¹⁸F-FDG PET/CT Parameters for Predicting Prognosis in Esophageal Cancer Patients Treated With Concurrent Chemoradiotherapy

Abstract

Background and Aims: This study evaluated the prognostic value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (18F-FDG PET/CT) performed before and after concurrent chemoradiotherapy (CCRT) in esophageal cancer. Methods: We analyzed the prognosis of 50 non-metastatic squamous cell esophageal cancer (T1-4N0-2) patients who underwent CCRT with curative intent at Inje University Busan Paik Hospital and Haeundae Paik Hospital from 2009 to 2019. Median total radiation dose was 54 Gy (range 34-66 Gy). Our aim was to investigate the relationship between PET/CT values and prognosis. The primary end point was progression-free survival (PFS). Results: The median follow-up period was 9.9 months (range 1.7-85.7). Median baseline maximum standard uptake value (SUVmax) was 14.2 (range 3.2-27.7). After treatment, 29 patients (58%) showed disease progression. The 3-year PFS and overall survival (OS) were 24.2% and 54.5%, respectively. PFS was significantly lower ( P = 0.015) when SUVmax of initial PET/CT exceeded 10 (n = 22). However, OS did not reach a significant difference based on maximum SUV ( P = 0.282). Small metabolic tumor volume (≤14.1) was related with good PFS ( P = 0.002) and OS ( P = 0.001). Small total lesion of glycolysis (≤107.3) also had a significant good prognostic effect on PFS ( P = 0.009) and OS ( P = 0.025). In a subgroup analysis of 18 patients with follow-up PET/CT, the patients with SUV max ≤3.5 in follow-up PET/CT showed longer PFS ( P = 0.028) than those with a maximum SUV >3.5. Conclusion: Maximum SUV of PET/CT is useful in predicting prognosis of esophageal cancer patients treated with CCRT. Efforts to find more effective treatments for patients at high risk of progression are still warranted.

Can 18F-FDG PET/CT Radiomics Features Predict Clinical Outcomes in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma?

“…In the literature, assessment of conventional parameters on PET/CTs for predicting PFS has been shown to be difficult. PFS decreases with increased SUVmax at the initial PET/CT [ 30 ]. In a systematic review of 16 studies, the pooled hazard ratio (HR) of the MTV and TLG for event-free survival based on pretreatment PET/CTs was 2.03 (95% CI 1.66–2.49) and 2.57 (95% CI 1.82–3.62), respectively [ 31 ].…”

18F‐FDG PET/CT for Identifying the Potential Primary Diseases and Predicting Prognosis of Secondary Hemophagocytic Lymphohistiocytosis in Children

“…18 F-FDG PET/CT is a medical imaging technique displaying anatomical morphology and functional metabolism, with high sensitivity and noninvasiveness. It is one of the best methods to diagnose and guide the treatment of hematological tumor diseases [ 9 ]. Because fever and enlarged lymph nodes are the first manifestations of HLH in the early stage, and lymphoma is the most common malignant disease in children with sHLH, early 18 F-FDG PET/CT examination has a particular significance for the detection of the underlying disease in sHLH [ 10 ].…”

Prognostic Value of [18F]-FDG PET/CT Radiomics combined with Sarcopenia Status among Patients with Advanced Gastroesophageal Cancer

“…There is con icting literature about the prognostic ability of quantitative metabolic measurements in terms of prognostication. While several studies suggesting standard metabolic parameters, such as SUVmean and SUVmax, can be helpful prognostic tools among patients with esophageal and gastroesophageal cancer [29,30], the results of several other studies do not support this nding, showing no improvement in outcome prediction taking into account these parameters [31,32]. More advanced volumetric parameters, including metabolic tumor volume (MTV) or total lesion glycolysis (TLG), which integrate metabolically active tumor volume with tumor FDG uptake have also been proposed as effective prognostic tools [29].…”