed. Maximum standard uptake value (SUV) at the site of the primary tumor was recorded before and 6 weeks after neoadjuvant therapy. Upon completion of surgery, TRG was determined by a specialized site-specific gastrointestinal pathologist. Spearman correlation was used to compare pre, post, and change in maximum SUV, TRG, and overall survival.
  
  
  
  The median follow-up was 24 months. Although no significant correlation was found between pretreatment SUV and TRG (r=0.073, P=0.32), post-CRT SUV, however, showed a significant positive correlation with TRG (r=0.374, P<0.01). There was no significant correlation between the absolute change in fluorodeoxyglucose uptake after CRT and TRG (r=0.057, P=0.44); however, the rate of SUV change showed a significant correlation with TRG (r=0.178, P=0.017). Similar to previous studies, our study showed a significant difference in overall survival between TRG groups (log-rank test, P=0.019). Patients with TRG 3 showed prominently worse survival with median survival of 27.4 months. Patients with favorable pathologic responses were those whose scans demonstrated a metabolic response defined as a decrease in SUV≥70%.
  
  
  
  Changes in SUV uptake on PET/CT scans after CRT have prognostic value in predicting pathologic response of esophageal cancer after neoadjuvant therapy. Further studies are needed to validate the integration of PET/CT as a decision-making tool.
authors.affiliation: Departments of Gastrointestinal Oncology.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Baksh
authors.affiliation: Departments of Gastrointestinal Oncology.
authors.forename: Gopi
authors.initials: G
authors.lastname: Prithviraj
authors.affiliation: Biostatistics and Bioinformatics.
authors.forename: Youngchul
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Radiation Oncology.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hoffe
authors.affiliation: Radiation Oncology.
authors.forename: Ravi
authors.initials: R
authors.lastname: Shridhar
authors.affiliation: Anatomic Pathology, Tampa.
authors.forename: Domenico
authors.initials: D
authors.lastname: Coppola
authors.affiliation: Anatomic Pathology, Tampa.
authors.forename: Barbara
authors.initials: B
authors.lastname: Centeno
authors.affiliation: Departments of Gastrointestinal Oncology.
authors.forename: Jose
authors.initials: J
authors.lastname: Pimiento
authors.affiliation: Department of Surgery, Sarasota Memorial Hospital, Sarasota, FL.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Meredith
authors.affiliation: Departments of Gastrointestinal Oncology.
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Almhanna
mesh_terms: D000328:Adult; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D060787:Neoplasm Grading; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies