MIS3-5 - Fluorodeoxyglucose Positron Emission Tomography for Evaluating Early Response During Neoadjuvant Chemoradiotherapy in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma

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ABSTRACT Background To determine whether fluorodeoxyglucose positron emission tomography (FDG-PET) could differentiate between responding and non-responding locally advanced esophageal squamous cell carcinoma (ESCC) early in the course of neoadjuvant chemoradiotherapy (CRT). Methods Patients with T3 or N1M0-1a (AJCC, 6th ed.) ESCC first received a 21-day cycle of induction CT with paclitaxel, cisplatin, 5-FU/leucovorin D 1, 8). This was followed by concurrent paclitaxel, cisplatin CRT (Lin CC et al. Ann Oncol 18: 93; 2007). When the accumulated RT dose reached 40 Gy, the feasibility of esophagectomy was evaluated. In patients for whom esophagectomy was not feasible, CCRT was continued to a dose of 60 Gy. Serial FDG-PETs were carried out before and 14 days after the start of induction CT. Pathologic response (PR) was defined as no or microscopic residual disease. PET response was measured using the standardized uptake value (SUV). Receiver operating characteristic (ROC) analysis was used to evaluate the SUV ability in distinguishing between PR and non-PR. Results Of 65 patients (M:F = 60:5, median age 55, range 39–71) with locally advanced (M0:M1a = 58:7) ESCC enrolled from March 2008 to December 2011, 40 patients underwent esophagectomy and 26 patients were pathologic responders. The median SUV decrease 140 days after the start of therapy was 75.8% for pathologic responders and 30.1% for non-responders (P Conclusions A 35% SUV decrease 14 days after the start of induction CT is significantly associated with PR, but its accuracy in detecting non-responders is too low to justify the clinical use of FDG-PET for early discontinuation of neoadjuvant CRT in patients with locally advanced ESCC.