Lack of fludeoxyglucose F 18 uptake in posttreatment positron emission tomography as a significant predictor of survival after subsequent surgery in multimodality treatment for patients with locally advanced esophageal squamous cell carcinoma

Higuchi, Ichirou; Yasuda, Takushi; Yano, Masahiko; Doki, Yuichirou; Miyata, Hiroshi; Tatsumi, Mitsuaki; Fukunaga, Hironori; Takiguchi, Shuji; Fujiwara, Yoshiyuki; Hatazawa, Jun; Monden, Morito

doi:10.1016/j.jtcvs.2008.02.016

Cited by 43 publications

(33 citation statements)

References 27 publications

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“…Furthermore, clinical over-staging may also lead to a reduced chance of cure in a number of patients, in which the diagnosis of T4 was made in error. Our previous studies 29) as well as recent reports 30) have shown that the metabolic response of esophageal cancers to preoperative CRT as assessed by FDG-PET more accurately reflects tumor regression and predicts prognosis, compared with that by conventional imaging including CT. Therefore, accurate initial staging and response evaluation by using multimodal diagnostic tools including FDG-PET is no doubt necessary to provide appropriate treatments and also to improve prognosis of esophageal cancer patients with T4 tumors.…”

Section: Commentsmentioning

confidence: 80%

Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Makino

Doki

2011

ATCS

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The outcome of patients with T4 esophageal cancer, defined as a tumor that invades neighboring structures (e.g., aorta, trachea, bronchus, and lung), is extremely poor. Despite recent advances in surgical techniques, these tumors are usually considered inoperable. Two distinct therapeutic options are currently available for T4 esophageal cancers: chemo-radiotherapy followed by surgery (CRT-S), which comprises esophagectomy following down-staging of the tumor by CRT, and definitive chemo-radiotherapy (D-CRT), which is designed to avoid esophagectomy by using maximum doses of irradiation. CRT-S is superior to D-CRT with respect to local control and short-term survival although CRT-S is associated with relatively higher perioperative mortality and morbidity. On the other hand, it is sometimes difficult to achieve local control with D-CRT and the treatment often results in fistula formation, though a complete response to CRT is often associated with better prognosis. Admittedly, the difference in the survival rate between the two modalities is marginal at long-term follow-up due to operative morbidity and inadequate control of distant metastasis in CRT-S. Changes in perioperative management and intensive systemic chemotherapy may enhance the outcome. Randomized controlled trials involving large population samples are needed to define the standard treatment for T4 esophageal cancer.

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Section: Commentsmentioning

confidence: 80%

Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Makino

Doki

2011

ATCS

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“…In our institute, EUS is routinely performed for staging of superficial oesophageal cancers, but not for deeply invading (T3-T4) oesophageal cancers because the fiberscope often could not pass through the latter tumours due to stenosis. From March 2000, we have used FDG-PET for the clinical staging of locally advanced oesophageal cancers and for evaluating the patient response to neoadjuvant treatment (22)(23)(24). FDG-PET reportedly achieves higher specificity and comparable sensitivity for assessing regional and distant LN involvement, compared with CT and EUS (21,43,44).…”

Section: ------------------------------------------------------------mentioning

confidence: 99%

“…Spherical LNs >1.0 cm in maximum transverse diameter were diagnosed as metastasis-positive on CT scans (13,20,21). LNs that were visible but <1.0 cm on the long axis by CT scan were regarded as metastasis-positive if focal prominent 18-FDG uptake was significant on the PET scan, compared with normal mediastinal activity (22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

Pre- and post-therapy nodal status equally affects survival of patients with oesophageal squamous cell carcinoma receiving preoperative chemoradiation

et al. 2010

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Abstract. Patients with deeply invading (T3-T4) oesophageal cancers usually receive chemoradiotherapy with or without surgery. However, the prognostic significance of pre-therapy and post-therapy lymph node (LN) status remains unclear. We studied 195 patients who received chemoradiotherapy for deeply invading oesophageal cancers (T3-4, N0-1, M0). Of these, 105 patients underwent surgery while 90 were treated by chemoradiotherapy alone. Of the 105 surgically treated patients, overall survival was significantly better in cN0 patients than in cN1 (3-year survival rate, 65.3 vs. 25.8%, P=0.0014). This difference was similarly observed in 90 patients who received chemoradiotherapy alone. Patient survival differed significantly among patients with no positive LN, 1 positive LN and 2-4 positive LN (3-year survival rate, 57.1 vs. 40.5 vs. 17.6%, P<0.0001). However, there was no significant difference in survival between patients with 2-4 positive LN and ≥5 positive LN. Multivariate analysis identified pre-therapy LN status and the number of involved LNs as the most important independent prognostic factors prior to histopathological tumour regression. In conclusion, pretherapy LN status and the number of post-therapy involved LNs equally affect survival of patients who receive neoadjuvant chemoradiotherapy. Control of systemic metastasis is required, based on pre-and post-therapy LN status.

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“…10% to 80%) and typically has been chosen tailored to a retrospective data set rather than prospectively evaluated [8,[10][11][12][13][14] . In other studies, persistent uptake within the primary tumor site on a single post-treatment PET correlated with residual viable tumor and poor survival [9,[15][16][17] . However, the specific SUVmax value used in these series as a cutoff varied from 2.5 to 4.0, and unfortunately other recent studies similarly designed have concluded that a single post-therapy PET scan is not adequate in determining response within the primary tumor [18][19][20] .…”

Section: Pet Utility In Treatment Responsementioning

confidence: 76%

“…Patients with persistent disease after neoadjuvant therapy and prior to surgery have a poorer outcome and may best be managed without surgery [8,9] . A PET scan may be helpful in more accurately determining patient response to treatment to facilitate choosing appropriate additional therapy.…”

Section: Pet Utility In Treatment Responsementioning

confidence: 99%

Positron emission tomography’s changing significance in the treatment of esophageal cancer

Hopkins

Yang

2009

WJGO

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Incidence of esophageal cancer has been rising, and Positron Emission Tomography (PET) is one tool that has shown utility and promise as a tool for staging, treatment response, and prognosis. PET delivery has evolved over time and is now frequently registered with a CT scan at the time of acquisition. However, resolution and confounders such as post-treatment radiation changes may limit clinical utility. PET has been shown to be helpful in staging, especially in evaluating for distant metastases. PET acquired after chemoradiation may give important prognostic information that can guide additional treatment decisions. Studies have had substantial variability in recommendations for the timing and manner of using PET for this purpose, and additional study is needed.

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Lack of fludeoxyglucose F 18 uptake in posttreatment positron emission tomography as a significant predictor of survival after subsequent surgery in multimodality treatment for patients with locally advanced esophageal squamous cell carcinoma

Abstract: Posttreatment positron emission tomography with fludeoxyglucose F 18 reliably predicted histologic response and postoperative survival in advanced esophageal squamous cell carcinoma. This tool could potentially be used to tailor optimal treatment according to individual responses.

Cited by 43 publications

References 27 publications

Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Pre- and post-therapy nodal status equally affects survival of patients with oesophageal squamous cell carcinoma receiving preoperative chemoradiation

Positron emission tomography’s changing significance in the treatment of esophageal cancer

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