Preoperative chemo-radiation-induced ulceration in patients with esophageal cancer: A confounding factor in tumor response assessment in integrated computed tomographic-positron emission tomographic imaging

Jeremy J. Erasmus, Reginald F. Munden, Mylene T. Truong, Jeremy J. Ho, Wayne L. Hofstetter, Homer A. Macapinlac, Arlene M. Correa, Tsung Teh Wu, John F. Bruzzi, Edith M. Marom, Bradley S. Sabloff, Jaffer A. Ajani, Ritsuko Komaki, Zhongxing Liao, Jeffrey H. Lee, Norio Fukami, Robert Bresalier, Stephen G. Swisher

Research output: Contribution to journalArticle

54 Scopus citations

Abstract

HYPOTHESIS: Positron emission tomography can be useful in predicting response of esophageal cancer after preoperative chemo-radiation therapy (CRT). We evaluated the use of integrated computed tomography (CT)-PET among patients with esophageal cancer being considered for resection after CRT. METHODS: Three reviewers blinded to clinical and pathologic staging retrospectively reviewed the CT-PET scans of patients with esophageal cancer after preoperative CRT who underwent esophagectomy. [F]-fluoro-2-deoxy-D-glucose uptake for residual malignancy was determined by visual analysis and semi-quantitatively when standardized uptake value (SUV) was ≥4. RESULTS: Forty-two patients underwent esophageal resection. Using visual analysis, CT-PET had a sensitivity of 47% and specificity of 58% in detecting residual malignancy. Using semi-quantitative analysis, 19 patients had a SUV ≥4 in the region of the primary esophageal tumor and were interpreted as having residual malignancy (sensitivity 43%, specificity 50%). Of these 19, six had complete pathologic response to CRT. These false-positive results, due to therapy-induced ulceration detected at endoscopy, limit the use of CT-PET alone in detecting residual malignancy. Similarly, sensitivity (25%) and specificity (73%) of endoscopy/biopsy in detecting residual malignancy were poor. However, the accuracy of CT-PET in detecting residual malignancy was improved when combined with endoscopic findings. In the absence of ulceration at endoscopy, 8 of 8 patients with SUV ≥4 after chemo-radiation had residual malignancy at surgery. CONCLUSIONS: CRT-induced ulceration results in false-positive results on CT-PET and precludes accurate detection of residual esophageal tumor. However, CT-PET in combination with endoscopy is useful in identifying patients with a high risk of residual tumor post-CRT.

Original languageEnglish (US)
Pages (from-to)478-486
Number of pages9
JournalJournal of Thoracic Oncology
Volume1
Issue number5
DOIs
StatePublished - Jun 1 2006

Keywords

  • CT-PET
  • Cancer
  • Chemotherapy
  • Esophageal
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

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    Erasmus, J. J., Munden, R. F., Truong, M. T., Ho, J. J., Hofstetter, W. L., Macapinlac, H. A., Correa, A. M., Wu, T. T., Bruzzi, J. F., Marom, E. M., Sabloff, B. S., Ajani, J. A., Komaki, R., Liao, Z., Lee, J. H., Fukami, N., Bresalier, R., & Swisher, S. G. (2006). Preoperative chemo-radiation-induced ulceration in patients with esophageal cancer: A confounding factor in tumor response assessment in integrated computed tomographic-positron emission tomographic imaging. Journal of Thoracic Oncology, 1(5), 478-486. https://doi.org/10.1097/01243894-200606000-00016