gms | German Medical Science

27th German Cancer Congress Berlin 2006

German Cancer Society (Frankfurt/M.)

22. - 26.03.2006, Berlin

Early assessment of response during neoadjuvant radiochemotherapy in esophageal squamous cell carcinoma patients by 18-FDG-PET: individualized therapy ?

Meeting Abstract

  • corresponding author presenting/speaker Björn Brücher - Chirurgische Klinik und Poliklinik, TU München, Deutschland
  • Hinrich Wieder - Institut für Nuklearmedizin, TU München
  • Karen Becker - Institut für Pathologie, TU München
  • Florian Lordick - Chirurgische Klinik und Poliklinik, TU München
  • Michael Molls - Institut für Strahlentherapie, TU München
  • Raymonde Busch - Institut für Statistik und Epidemiologie, TU München
  • Jörg-Rüdiger Siewert - Chirurgische Klinik und Poliklinik, TU München
  • Markus Schwaiger - Institut für Nuklearmedizin, TU München

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocOP417

The electronic version of this article is the complete one and can be found online at:

Published: March 20, 2006

© 2006 Brücher et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



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) and neoadjuvant radiochemotherapy (RTx/CTx). This prospective study was undertaken to compare FDG-PET assessment of tumor response during RTx/CTx with histopathology in patients with ESCC, and to correlate the findings with survival.

Patients and Methods:Sixty-one patients with histologically proven ESCC (cT3, cN0/+, cM0) underwent preoperative, simultaneous RTx/CTx followed by esophagectomy between 1996 and 2004. The patients underwent FDG-PET prior to and 2 weeks after the begin of RTx/CTx (20Gray). Histopathological response was quantified as the percentage of residual tumor cells. The threshold pre-therapy-to-during-therapy decrease in standardized uptake value by FDG-PET used to define metabolic responders (∆SUVR) was –30%.

Results:Receiving-operator-curve analysis (ROC) for determination of metabolic response revealed an area-under-curve (AUC) of 7140 (p=0.005) with a sensitivity of 76%, specificity (70%), a positive predictive value of 81% and a negative predictive value of 64% (p<0.0001). Responder by FDG-PET during the neoadjuvant treatment (p=0.016) as well as Histopathology (p<0.0001) showed substantially better survival compared to nonresponders.

Conclusions: Changes in tumor metabolic activity by FDG-PET during neoadjuvant RTx/CTx allows an accurate determination of response due to the multimodal approach in patients with ESCC. This stratification may lead to a change of the neoadjuvant into a definitive therapy concept in nonresponders (individualized tumor therapy).