BACKGROUND: The aim of this prospective study was to assess whether [18 F]fluorodeoxyglucose PET can be used to predict histopathological response early in the course of neoadjuvant chemotherapy in patients with adenocarcinoma of the oesophagus and oesophagogastric junction. METHODS: Following the PET response criteria in solid tumours (PERCIST 1.0) as a standardized method for semiquantitative assessment of metabolic response, FDG-PET/CT was performed before (PET1) and after (PET2) initiation of the first cycle of chemotherapy. The relative changes in the peak standardized uptake value (ΔSUL) and total lesion glycolysis (ΔTLG) between PET1 and PET2 were correlated with histopathological response, defined as less than 50 per cent viable tumour cells in the resection specimen. A receiver operating characteristic (ROC) curve analysis was used to identify the optimal cut-off value with the highest accuracy of histopathological response prediction. RESULTS: PET2 was performed a median of 16 (range 12-22) days after the start of chemotherapy. Some 27 of 90 patients who underwent surgery had a histopathological response. There was no association between the median ΔSUL or median ΔTLG and the histopathological response. A post hoc analysis in 47 patients with PET2 performed 16 days or less after the start of chemotherapy showed that ΔTLG, but not ΔSUL, was associated with the histopathological response (P = 0·009). The optimal cut-off value of ΔTLG was 66 per cent or more. CONCLUSION: FDG-PET/CT after the first cycle of chemotherapy does not predict histopathological response in patients with adenocarcinoma of the oesophagus and oesophagogastric junction.

• MeSH
• Adenocarcinoma diagnostic imaging   drug therapy   pathology   surgery   MeSH
• Chemotherapy, Adjuvant MeSH
• Adult MeSH
• Fluorodeoxyglucose F18 * MeSH
• Esophagogastric Junction diagnostic imaging   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Esophageal Neoplasms diagnostic imaging   drug therapy   pathology   surgery   MeSH
• Neoadjuvant Therapy MeSH
• Positron Emission Tomography Computed Tomography * MeSH
• Prospective Studies MeSH
• Antineoplastic Agents therapeutic use   MeSH
• Antineoplastic Combined Chemotherapy Protocols therapeutic use   MeSH
• Radiopharmaceuticals * MeSH
• ROC Curve MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH
• Multicenter Study MeSH

Časné neoplazie jícnu jsou v současnosti řešitelné endoskopicky za použití kombinace endoskopické resekce (event. disekce) a radiofrekvenční ablace. Jednoznačnou indikací k endoskopické léčbě jsou léze bez submukózní invaze. Nicméně endoskopickou léčbu lze nabídnout i pacientům s pokročilejšími neoplaziemi (např. submukózní invaze), pokud přidružené komorbidity chirurgický zákrok nedovolují či jej činí vysoce rizikovým. V naší kazuistice prezentujeme případ úspěšného endo­skopického řešení makroskopicky i histologicky pokročilého adenokarcinomu jícnu u pacienta s pokročilou jaterní cirhózou. Endoskopická léčba spočívala v kombinaci endoskopické resekce (dvě etapy) a radiofrekvenční ablace (dvě etapy).

Combination of endoscopic mucosal resection (or submucosal dissection) with radiofrequency ablation is a method of choice for treatment of early esophageal neoplasia. Endoscopic therapy should be preferred for management of patients with intramucosal neoplasia. However, endoscopic treatment should also be considered in patients with more advanced le­sions (e.g. superficial submucosal cancer), particularly in those where surgery is an unacceptable risk or contraindicated due to severe comorbidities. We present a case of a successful endoscopic treatment of macroscopically, as well as histologically, advanced esophageal adenocarcinoma in a patient with liver cirrhosis Child-Pugh B. Endoscopic therapy consisted of two sessions of endoscopic mucosal resection and two sessions of radiofrequency ablation. Key words: Barrett's esophagus – endoscopic mucosal resection – radiofrequency ablation – esophageal adenocarcinoma The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers. Submitted: 23. 7. 2013 Accepted: 5. 8. 2013

• Keywords
• endoskopická mukozální resekce,
• MeSH
• Adenocarcinoma * diagnosis   therapy   MeSH
• Barrett Esophagus * diagnosis   physiopathology   therapy   MeSH
• Endoscopy methods   MeSH
• Esophagectomy * utilization   MeSH
• Gastroscopy MeSH
• Liver Cirrhosis * MeSH
• Catheter Ablation MeSH
• Middle Aged MeSH
• Humans MeSH
• Esophageal Neoplasms * therapy   MeSH
• Risk MeSH
• Temperance MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

Combined modality treatment for esophageal carcinoma seems to improve survival over surgery alone. Different combinations of cytotoxic drugs have been studied to improve antitumor efficacy and limit the toxicity of chemoradiotherapy (CRT) with inconsistent results. We present a prospective study of neoadjuvant CRT with or without paclitaxel in chemotherapy schedule. One hundred seven patients (93 males, 14 females), median age 59 years (range 44-76), with operable esophageal cancer were enrolled. They received the following neoadjuvant therapy: Carboplatin, area under curve (AUC) = 6, intravenously on days 1 and 22, 5-fluorouracil (5-FU), 200 mg/m(2)/day, continuous infusion on days 1 to 42, radiation therapy 45 grays/25fractions/5 weeks beginning on day 1. Forty-four patients (41%) were furthermore non-randomly assigned to paclitaxel 200 mg/m(2)/3 h intravenously on days 1 and 22. Nutritional support from the beginning of the treatment was offered to all patients. Surgery was done within 4-8 weeks after completion of CRT, if feasible. All patients were evaluated for grade 3 plus 4 toxicities: leukopenia (28%), neutropenia (30%), anemia (6%), thrombocytopenia (31%), febrile neutropenia (6%), esophagitis (24%), nausea and vomiting (7%), pneumotoxicity (8%). Seventy-eight patients (73%) had surgery and 63 of them were completely resected. Twenty-two patients (20%) achieved pathological complete remission, and additional 20 (19%) had node-negative and esophageal wall-positive residual disease. There were 10 surgery-related deaths, mostly due to pulmonary insufficiency. Twenty-nine patients were not resected, 15 for early progression, 14 for medical reasons or patient refusal. After a median follow-up of 52 months (range 27-80), median survival of 18.0 months and 1-, 2-, 3- and 5-year survival of 56.7, 37.5, 27.0 and 21% was observed in the whole group of 107 patients. Addition of paclitaxel to carboplatin and continual infusion of FU significantly increased hematologic and non-hematologic toxicity, but treatment results as overall survival or time to progression did not differ significantly in groups with and without paclitaxel. Patients achieving pathological complete remission or nodes negativity after neoadjuvant therapy had favorable survival prognosis, whereas long-term prognosis of node positive patients was poor. Distant metastases prevailed as a cause of the treatment failure. Factors significant for survival prognosis in multivariate analysis were postoperative node negativity, performance status, and grade of dysphagia. Addition of paclitaxel to carboplatin and continual FU significantly increased hematologic and non-hematologic toxicity without influencing efficacy of the treatment. This study confirmed improved prognosis of patients after achieving negativity of nodes. Distant metastases prevailed as cause of the treatment failure. Prospectively, it is important to look for a therapeutic combination with better systemic effect.

• MeSH
• Chemotherapy, Adjuvant MeSH
• Radiotherapy, Adjuvant MeSH
• Adult MeSH
• Esophagitis etiology   MeSH
• Fluorouracil administration & dosage   MeSH
• Dose Fractionation, Radiation MeSH
• Antineoplastic Agents, Phytogenic administration & dosage   MeSH
• Remission Induction MeSH
• Carboplatin administration & dosage   MeSH
• Leukopenia etiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Survival Rate MeSH
• Esophageal Neoplasms drug therapy   radiotherapy   surgery   MeSH
• Follow-Up Studies MeSH
• Neoadjuvant Therapy MeSH
• Neutropenia etiology   MeSH
• Paclitaxel administration & dosage   MeSH
• Prospective Studies MeSH
• Antimetabolites, Antineoplastic administration & dosage   MeSH
• Antineoplastic Agents administration & dosage   MeSH
• Antineoplastic Combined Chemotherapy Protocols therapeutic use   MeSH
• Aged MeSH
• Carcinoma, Squamous Cell drug therapy   radiotherapy   surgery   MeSH
• Thrombocytopenia etiology   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH
• Research Support, Non-U.S. Gov't MeSH

• Publication type
• Abstracts MeSH