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2‐Fluoro‐2‐deoxy‐D‐glucose positron emission tomography imaging is predictive of pathologic response and survival after preoperative chemoradiation in patients with esophageal carcinoma
Author(s) -
Swisher Stephen G.,
Erasmus Jeremy,
Maish Mary,
Correa Arlene M.,
Macapinlac Homer,
Ajani Jaffer A.,
Cox James D.,
Komaki Ritsuko R.,
Hong David,
Lee Hoon K.,
Putnam Joe B.,
Rice David C.,
Smythe W. Roy,
Thai Linh,
Vaporciyan Ara A.,
Walsh Garrett L.,
Wu TsungTeh,
Roth Jack A.
Publication year - 2004
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.20585
Subject(s) - medicine , positron emission tomography , esophageal cancer , esophagectomy , standardized uptake value , carcinoma , univariate analysis , neoadjuvant therapy , nuclear medicine , radiology , cancer , multivariate analysis , breast cancer
BACKGROUND The current study was performed to assess the value of 2‐fluoro‐2‐deoxy‐d‐glucose positron emission tomography (FDG‐PET) in predicting the pathologic response and survival of patients with esophageal carcinoma treated with preoperative chemoradiation (CRT) and tumor resection. Preliminary reports suggest that FDG‐PET may be predictive of the response of esophageal carcinoma patients to preoperative CRT. METHODS Eighty‐three patients with resectable esophageal carcinoma who underwent preoperative CRT and FDG‐PET and tumor resection were evaluated for pathologic response to CRT, percent residual tumor, and survival. RESULTS The majority of patients in the current study were men (74 of 83 patients; 89%). Most tumors were adenocarcinomas (73 of 83 tumors; 88%) and clinical EUS T3/4 (69 tumors; 83%) or N1 (46 tumors; 55%). FDG‐PET after preoperative CRT identified pathologic responders but failed to rule out microscopic residual tumor in 13 of 73 cases (18%). Pathologic response was found to correlate with the post‐CRT FDG‐PET standardized uptake value (SUV) ( P = 0.03) and a post‐CRT FDG‐PET SUV of ≥ 4 was found to be the only preoperative factor to correlate with decreased survival (2‐year survival rate of 33% vs. 60%; P = 0.01). On univariate Cox regression analysis, only post‐CRT FDG‐PET was found to be correlated with post‐CRT survival ( P = 0.04). CONCLUSIONS Post‐CRT FDG‐PET was found to be predictive of pathologic response and survival in patients with esophageal carcinoma who undergo preoperative CRT. Esophagectomy should still be considered even if the post‐CRT FDG‐PET scan is normal because microscopic residual disease cannot be ruled out. Cancer 2004. © 2004 American Cancer Society.