Article
Prediction of response to chemotherapy using 18-fluorodeoxyglucose positron emission tomography in advanced oesophageal and gastric cancer
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Published: | March 20, 2006 |
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This study was carried through to assess the value of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) for the early metabolic response assessment in oesophago-gastric cancer. 26 patients who were treated for advanced disease (18 adenocarcinomas, 6 squamous-cell cancers) underwent FDG-PET before and two weeks after the onset of chemotherapy with either oxaliplatin-fluorouracil-folinic acid or with docetaxel-capecitabine. 24 tumours (92%) could be visualised by FDG-PET and were also assessable by a second PET 2 weeks after the start of chemotherapy. Receiver Operating Characteristic (ROC) analysis revealed a 30% decrease of the standard uptake value (SUV) as most accurate and clinically meaningful in predicting response according to RECIST. Applying this 30% cut off value, PET imaging correctly predicted clinical response with a sensitivity of 73% and a specificity of 50% (60% and 33% in gastric cancer compared to 100% and 60% in oesophageal cancer). Median time to progression and overall survival were not significantly different for metabolic responders and nonresponders (6.3 versus 5.3 months and 14.1 versus 12.5 months, respectively). Data indicate that FDG-PET is inaccurate for the prediction of response in gastric cancer. In contrast, the method is promising in advanced oesophageal cancer and merits further investigation.