Abstract
Purpose[18F] fluorodeoxyglucose positron emission tomography/computed tomography ([18F] FDG-PET/CT) is used for diagnosis, staging, response assessment and prognosis prediction in different tumors, but its role in esophageal cancer is still debated. The aim of this study was to evaluate the role of semiquantitative baseline PET parameters as possible prognostic and predictive factors in a series of esophageal carcinomas treated with combined modalities.Methods43 patients with esophageal carcinoma were treated with chemoradiotherapy (CRT) followed by surgery in 20 cases and underwent pre-treatment 18F-FDG-PET/CT. Semiquantitative PET parameters were evaluated including Standardized Uptake Value (SUVmax e SUVmean), Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG) with isocontour of 41 and 50%. Further variables analyzed were gender, primary tumor site, histological type, use of surgery, achievement of a radical resection and the type of chemotherapy regimen. The correlation of all variables with treatment response, loco-regional control (LR), Overall survival (OS) and Disease-Free Survival (DFS) was evaluated.ResultsSUVmax, SUVmean50 and SUVmean41 were significantly higher in node-positive cases and in squamous cell carcinomas. With respect to prognostic factors, MTV was found to be correlated with OS: patients with MTV41 < 11.32 cm3 and MTV50 < 8.07 cm3 (both p values = 0.04) showed better 3-year OS rates (33 vs. 20%). Further factors predicting a better prognosis were the use of surgery and radical resection (R0) (both p values < 0.01).ConclusionsPre-treatment MTV values were significant prognostic factors for OS, together with the use of surgery and R0 resection in esophageal cancers treated with multimodal therapies.
Highlights
Esophageal cancer is the seventh most frequently diagnosed cancer and the sixth leading cause of cancer-related deaths in the world, representing a major global health problem [1, 2]
The aim of the present study is to evaluate the role of 18F-FDG Positron emission tomography (PET)/computed tomography (CT) as possible predictive and prognostic factor in a series of patients with esophageal carcinoma, treated with combined modality treatments
Seven patients were treated with 3-dimension-conformal RT (3D-CRT), 19 with static intensity modulated radiotherapy (IMRT) and 17 with volumetric modulated arc therapy (VMAT)
Summary
Esophageal cancer is the seventh most frequently diagnosed cancer and the sixth leading cause of cancer-related deaths in the world, representing a major global health problem [1, 2]. Combined modality therapy has been shown to improve survival in patients with loco-regional disease compared to surgery alone, since a complete (R0) tumor resection cannot be achieved in about 30% (T3)–50% (T4) of cases [3]. Clinical stage and lymph node involvement are the main tumor-related factors influencing the prognosis of esophageal cancer [6, 7]. 18F-FDG PET/CT may lead to a change in treatment management in up to a third of patients, representing the most accurate imaging modality for detecting distant metastases [11–13]. It is still matter of debate if metabolic parameters obtained by PET/CT could have a predictive and prognostic role [14–20]. Some of these parameters, such as maximum standard uptake value (SUVmax), SUVmean, SUVpeaks, tumor functional longitudinal length, metabolic tumor volume (MTV) and total glycolysis (TLG) have been proposed as prognostic indicators in esophageal and other solid tumors [19, 21–23]
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