Prognostic role of early 18-FDG PET/CT during neoadjuvant chemotherapy for resectable adenocarcinoma of the esophagus and esophagogastric junction
Language English Country Slovakia Media print-electronic
Document type Journal Article
PubMed
33440988
DOI
10.4149/neo_2020_200815n863
PII: 200815N863
Knihovny.cz E-resources
- MeSH
- Adenocarcinoma * diagnostic imaging drug therapy surgery MeSH
- Fluorodeoxyglucose F18 * MeSH
- Esophagogastric Junction diagnostic imaging MeSH
- Humans MeSH
- Neoadjuvant Therapy MeSH
- Positron Emission Tomography Computed Tomography MeSH
- Prognosis MeSH
- Radiopharmaceuticals MeSH
- Retrospective Studies MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Names of Substances
- Fluorodeoxyglucose F18 * MeSH
- Radiopharmaceuticals MeSH
We prospectively investigated whether metabolic response assessed by 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET/CT) early in the course of neoadjuvant chemotherapy is predictive of survival in patients with adenocarcinoma of the esophagus and esophagogastric junction. PET/CT was performed before and in the third week after the initiation of the first cycle of neoadjuvant chemotherapy, which consisted of epirubicin, cisplatin, and 5-fluorouracil or capecitabine. The metabolic response was defined as a relative decrease in the peak standardized uptake value (SUL) of the tumor by ≥35% or total lesion glycolysis (TLG) by ≥66%. The associations of metabolic response with overall survival (OS) and disease-free survival (DFS) were investigated using Kaplan-Meier curves and multivariable Cox regression analysis. Among 126 recruited patients, the early metabolic response was assessed in 107 patients (90 of them underwent surgical resection). The five-year OS and DFS rates of all patients were 28% and 27%, respectively. No difference was found in OS (p=0.10 for SUL, p=0.08 for TLG) or DFS (p=0.50 for SUL, p=0.20 for TLG) between metabolic responders and non-responders. Post hoc analysis of the patients with a follow-up PET/CT within 16 days showed that metabolic response reflected by SUL predicted OS (p=0.03). We concluded that metabolic response assessed by PET/CT after the first cycle of neoadjuvant chemotherapy does not predict survival in patients with adenocarcinoma of the esophagus and esophagogastric junction. However, proper timing of the follow-up PET/CT may affect the prognostic ability of the early metabolic response.
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