title: Predictive value of repeated F-18 FDG PET/CT parameters changes during preoperative chemoradiotherapy to predict pathologic response and overall survival in locally advanced esophageal adenocarcinoma patients.
abstract: BACKGROUND
  The goal of the current study was to investigate the predictive and prognostic values of repeated F-18 FDG PET/CT parameter changes for prediction of complete pathologic response (pCR) in patients with adenocarcinoma of locally advanced esophageal cancer (LAEC) who received preoperative concurrent chemoradiotherapy (PCRT).
  
  
  METHODS
  A total 53 patients with LAEC patients were included in the current study. All patients were evaluated by F-18 FDG PET/CT before and during chemoradiotherapy. The percent changes (∆, %) in F-18 FDG PET/CT parameters were used to predict pCR and to calculate overall survival (OS). The predictive value for pCR of F-18 FDG PET/CT cutoff values was determined by ROC analysis. The prognostic significance was assessed using Kaplan-Meier analysis.
  
  
  RESULTS
  pCR occurred in 15 patients (28.3 %). When ΔSUVmax > 23.5 % was used as cutoff, the sensitivity and specificity of F-18 FDG PET/CT for prediction of pCR were 100 % and 52.6, respectively. The AUC was 0.750 (95 % CI; 0.612-0.859), and standard error (SE) was 0.0633 (p = 0.0002). ΔMTV resulted in 80 % sensitivity, 76.3 % specificity, and 0.731 AUC (95 % CI; 0.591-0.843, SE = 0.077, p = 0.0027) for cutoff values >25.5 %. When ΔTLG > 44.8 % was used as cutoff, the sensitivity and specificity of F-18 FDG PET/CT for prediction of pCR were 100 and 65.8 %, respectively. The AUC was 0.893 (95 % CI; 0.777-0.961), and SE was 0.0431 (p < 0.0001). Kaplan-Meier analysis showed that high ΔSUVmax, ΔMTV, and ΔTLG were associated with improved OS.
  
  
  CONCLUSIONS
  In conclusion, the current study shows the capability of the changes (Δ) in repeated F-18 FDG PET/CT parameters to predict the achievement of pCR during PCRT in LAEC patients. Among the parameters, the ΔSUVmax, ΔMTV, and ΔTLG were predictors for pCR and well associated with OS.
authors.affiliation: Department of Nuclear Medicine, Pusan National University Hospital, Busan, 602-739, Republic of Korea. growthkim@daum.net.|Biomedical Research Institute, Pusan National University Hospital, Busan, 602-739, Republic of Korea. growthkim@daum.net.
authors.forename: Seong-Jang
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Radiology, University of Colorado School of Medicine, 12401 E 17th Ave, L-954, Aurora, CO, 80045, USA.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Koo
authors.affiliation: Department of Radiology, University of Colorado School of Medicine, 12401 E 17th Ave, L-954, Aurora, CO, 80045, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Chang
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000368:Aged; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012372:ROC Curve; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: FDG; Locally advanced esophageal cancer; PCRT; PET/CT; Pathologic response; Prognosis