Increased evidence for the prognostic value of FDG uptake on late-treatment PET in non-tumour-affected oesophagus in irradiated patients with oesophageal carcinoma

Li, Yimin; Hofheinz, Frank; Furth, Christian; Chen, Lili; Wu, Hua; Ghadjar, Pirus; Zschaeck, Sebastian

doi:10.1007/s00259-018-3996-1

Cited by 8 publications

(14 citation statements)

References 38 publications

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“…That may be another reason why the Cox multi-factor regression did not show positive results for ΔTLG in our study. Non-tumour-affected oesophagus (NTO) on restaging PET may be a promising method to deal with the treatment-induced inflammation [34]. Additional PET biomarkers are under investigation for EC right now.…”

Section: Discussionmentioning

confidence: 99%

Metabolic parameters of sequential 18F-FDG PET/CT predict overall survival of esophageal cancer patients treated with (chemo-) radiation

Zschaeck

et al. 2019

Radiat Oncol

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Background To evaluate the prognostic value of metabolic parameters of pre-treatment and interim 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for overall survival (OS) of esophageal cancer(EC) patients undergoing (chemo-) radiotherapy. Methods A retrospective analysis of 134 patients with pathology confirmed squamous cell EC treated between July 2009 and October 2013 in our hospital was performed. Inclusion criteria for this study were curative intended radiotherapy and availability of pre-treatment and interim 18F-FDG PET. 18F-FDG PET/CT scans were acquired before treatment and after 40 Gray (Gy) of radiotherapy. Maximum standard uptake value (SUV max ), metabolic tumor volume(MTV), total lesion glycolysis (TLG), and the percentual changes during both PET scans were recorded. The parameters were named as SUVmax1,MTV1,TLG1,SUVmax2,MTV2,TLG2,△SUV max ,△MTV and △TLG. The receiver operating characteristic curve (ROC) was used to analyze the relationship between metabolic parameters and OS, survival analysis was carried out by Kaplan-Meier and Cox regression analysis. Results Univariate survival analysis showed that SUVmax2、MTV1、△MTV、TLG1、TLG2 and △TLG were associated with OS. Based on the largest Youden index of ROC curves, patients with SUVmax2 < 7.8, MTV1 < 10.5, △MTV < 0.075, TLG1 < 59.8, TLG2 < 44.3 and △TLG < 0.27 tended to live longer. Stratified for these parameters, the estimated median survival time were 27.9 months (m) vs 9.8 m, 36.9 m vs 11.3 m, 41.6 m vs 12 m, 48.9 m vs 14.3 m, 32.6 m vs 13.2 m, and 41.6 m vs 14.5 m. Cox multi-factor regression analyses revealed SUV max 2 as an independent prognostic factor for OS complementary to TNM staging and the length of primary tumor. Conclusions Sequential 18F-FDG PET/CT metabolic parameters bear important prognostic value for OS of EC patients. 18F-FDG PET/CT scan before treatment and during chemoradiotherapy seems helpful to evaluate the effect of chemoradiotherapy, guide clinical decisions and provide patients with personalized treatment.

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Section: Discussionmentioning

confidence: 99%

Metabolic parameters of sequential 18F-FDG PET/CT predict overall survival of esophageal cancer patients treated with (chemo-) radiation

Zschaeck

et al. 2019

Radiat Oncol

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“…152 patients from the Department of Radiation Oncology of the University Hospital Xiamen were included in this study. Imaging and treatment of patients have been previously described 29 , 30 . Briefly, patients received definitive CRT between 2009 and 2013, mostly using intensity modulated radiotherapy (IMRT).…”

Section: Methodsmentioning

confidence: 99%

A FDG-PET radiomics signature detects esophageal squamous cell carcinoma patients who do not benefit from chemoradiation

Beck

Päßler

et al. 2020

Sci Rep

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Detection of patients with esophageal squamous cell carcinoma (ESCC) who do not benefit from standard chemoradiation (CRT) is an important medical need. Radiomics using 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a promising approach. In this retrospective study of 184 patients with locally advanced ESCC. 152 patients from one center were grouped into a training cohort (n = 100) and an internal validation cohort (n = 52). External validation was performed with 32 patients treated at a second center. Primary endpoint was disease-free survival (DFS), secondary endpoints were overall survival (OS) and local control (LC). FDG-PET radiomics features were selected by Lasso-Cox regression analyses and a separate radiomics signature was calculated for each endpoint. In the training cohort radiomics signatures containing up to four PET derived features were able to identify non-responders in regard of all endpoints (DFS p < 0.001, LC p = 0.003, OS p = 0.001). After successful internal validation of the cutoff values generated by the training cohort for DFS (p = 0.025) and OS (p = 0.002), external validation using these cutoffs was successful for DFS (p = 0.002) but not for the other investigated endpoints. These results suggest that pre-treatment FDG-PET features may be useful to detect patients who do not respond to CRT and could benefit from alternative treatment.

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“…18 Furthermore, recent studies reported a high prognostic value of the FDG uptake within irradiated nontumor affected (o)esophagus (NTO) in a cohort of patients treated with pCRT and dCRT, most likely reflecting radiation-induced inflammation. 21,22 The aim of our study was to confirm that both established interim FDG-PET parameters are prognostic and can identify patients that would be candidates for organ preservation.…”

Section: Introductionmentioning

confidence: 94%

“…Details of the 72 patients from the Department of Radiation Oncology of the University Hospital Xiamen have been previously described. 21,23 Briefly, patients received dCRT between 2009 and 2013, mostly using intensity-modulated radiotherapy (IMRT). After a radiation dose of 50 Gy to the tumor, affected lymph nodes, safety margins, and elective lymph nodes, a consecutive boost of 4-16 Gy was prescribed to tumor/affected lymph nodes (average total dose: 58.9 Gy) with reduced margins.…”

Section: Patients Treatment and Follow-upmentioning

confidence: 99%

Combined tumor plus nontumor interim FDG‐PET parameters are prognostic for response to chemoradiation in squamous cell esophageal cancer

Zschaeck

Bütof

et al. 2020

Intl Journal of Cancer

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We have investigated the prognostic value of two novel interim 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) parameters in patients undergoing chemoradiation (CRT) for esophageal squamous cell carcinoma (ESCC): one tumor parameter (maximal standardized uptake ratio rSUR) and one normal tissue parameter (change of FDG uptake within irradiated nontumoraffected esophagus ΔSUV NTO). PET data of 134 European and Chinese patients were analyzed. Parameter establishment was based on 36 patients undergoing preoperative CRT plus surgery, validation was performed in 98 patients receiving definitive CRT. Patients received PET imaging prior and during fourth week of CRT. Clinical parameters, baseline PET parameters, and interim PET parameters (rSUR and ΔSUV NTO) were analyzed and compared to event-free survival (EFS), overall survival (OS), loco-regional control (LRC) and freedom from distant metastases (FFDM). Combining rSUR and ΔSUV NTO revealed a strong prognostic impact on EFS, OS, LRC and FFDM in patients undergoing preoperative CRT. In the definitive CRT cohort, univariate analysis with respect to EFS revealed several staging plus both previously established interim PET parameters as significant prognostic factors. Multivariate analyses revealed only rSUR and ΔSUV NTO as independent prognostic factors (p = 0.003, p = 0.008). Combination of these parameters with the cutoff Additional Supporting Information may be found in the online version of this article.

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Increased evidence for the prognostic value of FDG uptake on late-treatment PET in non-tumour-affected oesophagus in irradiated patients with oesophageal carcinoma

Cited by 8 publications

References 38 publications

Metabolic parameters of sequential 18F-FDG PET/CT predict overall survival of esophageal cancer patients treated with (chemo-) radiation

Metabolic parameters of sequential 18F-FDG PET/CT predict overall survival of esophageal cancer patients treated with (chemo-) radiation

A FDG-PET radiomics signature detects esophageal squamous cell carcinoma patients who do not benefit from chemoradiation

Combined tumor plus nontumor interim FDG‐PET parameters are prognostic for response to chemoradiation in squamous cell esophageal cancer

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