A strategy for N(+) advanced esophageal squamous cell carcinoma: Arranging by FDG-PET

Abstract

654

Objectives: Advanced esophageal squamous cell carcinoma (SCC) accompanied with highly spreading lymph node (LN) metastasis is a systemic disease. The three-year overall survival rates after surgery of the patients accompanied with no/1-3/4-7/8-metastatic LNs are 74/49/28/16%, so surgery alone rarely cures the patient who has more than four metastatic LNs. To improve overall survival of such patients, preoperative chemotherapy has been used, however, in order to evaluate the pathological effect for LNs metastasis or the number of residual metastatic LNs, the morphological imaging modalities were hardly sufficient. Then we assessed the usefulness of positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET) for predicting the histological response and judging the indication for second-line surgery in patients with advanced esophageal SCC.

Methods: Twenty-eight patients of esophageal SCC accompanied with LN metastasis who received neoadjuvant chemotherapy underwent FDG-PET before surgery. We compared the PET N-stage with the pathological N-stage, the number of pathological metastatic LNs, and prognosis after surgery.

Results: Fourteen patients were PET N(-) after preoperative chemotherapy, and all of these patients had less than three metastatic LNs (nine of them were pathological N0). Other fourteen patients were PET N(+) after chemotherapy, none of them was pathological N0, only three had 1-3 metastatic LNs, and eleven patients had more than four. The one- and three-year overall survival rate were 100 and 75.8% in the PET N(-) group compared with 63.6 and 0% in the PET N(+) group.

Conclusions: PET N(-) after chemotherapy does not always mean pathological N0, but means that the metastatic LNs seems to be less than three and is a good candidate for second-line surgery. In the therapeutic strategy for advanced esophageal SCC, FDG-PET may be an extremely useful modality.