TY - JOUR
T1 - 18F-FDG PET response after induction chemotherapy can predict who will benefit from subsequent esophagectomy after chemoradiotherapy for esophageal adenocarcinoma
AU - Xi, Mian
AU - Liao, Zhongxing
AU - Hofstetter, Wayne L.
AU - Komaki, Ritsuko
AU - Ho, Linus
AU - Lin, Steven H.
N1 - Funding Information:
This study was funded in part by support grant CA016672 from the National Cancer Institute Cancer Center. Steven H. Lin has received research funding from Elekta, STCube Pharmaceuticals, Peregrine Pharmaceuticals, Hitachi Chemical, and Roche/Genentech; has served as consultant for AstraZeneca; and has received honoraria from US Oncology and ProCure. No other potential interest relevant to this article was reported.
Publisher Copyright:
COPYRIGHT © 2017 by the Society of Nuclear Medicine and Molecular Imaging.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - This study aimed to determine whether 18F-FDG PET response after induction chemotherapy before concurrent chemoradiotherapy can identify patients with esophageal adenocarcinoma who may benefit from subsequent esophagectomy. Methods: We identified and analyzed 220 patients with esophageal adenocarcinoma who had received induction chemotherapy before chemoradiotherapy, with or without surgery, with curative intent; all underwent 18F-FDG PET scanning before and after induction chemotherapy. 18F-FDG PET responders were defined as patients who achieved complete response (CR) after induction chemotherapy (maximum SUV # 3.0). The predictive value of 18F-FDG PET response for patient outcomes was evaluated. Results: Overall, 86 patients had bimodality therapy (BMT; induction chemotherapy 1 chemoradiotherapy) and 134 had trimodality therapy (TMT; induction chemotherapy 1 chemoradiotherapy with surgery). Forty-eight patients (21.8%) achieved an 18F-FDG PET CR after induction chemotherapy. 18F-FDG PET CR was found to correlate with overall survival (OS) and progression-free survival (PFS) in BMT patients. For TMT patients, 18F-FDG PET CR predicted pathologic response (P 5 0.003) but not survival. Among 18F-FDG PET nonresponders, TMT patients had significantly better survival than did BMT patients (P, 0.001). However, among 18F-FDG PET responders, BMT patients had OS (P 5 0.201) and PFS (P 5 0.269) similar to that of TMT patients. After propensity score-matched analysis, 18F-FDG PET responders treated with BMT versus TMT still had comparable OS and PFS, but TMT was associated with better locoregional control. Conclusion: 18F-FDG PET response to induction chemotherapy could be a useful imaging biomarker to identify patients with esophageal adenocarcinoma who could benefit from subsequent esophagectomy after chemoradiotherapy. Compared with BMT, TMT can significantly improve survival in 18F-FDG PET nonresponders. However, outcomes for 18F-FDG PET responders were similar after either treatment (BMT or TMT). Prospective validation of these findings is warranted.
AB - This study aimed to determine whether 18F-FDG PET response after induction chemotherapy before concurrent chemoradiotherapy can identify patients with esophageal adenocarcinoma who may benefit from subsequent esophagectomy. Methods: We identified and analyzed 220 patients with esophageal adenocarcinoma who had received induction chemotherapy before chemoradiotherapy, with or without surgery, with curative intent; all underwent 18F-FDG PET scanning before and after induction chemotherapy. 18F-FDG PET responders were defined as patients who achieved complete response (CR) after induction chemotherapy (maximum SUV # 3.0). The predictive value of 18F-FDG PET response for patient outcomes was evaluated. Results: Overall, 86 patients had bimodality therapy (BMT; induction chemotherapy 1 chemoradiotherapy) and 134 had trimodality therapy (TMT; induction chemotherapy 1 chemoradiotherapy with surgery). Forty-eight patients (21.8%) achieved an 18F-FDG PET CR after induction chemotherapy. 18F-FDG PET CR was found to correlate with overall survival (OS) and progression-free survival (PFS) in BMT patients. For TMT patients, 18F-FDG PET CR predicted pathologic response (P 5 0.003) but not survival. Among 18F-FDG PET nonresponders, TMT patients had significantly better survival than did BMT patients (P, 0.001). However, among 18F-FDG PET responders, BMT patients had OS (P 5 0.201) and PFS (P 5 0.269) similar to that of TMT patients. After propensity score-matched analysis, 18F-FDG PET responders treated with BMT versus TMT still had comparable OS and PFS, but TMT was associated with better locoregional control. Conclusion: 18F-FDG PET response to induction chemotherapy could be a useful imaging biomarker to identify patients with esophageal adenocarcinoma who could benefit from subsequent esophagectomy after chemoradiotherapy. Compared with BMT, TMT can significantly improve survival in 18F-FDG PET nonresponders. However, outcomes for 18F-FDG PET responders were similar after either treatment (BMT or TMT). Prospective validation of these findings is warranted.
KW - Chemoradiotherapy
KW - Esophageal cancer
KW - FDG-PET response
KW - Induction chemotherapy
KW - Prognosis
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U2 - 10.2967/jnumed.117.192591
DO - 10.2967/jnumed.117.192591
M3 - Article
C2 - 28522744
AN - SCOPUS:85030090055
SN - 0161-5505
VL - 58
SP - 1756
EP - 1763
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 11
ER -