Abstract

Background and objectivesWe retrospectively evaluated the value of PET/CT in predicting survival and histopathological tumour-response in patients with distal oesophageal and gastric adenocarcinoma following neoadjuvant treatment.MethodsTwenty-one patients with resectable distal oesophageal adenocarcinoma and 14 with gastric adenocarcinoma between January 2002 and December 2011, who had undergone serial PET before and after neoadjuvant therapy followed by surgery, were enrolled. Maximum standard uptake value (SUVmax) and metabolic tumour volume were measured and correlated with tumour regression grade and survival.ResultsHistopathological tumour response (PR) is a stronger predictor of overall and disease-free survival compared to metabolic response. ∆%SUVmax ≥70% was the only PET metric that predicted PR (82.4% sensitivity, 61.5% specificity, p = 0.047). Histopathological non-responders had a higher risk of death (HR 8.461, p = 0.001) and recurrence (HR 6.385, p = 0.002) and similarly in metabolic non-responders for death (HR 2.956, p = 0.063) and recurrence (HR 3.614, p = 0.028). Ordinalised ∆%SUVmax showed a predictive trend for OS and DFS, but failed to achieve statistical significance.ConclusionsPR was a stronger predictor of survival than metabolic response. ∆%SUVmax ≥70% was the best biomarker on PET that predicted PR and survival in oesophageal and gastric adenocarcinoma. Ordinalisation of ∆%SUVmax was not helpful in predicting primary outcomes.

Highlights

  • Despite the increase in the incidence of oesophageal adenocarcinoma since 1988 and the steady decline in the incidence of gastric adenocarcinoma since 1982, oesophageal and gastric malignancies collectively accounted for 2317 deaths in Australia in 2010 [1]

  • This study comprised a heterogeneous group with resectable adenocarcinoma of the distal oesophagus and stomach

  • We found that a favourable metabolic response is associated with favourable PR

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Summary

Introduction

Despite the increase in the incidence of oesophageal adenocarcinoma since 1988 and the steady decline in the incidence of gastric adenocarcinoma since 1982, oesophageal and gastric malignancies collectively accounted for 2317 deaths in Australia in 2010 [1]. Et al [10] validated the use of therapy-induced changes in PET metrics to predict PR and to stratify distal oesophageal and gastric cardia adenocarcinoma patients into different prognostic groups. They concluded that 35% regression of maximum standardised uptake value ­(SUVmax), a semi-quantitative measure of 18F-FDG retention in the primary tumour bed was the optimal cut-off to identify histopathological responders with 100% sensitivity and 58% specificity. We retrospectively evaluated the value of PET/CT in predicting survival and histopathological tumour-response in patients with distal oesophageal and gastric adenocarcinoma following neoadjuvant treatment. Ordinalisation of ∆%SUVmax was not helpful in predicting primary outcomes

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