Percentage Change on FDG-PET/CT Predicts Complete Response to Neoadjuvant Radiochemotherapy in Esophageal Cancer

Abstract

Objective: We evaluated whether the changes in FDG-PET/CT uptake between pre/and post-treatment might predict a complete response in esophageal cancer (EC). Patients and Methods: Fifty-six patients with 2 PET-CTs studies were evaluated retrospectively. Images were evaluated qualitatively and semiquantitatively (SUVs). Patients were classified as persistence of disease, complete metabolic response and unspecific FDG uptake. The SUVmax values and percentages of change in SUV were measured. Results: A significant difference was found between the persistence group and the non-persistence group regarding the median percentage change in SUVtumor (72.95% vs. 54.12%; p = 0.04) and regarding the percentage change in SUVnode (89.91% vs. 59.91%, p = 0.04). In patients treated with radiochemotherapy (RCTX), a significant difference was found between the persistence group and the no persistence group regarding the percentage change in SUVtumor (58.02% vs. 78.59%). Overall survival rate was related to the percentage of change in the SUVtumor. The group of ≥75% of change SUVtumor showed a median survival of 37.32 months (IC: 95% = 49.93-24.70) and the group of <75% of change SUVtumor showed a median survival of 18.39 months (IC: 95% = 25.14-11.65) (p = 0.04). In patients with metastatic relapse, a significant difference was found regarding the percentage change in SUVnode (94.63% vs. 74.09%). Conclusion: Our study provides evidence that the percentage change in the SUVmax is a predictor of the response to neoadjuvant treatment in patients with EC.

Acceptance and disparities of PET/CT use in patients with esophageal or gastro-esophageal junction cancer: Evaluation of mature registry data

“…The prognosis of esophageal cancer (EC) has generally improved over the years, however it remains relatively low even in patients with early-stage disease treated with curative intent. FDG-PET/CT plays a crucial role in the evaluation of EC and gastroesophageal junction cancers (GEJ) due to increased sensitivity for the detection of metastatic disease, as demonstrated in studies dating back to 1997 (2)(3)(4)(5)(6)(7). PET/CT also permits functional tumour assessment, with an emerging evidence-base supporting its use in evaluating response to neoadjuvant therapy (5)(6)(7)(8)(9)(10)(11) and detection of recurrent disease (1)(2)(3)(5)(6)(7).…”