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18F-FDG-PET/CT in assessing response to neoadjuvant chemoradiotherapy for potentially resectable locally advanced esophageal cancer

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Abstract

Purpose

To correlate metabolic response to neoadjuvant chemoradiotherapy (NACR) on FDG-PET/CT using PERCIST-based criteria to pathologic and clinical response, and survival in patients with locally advanced esophageal cancer (LAEC).

Materials and methods

Forty-five patients with LAEC underwent PET/CT at baseline and after NACR. Tumors were evaluated using PERCIST (PET response criteria in solid tumors)-based criteria including SUL, SUL tumor/liver ratio, % change in SUL. These parameters were compared to pathology regression grade (PRG), clinical response (including residual or new disease beyond the surgical specimen), and overall survival.

Results

On surgical pathology, there was complete or near-complete regression of tumor in 51.1 %, partial response in 42.2 %, and lack regression in 4.4 %. One patient (2.2 %) had progression of disease on imaging and did not undergo surgical resection. None of the baseline PET parameters had significant correlation to pathology regression grade or clinical response. On follow-up, a positive correlation was found between post-therapy SUL ratio, %∆ SUL and %∆ SUL ratio and clinical response (p = 0.025, 0.035, 0.030, respectively). A weak correlation was found between post-therapy SUL ratio to PRG (p = 0.049). A strong correlation was found between the metabolic response score and PRG (p = 0.002) as well as between metabolic response and clinical response (p < 0.001).

Conclusion

PERCIST-based metabolic response assessment to NACR in LAEC may correlate with clinical outcome and survival.

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Author information

Authors and Affiliations

  1. Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, 610 University Ave., Suite 3-960, Toronto, ON, M5G 2M9, Canada

    Ur Metser, Farid Rashidi & Hadas Moshonov

  2. Office of Research and Development, Joint Department of Medical Imaging, UHN, MSH, WCH, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

    Hadas Moshonov

  3. Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada

    Rebecca Wong

  4. Department of Medical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada

    Jennifer Knox

  5. Department of Pathology and Laboratory Medicine, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada

    Maha Guindi

  6. Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada

    Gail Darling

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  1. Ur Metser
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Correspondence to Ur Metser.

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Metser, U., Rashidi, F., Moshonov, H. et al. 18F-FDG-PET/CT in assessing response to neoadjuvant chemoradiotherapy for potentially resectable locally advanced esophageal cancer. Ann Nucl Med 28, 295–303 (2014). https://doi.org/10.1007/s12149-014-0812-2

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  • DOI: https://doi.org/10.1007/s12149-014-0812-2

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