The value of 18F-FDG PET before and after induction chemotherapy for the early prediction of a poor pathologic response to subsequent preoperative chemoradiotherapy in oesophageal adenocarcinoma

Abstract

PurposeThe purpose of our study was to determine the value of 18F-FDG PET before and after induction chemotherapy in patients with oesophageal adenocarcinoma for the early prediction of a poor pathologic response to subsequent preoperative chemoradiotherapy (CRT).MethodsIn 70 consecutive patients receiving a three-step treatment strategy of induction chemotherapy and preoperative chemoradiotherapy for oesophageal adenocarcinoma, 18F-FDG PET scans were performed before and after induction chemotherapy (before preoperative CRT). SUVmax, SUVmean, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were determined at these two time points. The predictive potential of (the change in) these parameters for a poor pathologic response, progression-free survival (PFS) and overall survival (OS) was assessed.ResultsA poor pathologic response after induction chemotherapy and preoperative CRT was found in 27 patients (39 %). Patients with a poor pathologic response experienced less of a reduction in TLG after induction chemotherapy (p < 0.01). The change in TLG was predictive for a poor pathologic response at a threshold of −26 % (sensitivity 67 %, specificity 84 %, accuracy 77 %, PPV 72 %, NPV 80 %), yielding an area-under-the-curve of 0.74 in ROC analysis. Also, patients with a decrease in TLG lower than 26 % had a significantly worse PFS (p = 0.02), but not OS (p = 0.18).Conclusions 18F-FDG PET appears useful to predict a poor pathologic response as well as PFS early after induction chemotherapy in patients with oesophageal adenocarcinoma undergoing a three-step treatment strategy. As such, the early 18F-FDG PET response after induction chemotherapy could aid in individualizing treatment by modification or withdrawal of subsequent preoperative CRT in poor responders.

PET-guided treatment algorithms in oesophageal cancer: the promise of the near future!

“…It provided much-needed knowledge to help to make relevant individualized treatment decisions in the near future. The study of van Rossum et al (6) confirmed the results of previous studies which studied smaller patient cohorts (7)(8)(9), and also found a significant correlation between metabolic response and histopathologic response (7-11). The current study showed a higher predictive value, probably due to the use of a newer generation PET-scanner, with higher sensitivity and intrinsic resolution as compared to previous studies (7-9).…”

“…In the study of van Rossum et al (6) this imaging biomarker was FDG-PET, which significantly increased the predictive value of response to trimodality treatment. It provided much-needed knowledge to help to make relevant individualized treatment decisions in the near future.…”

PET response assessment in apatinib-treated radioactive iodine-refractory thyroid cancer

“…Studies have demonstrated the usefulness of 18 F-fluorodeoxyglucose ( 18 F-FDG) PET/CT for early response evaluation and prognosis assessment (Carr et al 2010, Takahashi et al 2012, Nakajo et al 2017. Recently, except standardised uptake value (SUV), 18 F-FDG PET/CT parameters, such as metabolic tumour volume (MTV) and total lesion glycolysis (TLG), have been shown to be of much clinical relevance in solid tumours such as oesophageal and pancreatic adenocarcinoma (Sakane et al 2017, van Rossum et al 2017. However, little has been reported for DTC, particularly for RAIR-DTC, after TKI therapy.…”

18F-FDG PET Response After Induction Chemotherapy Can Predict Who Will Benefit from Subsequent Esophagectomy After Chemoradiotherapy for Esophageal Adenocarcinoma

“…However, the prognostic value of 18 F-FDG PET response after chemoradiotherapy has not been definitively established, most likely because of the confounding effects of radiationinduced esophagitis (9,10). On the other hand, 18 F-FDG PET response after induction chemotherapy seems to be a more dependable imaging marker for predicting survival (11)(12)(13). Previous studies have suggested that 18 F-FDG PET response after induction chemotherapy could predict pathologic complete response (pCR) and was associated with survival outcomes in esophageal cancer patients treated with induction chemotherapy followed by neoadjuvant or definitive chemoradiotherapy (11)(12)(13).…”

“…On the other hand, 18 F-FDG PET response after induction chemotherapy seems to be a more dependable imaging marker for predicting survival (11)(12)(13). Previous studies have suggested that 18 F-FDG PET response after induction chemotherapy could predict pathologic complete response (pCR) and was associated with survival outcomes in esophageal cancer patients treated with induction chemotherapy followed by neoadjuvant or definitive chemoradiotherapy (11)(12)(13). Moreover, an early 18 F-FDG PET response could provide useful information for choosing a chemotherapy regimen to be used during radiation for those who do not show an 18 F-FDG PET response (14).…”