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Purpose  Although change in standardized uptake value (SUV) measures and PET-based textural features during treatment have shown promise in tumor response prediction, it is unclear which quantitative measure is the most predictive. We compared the relationship between PET-based features and pathologic response and overall survival with the SUV measures in esophageal cancer.    Methods  Fifty-four esophageal cancer patients received PET/CT scans before and after chemoradiotherapy. Of these, 45 patients underwent surgery and were classified into complete, partial, and non-responders to the preoperative chemoradiation. SUV max  and SUV mean , two cooccurrence matrix (Entropy and Homogeneity), two run-length matrix (RLM) (high-gray-run emphasis and Short-run high-gray-run emphasis), and two size-zone matrix (high-gray-zone emphasis and short-zone high-gray emphasis) textures were computed. The relationship between the relative difference of each measure at different treatment time points and the pathologic response and overall survival was assessed using the area under the receiver-operating-characteristic curve (AUC) and Kaplan–Meier statistics, respectively.    Results  All Textures, except Homogeneity, were better related to pathologic response than SUV max  and SUV mean . Entropy was found to significantly distinguish non-responders from the complete (AUC = 0.79,  p  = 1.7 × 10 −4 ) and partial (AUC = 0.71,  p  = 0.01) responders. Non-responders can also be significantly differentiated from partial and complete responders by the change in the run-length and size-zone matrix textures (AUC = 0.71–0.76,  p  ≤ 0.02). Homogeneity, SUV max , and SUV mean  failed to differentiate between any of the responders (AUC = 0.50–0.57,  p  ≥ 0.46). However, none of the measures were found to significantly distinguish between complete and partial responders with AUC <0.60 ( p  = 0.37). Median Entropy and RLM textures significantly discriminated patients with good and poor survival (log-rank  p  < 0.02), while all other textures and survival were poorly related (log-rank  p  > 0.25).    Conclusion  For the patients studied, temporal changes in Entropy and all RLM were better correlated with pathological response and survival than the SUV measures. The hypothesis that these metrics can be used as clinical predictors of better patient outcomes will be tested in a larger patient dataset in the future.

frontiers in oncology

Relationship between the Temporal Changes in Positron-Emission-Tomography-Imaging-Based Textural Features and Pathologic Response and Survival in Esophageal Cancer Patients