[18F]Fluorodeoxyglucose PET/CT and prediction of histopathological response to neoadjuvant chemotherapy for adenocarcinoma of the oesophagus and oesophagogastric junction

Harustiak, Tomas; Zemanová, Milada; Fencl, Pavel; Hornofova, Ludmila; Pazdro, Alexandr; Snajdauf, Martin; Šálková, Eva; Lischke, Robert; Stolz, A

doi:10.1002/bjs.10712

Cited by 6 publications

(3 citation statements)

References 33 publications

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“…All patients had gastro‐oesophageal adenocarcinoma. Three studies 27,28,30 used neo‐adjuvant chemotherapy alone prior to surgery, one 29 used neo‐adjuvant chemoradiotherapy and two 14,31 used initial neo‐adjuvant chemotherapy followed by radiotherapy in metabolic non‐responders (Table 2). In total, 20/519 (3.9%) of patients progressed during neo‐adjuvant therapy and were no longer eligible for surgery.…”

Section: Resultsmentioning

confidence: 99%

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Response rate and diagnostic accuracy of early PET‐CT during neo‐adjuvant therapies in oesophageal adenocarcinoma: A systematic review and meta‐analysis

et al. 2020

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Purpose Only 25% of oesophageal adenocarcinoma (OAC) patients have a pathological response to neo‐adjuvant therapy (NAT) before oesophagectomy. Early response assessment using PET imaging may help guide management of these patients. We performed a systematic review and meta‐analysis to synthesise the evidence detailing response rate and diagnostic accuracy of early PET‐CT assessment. Methods We systematically searched several databases including MEDLINE and Embase. Studies with mixed cohorts of histology, tumour location and a repeat PET‐CT assessment after more than one cycle of NAT were excluded. Reference standard was pathological response defined by Becker or Mandard classifications. Primary outcome was metabolic response rate after one cycle of NAT defined by a reduction in maximum standardised uptake value (SUVmax) of 35%. Secondary outcome was diagnostic accuracy of treatment response prediction, defined as the sensitivity and specificity of early PET‐CT using this threshold. Quality of evidence was also assessed. Random‐effects meta‐analysis pooled response rates and diagnostic accuracy. This study was registered with PROSPERO (CRD42019147034). Results Overall, 1341 articles were screened, and 6 studies were eligible for analysis. These studies reported data for 518 patients (aged 27‐78 years; 452 [87.3%] were men) between 2005 and 2020. Pooled sensitivity of early metabolic response to predict pathological response was 77.2% (95% CI 53.2%‐100%). Significant heterogeneity existed between studies (I2 = 80.6% (95% CI 38.9%‐93.8%), P = .006). Pooled specificity was 75.0% (95% CI 68.2%‐82.5%), however, no significant heterogeneity between studies existed (I2 = 0.0% (95% CI 0.0%‐67.4%), P = .73). Conclusion High‐quality evidence is lacking, and few studies met the inclusion criteria of this systematic review. The sensitivity of PET using a SUVmax reduction threshold of 35% was suboptimal and varied widely. However, specificity was consistent across studies with a pooled value of 75.0%, suggesting early PET assessment is a better predictor of treatment resistance than of pathological response. Further research is required to define optimal PET‐guided treatment decisions in OAC.

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Section: Resultsmentioning

confidence: 99%

“…Both reviewers identified 25 of the 32 full-text articles (78.1%) and the remaining 7 were included after agreement by the third reviewer. Important characteristics of the included studies 14,[27][28][29][30][31] are detailed in Table 1.…”

Section: Re Sultsmentioning

confidence: 99%

Response rate and diagnostic accuracy of early PET‐CT during neo‐adjuvant therapies in oesophageal adenocarcinoma: A systematic review and meta‐analysis

et al. 2020

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“… 7 In the consecutive MUNICON I and II studies, the same group of investigators demonstrated that an early metabolic response-guided treatment algorithm identifies non-responding patients and allows for the adjustment of the perioperative treatment strategy. 8 , 9 Since then, several other groups developed response-guided treatment algorithms with some modifications in methodology, endpoints and trial designs 10 – 13 but implementation into clinical practice is still lagging behind.…”

Section: Introductionmentioning

confidence: 99%

PET/CT-tailored treatment of locally advanced oesophago-gastric junction adenocarcinoma: a report on the feasibility of the multicenter GastroPET study

et al. 2021

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Background: Perioperative chemotherapy is a recommended treatment approach for localised oesophago-gastric junction adenocarcinoma, but not all patients respond to neoadjuvant chemotherapy. Early identification of non-responders and treatment adaptation in the preoperative period could improve outcomes. GastroPET is a national, multicentre phase II trial evaluating a 18FDG-PET/CT-guided preoperative treatment strategy with the R0 resection rate as a primary endpoint. Here, we report on the accuracy of the methodology, the feasibility of the study design and patient safety data after enrolment of the first 63 patients. Methods: Patients with locally advanced oesophago-gastric junction adenocarcinoma (Siewert I – III) stage Ib–IIIc underwent baseline 18FDG-PET/CT scanning and re-evaluation after 14 days of oxaliplatinum-5FU-(docetaxel) chemotherapy. Responders were defined by a ⩾ 35% decrease in tumour FDG standardised uptake value (SUV)average from baseline. Responders continued with the same chemotherapy for 2 to 3 months prior to surgery. PET-non-responders switched to preoperative chemoradiotherapy [weekly carboplatin and paclitaxel with concurrent radiotherapy (45 Gy in 25 fractions)]. Here, we aim to confirm the feasibility of FDG-PET-based response assessment in a multicenter setting and to compare local versus central reading. In addition, we report on the feasibility of the study conduct and patient safety data. Results: A total of 64 patients received baseline and sequential 14-day 18FDG-PET/CT scanning. And, 63 were allocated to the respective treatment arm according to PET-response [35 (56%) responders and 28 (44%) non-responders]. The concordance of local versus central reading of SUV changes was 100%. Until the date of this analysis, 47 patients (28 responders and 19 non-responders) completed surgery. Postoperative complications of grade ⩾ 3 (Common Terminology Criteria for Adverse Events, CTCAE Version 5.0) were reported in five responders (18%; 95% CI: 7.9–36%) and two non-responders (11%; 95% CI: 2.9–31%), with no statistical difference ( p = 0.685). One patient in each arm died after surgery, leading to a postoperative in-hospital mortality rate of 4.3% (2/47 patients; 95% CI: 1.2–14%). Conclusion: Local and central FDG-SUV quantification and PET-response assessment showed high concordance. This confirms the accuracy of a PET-response-guided treatment algorithm for locally advanced oesophago-gastric junction cancer in a multicenter setting. Preoperative treatment adaptation revealed feasible and safe for patients.

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Predicting tumor response and prognosis to neoadjuvant chemotherapy in esophageal squamous cell carcinoma patients using PERCIST: a multicenter study in Japan

Kaida

Kitajima

Nakajo

et al. 2021

Eur J Nucl Med Mol Imaging

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[18F]Fluorodeoxyglucose PET/CT and prediction of histopathological response to neoadjuvant chemotherapy for adenocarcinoma of the oesophagus and oesophagogastric junction

Abstract: FDG-PET/CT after the first cycle of chemotherapy does not predict histopathological response in patients with adenocarcinoma of the oesophagus and oesophagogastric junction.

Cited by 6 publications

References 33 publications

Response rate and diagnostic accuracy of early PET‐CT during neo‐adjuvant therapies in oesophageal adenocarcinoma: A systematic review and meta‐analysis

Response rate and diagnostic accuracy of early PET‐CT during neo‐adjuvant therapies in oesophageal adenocarcinoma: A systematic review and meta‐analysis

PET/CT-tailored treatment of locally advanced oesophago-gastric junction adenocarcinoma: a report on the feasibility of the multicenter GastroPET study

Predicting tumor response and prognosis to neoadjuvant chemotherapy in esophageal squamous cell carcinoma patients using PERCIST: a multicenter study in Japan

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