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

Department of Surgery, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Diseases of the Esophagus (Impact Factor: 2.06). 02/2008; 21(2):151-8. DOI: 10.1111/j.1442-2050.2007.00732.x
Source: PubMed

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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Neben ihrem Stellenwert im initialen Staging (v. a. zum Ausschluss einer Fernmetastasierung) und in der Rezidivdiagnostik des Ösophaguskarzinoms kann die Positronenemissionstomographie mit Fluordesoxyglucose (FDG-PET) auch zur Kontrolle des Therapieansprechens verwendet werden. Eine neoadjuvante Chemo-/Radiochemotherapie kann das Überleben von Patienten mit Ösophaguskarzinom signifikant verbessern, doch profitieren davon nur Patienten mit Ansprechen auf die Induktionstherapie. Die Kontrolle des Therapieansprechens kann spät, d. h. nach Ende der neoadjuvanten Therapie, sowie früh im Therapieverlauf erfolgen. Als Surrogatparameter zur Vorhersage des Therapieansprechens und der Prognose für Adenokarzinome des gastroösophagealen Übergangs wurde die FDG-PET bereits in mehreren Studien evaluiert und validiert. Die unizentrische MUNICON-Studie zeigte, dass eine PET/CT-gesteuerte Therapie beim Adenokarzinom des Ösophagus möglich ist, was hinsichtlich einer Individualisierung der multimodalen Therapie wichtig ist. In anderen Studien war die FDG-PET hinsichtlich Ansprechen und Prognose jedoch nicht aussagekräftig. Die Rolle der FDG-PET/CT in der Therapiekontrolle des Ösophaguskarzinoms wird intensiv diskutiert. Prospektive randomisierte multizentrische Studien sind noch erforderlich. Außerhalb von Studien sollte die PET/CT-gesteuerte Therapie nicht eingesetzt werden. Zukünftige Forschung wird sich auch neuen Möglichkeiten der molekularen Bildgebung sowie innovativen Therapieregimes widmen.
    Der Onkologe 01/2010; 16(5). · 0.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Functional imaging gives information about physiological heterogeneity in tumours. The utility of functional imaging tests in providing predictive and prognostic information after chemoradiotherapy for both oesophageal cancer and pancreatic cancer will be reviewed. The benefit of incorporating functional imaging into radiotherapy planning is also evaluated. In cancers of the upper gastrointestinal tract, the vast majority of functional imaging studies have used (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET). Few studies in locally advanced pancreatic cancer have investigated the utility of functional imaging in risk-stratifying patients or aiding target volume definition. Certain themes from the oesophageal data emerge, including the need for a multiparametric assessment of functional images and the added value of response assessment rather than relying on single time point measures. The sensitivity and specificity of FDG-PET to predict treatment response and survival are not currently high enough to inform treatment decisions. This suggests that a multimodal, multiparametric approach may be required. FDG-PET improves target volume definition in oesophageal cancer by improving the accuracy of tumour length definition and by improving the nodal staging of patients. The ideal functional imaging test would accurately identify patients who are unlikely to achieve a pathological complete response after chemoradiotherapy and would aid the delineation of a biological target volume that could be used for treatment intensification. The current limitations of published studies prevent integrating imaging-derived parameters into decision making on an individual patient basis. These limitations should inform future trial design in oesophageal and pancreatic cancers.
    Clinical Oncology 07/2014; · 2.83 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: PET with the glucose analog [18F]-FDG is increasingly used to monitor tumor response in patients undergoing chemotherapy and chemoradiotherapy. The clinical value of FDG PET for differentiation of residual tumor and therapy-induced fibrosis has been documented for gastrointestinal cancer. Furthermore, quantitative assessment of therapy-induced changes in tumor [18F]-FDG uptake may allow the prediction of tumor response and patient outcome very early in the course of therapy. This suggests that FDG PET may be used to identify nonresponders early during neoadjuvant chemoradiotherapy, allowing for early modifications of the treatment protocol.
    PET Clinics 04/2008; 3(2):217–226.

Full-text (2 Sources)

Available from
May 20, 2014