2-Fluoro-2-deoxy-d-glucose positron emission tomography imaging is predictive of pathologic response and survival after preoperative chemoradiation in patients with esophageal carcinoma

Stephen G. Swisher, Jeremy Erasmus, Mary Maish, Arlene M. Correa, Homer Macapinlac, Jaffer A. Ajani, James D. Cox, Ritsuko R. Komaki, David Hong, Hoon K. Lee, Joe B. Putnam, David C. Rice, W. Roy Smythe, Linh Thai, Ara A. Vaporciyan, Garrett L. Walsh, Tsung Teh Wu, Jack A. Roth

Research output: Contribution to journalArticle

230 Scopus citations

Abstract

BACKGROUND. The current study was performed to assess the value of 2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in predicting the pathologic response and survival of patients with esophageal carcinoma treated with preoperative chemoradiation (CRT) and tumor resection. Preliminary reports suggest that FDG-PET may be predictive of the response of esophageal carcinoma patients to preoperative CRT. METHODS. Eighty-three patients with resectable esophageal carcinoma who underwent preoperative CRT and FDG-PET and tumor resection were evaluated for pathologic response to CRT, percent residual tumor, and survival. RESULTS. The majority of patients in the current study were men (74 of 83 patients; 89%). Most tumors were adenocarcinomas (73 of 83 tumors; 88%) and clinical EUST3/4 (69 tumors; 83%) or N1 (46 tumors; 55%). FDG-PET after preoperative CRT identified pathologic responders but failed to rule out microscopic residual tumor in 13 of 73 cases (18%). Pathologic response was found to correlate with the post-CRT FDG-PET standardized uptake value (SUV) (P = 0.03) and a post-CRT FDG-PET SUV of ≥ 4 was found to be the only preoperative factor to correlate with decreased survival (2-year survival rate of 33% vs. 60%; P = 0.01). On univariate Cox regression analysis, only post-CRT FDG-PET was found to be correlated with post-CRT survival (P = 0.04). CONCLUSIONS. Post-CRT FDG-PET was found to be predictive of pathologic response and survival in patients with esophageal carcinoma who undergo preoperative CRT. Esophagectomy should still be considered even if the post-CRT FDG-PET scan is normal because microscopic residual disease cannot be ruled out.

Original languageEnglish (US)
Pages (from-to)1776-1785
Number of pages10
JournalCancer
Volume101
Issue number8
DOIs
StatePublished - Oct 15 2004

Keywords

  • 2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET)
  • Esophageal carcinoma
  • Preoperative chemoradiation (CRT)
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Swisher, S. G., Erasmus, J., Maish, M., Correa, A. M., Macapinlac, H., Ajani, J. A., Cox, J. D., Komaki, R. R., Hong, D., Lee, H. K., Putnam, J. B., Rice, D. C., Smythe, W. R., Thai, L., Vaporciyan, A. A., Walsh, G. L., Wu, T. T., & Roth, J. A. (2004). 2-Fluoro-2-deoxy-d-glucose positron emission tomography imaging is predictive of pathologic response and survival after preoperative chemoradiation in patients with esophageal carcinoma. Cancer, 101(8), 1776-1785. https://doi.org/10.1002/cncr.20585