Artikel
Final report of assessment of response to neoadjuvant radiochemotherapy in esophageal squamous cell carcinoma patients by 18-FDG-PET
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Veröffentlicht: | 20. März 2006 |
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Gliederung
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Purpose: Positron emission tomography with the glucose analog [18F]-fluorodeoxyglucose (FDG-PET) has been used for response evaluation in patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant radiochemotherapy (RTx/CTx). This prospective study was undertaken to compare FDG-PET assessment of tumor response to RTx/CTx with endoscopy computed tomography (CT), and histopathology in patients with ESCC, and to correlate the findings with survival and recurrence.
Patients and Methods: One hundred five patients with histologically proven ESCC (cT3, cN0/+, cM0) underwent preoperative, simultaneous RTx/CTx followed by esophagectomy between 1996 and 2004. The patients underwent endoscopy, CT and FDG-PET prior to and 3–4 weeks after completion of RTx/CTx. Response assessed by endoscopy and CT was classified by WHO criteria. Histopathological response was quantified as the percentage of residual tumor cells. The threshold pre-therapy-to-post-therapy decrease in standardized uptake value by FDG-PET used to define metabolic responders (∆SUVR) was –52%, as previously reported.
Results: Responders by FDG-PET (p=0.002) as well as Histopathology (p<0.0001) showed substantially better survival than nonresponders in contrast to endoscopy (p=0.6) or CT (p=0.1). Univariate as well as multivariate regression analysis revealed histopathological (p<0.0001) and FDG-PET response (p=0.015) to be independent predictive factors for survival. No correlation between response measured by endoscopy, Spiral-CT, or histopathology and the median recurrence-free-interval was found. FDG-PET responders showed a significantly longer median recurrence-free-interval compared to nonresponders (p=0.04).
Conclusions: Changes in tumor metabolic activity by FDG-PET are independent predictive for survival after neoadjuvant RTx/CTx in ESCC. FDG-PET responders show a longer recurrence-free interval compared to nonresponders.