18FDG uptake during induction chemoradiation for oesophageal cancer fails to predict histomorphological tumour response

Abstract

To determine whether [18 F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) could predict the pathological response in oesophageal cancer after only the first week of neoadjuvant chemoradiation. Thirty-two patients with localised oesophageal cancer had a pretreatment PET scan and a repeat after the first week of chemoradiation. The change in mean maximum standardised uptake value (SUV) and volume of metabolically active tissue (MTV) was compared with the tumour regression grade (TRG) in the final histology. Those who achieved a TRG of 1 and 2 were deemed responders and 3 -5 nonresponders. In the responders (28%), the SUV fell from 12.6 (76.3) to 8.1 (72.9) after 1 week of chemoradiation (P ¼ 0.070). In nonresponders (72%), the results were 9.7 (75.4) and 7.1 (73.8), respectively (P ¼ 0.003). The MTV in responders fell from 36.6 (722.7) to 22.3 (710.4) cm 3 (P ¼ 0.180), while in nonresponders, this fell from 35.9 (736.7) to 31.9 (752.7) cm 3 (P ¼ 0.405). There were no significant differences between responders and nonresponders. The hypothesis that early repeat FDG-PET scanning may predict histomorphologic response was not proven. This may reflect an inflammatory effect of radiation that obscures tumour-specific metabolic changes at this time. This assessment may have limited application in predicting response to multimodal regimens for oesophageal cancer.

Prognostic significance of SUV on PET/CT in patients with localised oesophagogastric junction cancer receiving neoadjuvant chemotherapy/chemoradiation: a systematic review and meta-analysis

“…Despite intensive efforts to identify molecular markers, which are predictive for tumour response and prognosis, the value of each of these markers is currently not sufficiently validated to use them for the selection of patients for therapy [43][44][45]. Most previously reported studies showed that changes in tumour glucose uptake assessed by 18 F-FDG PET during or immediately after neoadjuvant therapy were associated with response and prognosis in oesophageal and oesophagogastric cancer [15,21,25,35,37,42,[46][47][48][49][50]. Therefore, a meta-analysis is useful because it reduces the effect that chance plays on the individual result, and quality assessments are important for reducing bias.…”

Positron emission tomography for monitoring response to neoadjuvant therapy in patients with oesophageal and gastro-oesophageal junction carcinoma

“…The majority of studies [3,[29][30][31][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] have based or part based PET responses according to pathological criteria for determining response, either using reported pathological scoring systems [22,23] or with modifications to these systems. The…”

Prognostic Significance of 18F-fluorodeoxyglucose Positron Emission Tomography (PET)-based Parameters in Neoadjuvant Chemoradiation Treatment of Esophageal Carcinoma

“…Choi NC et al found an inverse correlation between postradiation SUVmax and pathologic tumor response in lung cancer (Choi et al, 2002). Although postradiation SUVmax could be used to stratify the prognosis, it was obviously influenced by radiation inflammatory reaction in prediction survival time (Gillham et al, 2006;Javeri et al, 2009a;Jingu et al, 2010;Suzuki et al, 2011). Most important was that above two parameters did not correlate to survival time (Table 4).…”