Objective: To evaluate the role of 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in the assessment of tumor response after the completion of neoadjuvant chemoradiation (CRT) in patients with locally advanced resectable esophageal cancer.
Background: After primary CRT, a noninvasive evaluation of the tumor response could help in the treatment decision to identify patients who may benefit from surgery. Whether FDG-PET provides clinically relevant information remains questionable.
Methods: Operable patients with locally advanced esophageal cancer (clinically staged T3 N0-1 M0) were enrolled in this prospective study. The complete treatment plan included neoadjuvant CRT (cisplatin + 5-fluorouracil/45 Gy) followed 6 to 8 weeks later by a transthoracic en bloc esophagectomy. Morphological evaluation combined with FDG-PET was performed 2 weeks before the start of CRT and 4 to 6 weeks after the completion of CRT. Intratumoral pre- and posttreatment FDG-standardized uptake values (SUV1, SUV2, percentage change) were assessed. These variables were correlated with pathological and morphologic responses and survival. Investigators were blinded to the FDG-PET results unless they revealed metastatic disease.
Results: Of 60 total patients, 46 underwent the complete treatment plan (median age: 60.1 years; adenocarcinoma: 25 patients; squamous cell cancer: 21 patients). A major pathological response occurred in 45.7% of patients and was associated with a favorable outcome (P = 0.057). Neoadjuvant CRT led to a significant reduction in intratumoral FDG-uptake (P < 0.001). No significant association was seen between a pathological response (either complete or major) and the FDG-PET results (P > 0.280). The SUV2 value was correlated with a morphological response and the possibility to perform an R0 resection (P < 0.018; receiver operating characteristic curve analysis: SUV2 threshold = 5.5). No significant association was found between metabolic imaging and recurrence or survival.
Conclusions: FDG-PET does not effectively correlate with pathological response and long-term survival in patients with locally advanced esophageal cancer undergoing neoadjuvant CRT followed by surgery. (Registered on the www.e-cancer RECF0350.)
Although 18F-fluorodeoxyglucose positron emission tomography has been considered a promising tool to evaluate the response to neoadjuvant treatment, we use a prospective study to demonstrate that standardized uptake value variation before and after neoadjuvant chemoradiation is not correlated to pathological response or survival in resected patients with esophageal cancer.
*Department of Digestive and Oncological Surgery, University Hospital of Lille, Lille, France
†University of Lille, Nord de France, Lille, France
‡Inserm, UMR837, Jean-Pierre Aubert Research Center, Team 5 Mucins, Epithelial Differentiation and Carcinogenesis, rue Polonovski, Lille Cedex, France
§Department of Nuclear Medicine, University Hospital of Lille, Lille, France
¶Department of Statistics, University Hospital of Lille, Lille, France
‖Academic Radiotherapy Department, CLCC Oscar Lambret Comprehensive Cancer Center, Lille, France
**Inserm, U703, Institute of Medical Technology, University Hospital of Lille, Lille, France.
Reprints: Christophe Mariette, MD, PhD, Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Centre Hospitalier régional et Universitaire, Place de Verdun F-59037, Lille, France. E-mail: email@example.com.
This article was presented in part at the 7th French meeting of Digestive and Hepatobiliary Surgery, Paris, France, November 30 to December 2, 2011.
Supported by the French Ministry of Health—Programme Hospitalier de Recherche Clinique régional 2002.
Disclosure: The authors declare no conflicts of interest.