Abstract
PurposeThe purpose of our study was to determine the value of 18F-FDG PET before and after induction chemotherapy in patients with oesophageal adenocarcinoma for the early prediction of a poor pathologic response to subsequent preoperative chemoradiotherapy (CRT).MethodsIn 70 consecutive patients receiving a three-step treatment strategy of induction chemotherapy and preoperative chemoradiotherapy for oesophageal adenocarcinoma, 18F-FDG PET scans were performed before and after induction chemotherapy (before preoperative CRT). SUVmax, SUVmean, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were determined at these two time points. The predictive potential of (the change in) these parameters for a poor pathologic response, progression-free survival (PFS) and overall survival (OS) was assessed.ResultsA poor pathologic response after induction chemotherapy and preoperative CRT was found in 27 patients (39 %). Patients with a poor pathologic response experienced less of a reduction in TLG after induction chemotherapy (p < 0.01). The change in TLG was predictive for a poor pathologic response at a threshold of −26 % (sensitivity 67 %, specificity 84 %, accuracy 77 %, PPV 72 %, NPV 80 %), yielding an area-under-the-curve of 0.74 in ROC analysis. Also, patients with a decrease in TLG lower than 26 % had a significantly worse PFS (p = 0.02), but not OS (p = 0.18).Conclusions18F-FDG PET appears useful to predict a poor pathologic response as well as PFS early after induction chemotherapy in patients with oesophageal adenocarcinoma undergoing a three-step treatment strategy. As such, the early 18F-FDG PET response after induction chemotherapy could aid in individualizing treatment by modification or withdrawal of subsequent preoperative CRT in poor responders.
Highlights
The long-term survival of patients with locoregionally advanced oesophageal cancer remains quite poor despite considerable advances in surgery, radiotherapy, and chemotherapy, with 5-year survival rates still below 50 % [1, 2]
From a total of 132 patients with an oesophageal adenocarcinoma who underwent induction chemotherapy and preoperative chemoradiotherapy followed by surgery in the study period, 70 were considered eligible for analysis
The value of 18F-FDG PET before and after induction chemotherapy for the prediction of response to neoadjuvant treatment was investigated in patients undergoing induction chemotherapy followed by trimodality therapy for oesophageal adenocarcinoma
Summary
The long-term survival of patients with locoregionally advanced oesophageal cancer remains quite poor despite considerable advances in surgery, radiotherapy, and chemotherapy, with 5-year survival rates still below 50 % [1, 2]. An important observation in patients treated with trimodality therapy (i.e., preoperative CRT followed by oesophagectomy) is that the most common pattern of treatment failure is distant progression [8, 9]. In an attempt to eliminate micrometastases and thereby improve the distant failure rate and overall outcome, additional induction chemotherapy before trimodality therapy has been investigated in the United States and Europe, as well as in Asia [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29]. It has been suggested that the use of induction chemotherapy may permit early identification of poorly responding patients in whom neoadjuvant treatment is ineffective or even harmful [24, 30,31,32]
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