Abstract
This study aimed to determine whether 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) response after induction chemotherapy before concurrent chemoradiotherapy can identify patients with esophageal adenocarcinoma who may benefit from subsequent esophagectomy. Methods: We identified and analyzed 220 patients with esophageal adenocarcinoma who had received induction chemotherapy before chemoradiotherapy, with or without surgery, with curative intent; all underwent FDG-PET scanning before and after induction chemotherapy. FDG-PET responders were defined as patients who achieved complete response (CR) after induction chemotherapy (maximum standardized uptake value ≤ 3.0). The predictive value of FDG-PET response for patient outcomes was evaluated. Results: Overall, 86 patients had bimodality therapy (BMT; induction chemotherapy + chemoradiotherapy) and 134 had trimodality therapy (TMT; induction chemotherapy + chemoradiotherapy with surgery). Forty-eight patients (21.8%) achieved a FDG-PET-CR after induction chemotherapy. FDG-PET-CR was found to correlate with overall survival (OS) and progression-free survival (PFS) in BMT patients. For TMT patients, FDG-PET-CR predicted pathologic response (P = 0.003) but not survival. Among FDG-PET non-responders, TMT patients had significantly better survival than did BMT patients (P < 0.001). However, among FDG-PET responders, BMT patients had similar OS (P = 0.201) and PFS (P = 0.269) as did TMT patients. After propensity score-matched analysis, FDG-PET responders treated with BMT versus TMT still had comparable OS and PFS, but TMT was associated with better locoregional control. Conclusion: FDG-PET response to induction chemotherapy could be a useful imaging biomarker to identify patients with esophageal adenocarcinoma who could benefit from subsequent esophagectomy after chemoradiotherapy. Compared with BMT, TMT can significantly improve survival in FDG-PET non-responders. However, outcomes for FDG-PET responders were similar after either treatment (BMT or TMT). Prospective validation of these findings is warranted.
- Gastrointestinal
- Oncology: GI
- PET
- Chemoradiotherapy
- Esophageal cancer
- FDG-PET response
- Induction chemotherapy
- Prognosis
- Copyright © 2017 by the Society of Nuclear Medicine and Molecular Imaging, Inc.