Positron emission tomography and pathological evidence of response to neoadjuvant therapy in adenocarcinoma of the esophagus

Smithers, B .M., Couper, G. C., Thomas, J. M., Wong, D., Gotley, D. C., Martin, I., Harvey, J., Thomson, D. B., Walpole, E., Watts, N. and Burmeister, B. (2008) Positron emission tomography and pathological evidence of response to neoadjuvant therapy in adenocarcinoma of the esophagus. Diseases of the Esophagus, 21 2: 151-158. doi:10.1111/j.1442-2050.2007.00732.x


Author Smithers, B .M.
Couper, G. C.
Thomas, J. M.
Wong, D.
Gotley, D. C.
Martin, I.
Harvey, J.
Thomson, D. B.
Walpole, E.
Watts, N.
Burmeister, B.
Title Positron emission tomography and pathological evidence of response to neoadjuvant therapy in adenocarcinoma of the esophagus
Journal name Diseases of the Esophagus   Check publisher's open access policy
ISSN 1120-8694
Publication date 2008-01-01
Year available 2008
Sub-type Article (original research)
DOI 10.1111/j.1442-2050.2007.00732.x
Open Access Status Not yet assessed
Volume 21
Issue 2
Start page 151
End page 158
Total pages 8
Editor B. Levos-Beale
Place of publication Carlton, Vic. Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Subject C1
1112 Oncology and Carcinogenesis
110323 Surgery
Abstract Our aim was to determine if fluorodeoxyglucose positron emission tomography (FDG-PET) could be correlated with a pathological response in patients with esophageal adenocarcinoma receiving neoadjuvant chemotherapy and/or chemoradiation therapy. Patients with resectable, histologically proven adenocarcinoma of the esophagus were entered in the study. Preoperative chemotherapy comprised two cycles of cisplatin and 5-fluorouracil. Radiation therapy commenced with the second cycle on day 22. FDG-PET images were obtained pre-treatment and on completion of intended neo-adjuvant treatment. Quantification was achieved by the calculation of both standardized uptake values (SUV) and tumor/liver ratios (TLR). Evidence of histopathological response was identified according to the Mandard tumor regression scoring system. There were 45 patients, 22 receiving neoadjuvant chemotherapy and 23 chemoradiation therapy. Forty patients underwent surgical resection. Seven patients (16%) had a histopathological response. The mean percentage change in SUV in the histological responders group was -56.8% (SD 29) and in the non-responders -27.8% (SD 32.1) (P = 0.035). The mean percentage change in TLR was -49.1% (SD 44.8) in the responders and in the non-responders -27.3% (SD 31.3) (P = 0.128). There was no difference between the two methods of assessment, however there was less variation with SUV. There was no correlation between the FDG-PET response and the histopathological response. Presently an FDG-PET scan performed 3-6 weeks after neoadjuvant therapy for adenocarcinoma of the esophagus should not be used as a marker of the potential result of the treatment. The optimal timing of a second FDG-PET remains unclear.
Formatted abstract
Our aim was to determine if fluorodeoxyglucose positron emission tomography (FDG-PET) could be correlated with a pathological response in patients with esophageal adenocarcinoma receiving neoadjuvant chemotherapy and/or chemoradiation therapy. Patients with resectable, histologically proven adenocarcinoma of the esophagus were entered in the study. Preoperative chemotherapy comprised two cycles of cisplatin and 5-fluorouracil. Radiation therapy commenced with the second cycle on day 22. FDG-PET images were obtained pre-treatment and on completion of intended neo-adjuvant treatment. Quantification was achieved by the calculation of both standardized uptake values (SUV) and tumor/liver ratios (TLR). Evidence of histopathological response was identified according to the Mandard tumor regression scoring system. There were 45 patients, 22 receiving neoadjuvant chemotherapy and 23 chemoradiation therapy. Forty patients underwent surgical resection. Seven patients (16%) had a histopathological response. The mean percentage change in SUV in the histological responders group was –56.8% (SD 29) and in the non-responders –27.8% (SD 32.1) (P = 0.035). The mean percentage change in TLR was –49.1% (SD 44.8) in the responders and in the non-responders –27.3% (SD 31.3) (P = 0.128). There was no difference between the two methods of assessment, however there was less variation with SUV. There was no correlation between the FDG-PET response and the histopathological response. Presently an FDG-PET scan performed 3–6 weeks after neoadjuvant therapy for adenocarcinoma of the esophagus should not be used as a marker of the potential result of the treatment. The optimal timing of a second FDG-PET remains unclear.
Keyword Esophageal adenocarcinoma
Neoadjuvant therapy
Positron emission tomography
Tumor response
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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