title: Prediction of disease-free survival using relative change in FDG-uptake early during neoadjuvant chemoradiotherapy for potentially curable esophageal cancer: A prospective cohort study.
abstract: 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) has been investigated as a tool for monitoring response to neoadjuvant chemo- and chemoradiotherapy (CT and CRT, respectively) and as a predictor for survival in patients with esophageal cancer. In contrast to patients who undergo neoadjuvant CT, it is not known whether patients who are clinically identified as responders after neoadjuvant CRT show better disease-free survival (DFS) than patients identified as nonresponders. The aim of the study was to determine the predictive value of FDG-uptake measured prior to and early during neoadjuvant CRT. Patients treated with neoadjuvant CRT between 2004 and 2009 within a randomized trial were included. FDG-uptake was measured at baseline and after 14 days of CRT. According to the PERCIST-criteria, patients were allocated to have metabolic response, stable disease, or progression. Patients were followed until recurrence of disease or death. The predictive value of FDG-PET was determined with univariable and multivariable analysis in patients who underwent potentially curative surgery. One-hundred and six patients were included in the analysis. Minimal follow-up for surviving patients was 60 months. No significant differences in DFS were found between patients with metabolic response, stable disease, or progression, with 5-year DFS rates of 66%, 53%, and 67%, respectively (P = 0.39). Relative change in FDG uptake after 14 days of CRT is not associated with DFS in patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy followed by surgery. These measurements should not be used for prognostication in this specific group of patients.
authors.affiliation: Department of Surgery, Erasmus Medical Center, Rotterdam.
authors.forename: P V
authors.initials: PV
authors.lastname: Hagen
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam.|Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: M V
authors.initials: MV
authors.lastname: Heijl
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam.
authors.forename: Mark I.
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.affiliation: Department of Nuclear Medicine and PET research, VU Medical Center, Amsterdam.
authors.forename: R
authors.initials: R
authors.lastname: Boellaard
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam.
authors.forename: P M M
authors.initials: PM
authors.lastname: Bossuyt
authors.affiliation: Department of Pathology, Academic Medical Center, Amsterdam.|Department of Pathology, Erasmus Medical Center, Rotterdam.
authors.forename: F J W T
authors.initials: FJ
authors.lastname: Kate
authors.affiliation: Department of Pathology, Erasmus Medical Center, Rotterdam.|Department of Pathology, Sint Lucas Andreas Hospital, Amsterdam.
authors.forename: H V
authors.initials: HV
authors.lastname: Dekken
authors.affiliation: Department of Nuclear Medicine and PET research, VU Medical Center, Amsterdam.
authors.forename: O S
authors.initials: OS
authors.lastname: Hoekstra
authors.affiliation: Department of Nuclear Medicine, Academic Medical Center, Amsterdam.|Department of Nuclear Medicine, Groene Hart Hospital, Gouda.
authors.forename: G W
authors.initials: GW
authors.lastname: Sloof
authors.affiliation: Department of Surgery, Erasmus Medical Center, Rotterdam.|Department of Surgery, Academic Medical Center, Amsterdam.
authors.forename: J J B V
authors.initials: JJ
authors.lastname: Lanschot
mesh_terms: D000328:Adult; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D018450:Disease Progression; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-fluorodeoxyglucose positron emission tomography; chemoradiotherapy; esophageal cancers