title: The value of18F-FDG PET before and after induction chemotherapy for the early prediction of a poor pathologic response to subsequent preoperative chemoradiotherapy in oesophageal adenocarcinoma.
abstract: The purpose of our study was to determine the value of18F-FDG PET before and after induction chemotherapy in patients with oesophageal adenocarcinoma for the early prediction of a poor pathologic response to subsequent preoperative chemoradiotherapy (CRT).
  
  
  
  In 70 consecutive patients receiving a three-step treatment strategy of induction chemotherapy and preoperative chemoradiotherapy for oesophageal adenocarcinoma,18F-FDG PET scans were performed before and after induction chemotherapy (before preoperative CRT). SUVmax, SUVmean, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were determined at these two time points. The predictive potential of (the change in) these parameters for a poor pathologic response, progression-free survival (PFS) and overall survival (OS) was assessed.
  
  
  
  A poor pathologic response after induction chemotherapy and preoperative CRT was found in 27 patients (39 %). Patients with a poor pathologic response experienced less of a reduction in TLG after induction chemotherapy (p < 0.01). The change in TLG was predictive for a poor pathologic response at a threshold of -26 % (sensitivity 67 %, specificity 84 %, accuracy 77 %, PPV 72 %, NPV 80 %), yielding an area-under-the-curve of 0.74 in ROC analysis. Also, patients with a decrease in TLG lower than 26 % had a significantly worse PFS (p = 0.02), but not OS (p = 0.18).
  
  
  
  18F-FDG PET appears useful to predict a poor pathologic response as well as PFS early after induction chemotherapy in patients with oesophageal adenocarcinoma undergoing a three-step treatment strategy. As such, the early18F-FDG PET response after induction chemotherapy could aid in individualizing treatment by modification or withdrawal of subsequent preoperative CRT in poor responders.
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. P.S.N.vanRossum-2@umcutrecht.nl.|Department of Radiation Oncology, University Medical Center Utrecht, PO Box 85500, Q00.3.11, 3508GA, Utrecht, The Netherlands. P.S.N.vanRossum-2@umcutrecht.nl.
authors: Peter S N
authors: PSN
authors: van Rossum
authors: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: David V
authors: DV
authors: Fried
authors: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Lifei
authors: L
authors: Zhang
authors: Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Wayne L
authors: WL
authors: Hofstetter
authors: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Linus
authors: L
authors: Ho
authors: Department of Radiation Oncology, University Medical Center Utrecht, PO Box 85500, Q00.3.11, 3508GA, Utrecht, The Netherlands.
authors: Gert J
authors: GJ
authors: Meijer
authors: Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Brett W
authors: BW
authors: Carter
authors: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Laurence E
authors: LE
authors: Court
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. SHLin@mdanderson.org.
authors: Steven H
authors: SH
authors: Lin
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant / Q000401:mortality; D018572:Disease-Free Survival; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D060828:Induction Chemotherapy / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods / Q000706:statistics & numerical data*; D011300:Preoperative Care / Q000401:mortality; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET; Chemoradiotherapy; Chemotherapy; Oesophageal cancer; Treatment response