Annals of Oncology 13:361-368, 2002
© 2002 European Society for Medical Oncology
Positron emission tomography for assessment of the response to induction radiochemotherapy in locally advanced oesophageal cancer
1Departments of Nuclear Medicine, 2Internal Medicine, 3Radiology, 4Radiation Oncology, 5Pathology and 6Thoracic Surgery, University Hospital Gasthuisberg, Katholieke Universiteit Leuven (KUL), Leuven, Belgium
Received 9 July 2001; revised 25 September 2001; accepted 25 October 2001.
Aims
This prospective study was designed to determine the utility of 18F-labelled deoxyglucose (FDG) in positron emission tomography (PET) (FDG-PET) for assessing the response to neoadjuvant chemoradiation therapy (CRT) in locally advanced oesophageal tumours.
Patients and methods
Thirty-six patients with locally advanced oesophageal cancer (clinical T4 stage) without organ metastases, underwent FDG-PET before and 1 month after CRT. Patients were classified as major responders by serial FDG-PET when the post-CRT PET demonstrated a strong reduction of FDG uptake at the primary tumour site (>80% reduction of tumour-to-liver uptake ratio) without any abnormal FDG uptake elsewhere in the body. PET response was compared with histology obtained during post-induction transthoracic oesophagectomy.
Results
A strong correlation was found between the extent of lymph node (LN) involvement as shown by the pre-CRT PET and the major response rate (P = 0.001): such response occurred in nine of 11 N0M0 patients (82%), in three of nine N1–2M0 patients (33%) and in two of 16 patients (13%) with distant lymphatic spread. Such a correlation was not found for computed tomography or endoscopic ultrasonography. The sensitivity of serial FDG-PET for a major CRT response was 10 of 14 (71%), its specificity 18 of 22 (82%). The concordance between the response assessment by PET and histopathology was 78%. The median survival time after CRT of PET major responders compared with PET non-major responders was 16.3 months and 6.4 months, respectively. The metabolic response as measured by serial FDG-PET is a stronger prognostic factor for overall survival (P = 0.002) than the extent of LN involvement seen on the pretreatment FDG-PET (P = 0.087).
Conclusions
These data indicate that CRT response as assessed by serial FDG-PET is strongly correlated with pathological response and survival.
Key words: induction therapy, oesophageal cancer, positron emission tomography, response assessment, survival
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