Comparison of changes in tumor metabolic activity and tumor size during chemotherapy of adenocarcinomas of the esophagogastric junction

Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
Journal of Nuclear Medicine (Impact Factor: 6.16). 12/2005; 46(12):2029-34.
Source: PubMed


We evaluated the temporal relationship between chemotherapy-induced changes in tumor glucose use and tumor size.
Twenty patients with adenocarcinoma of the esophagogastric junction (AEG) were studied by 18F-FDG PET and CT scans before neoadjuvant chemotherapy, 14 d after the initiation of therapy, and 4 wk after the completion of therapy.
The relative change in 18F-FDG uptake was more than 2 times larger than the decrease in tumor size at all time points (P<0.01). At 14 d after the initiation of chemotherapy, there was no correlation between the reduction in 18F-FDG uptake and tumor wall thickness. The change in 18F-FDG uptake after 14 d of therapy was significantly correlated with the reduction in tumor size after the completion of therapy.
In AEG, changes in tumor metabolism are a more sensitive parameter for assessing the effects of chemotherapy than are changes in tumor size. Early changes in metabolic activity predict the subsequent reduction in tumor size.

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Available from: Hinrich A Wieder,
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    • "Several parameters other than pretreatment SUVmax from FDG-PET with potential prognostic value have been reported. Some researchers suggested that a metabolic decrease in the FDG uptake of the tumor between pre- and post-CRT is correlated with a histopathologic response of the tumor [18, 23–25], but other studies did not find a significant correlation between a decrease in the SUV and response to treatment [26, 27]. The difficulty of differentiating radiation esophagitis or other radiation-induced inflammatory changes from residual esophageal cancer by FDG-PET after radiation therapy has been noted in some reports [26, 28, 29]. "
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    ABSTRACT: The purpose of this study was to assess the efficacy of (18)F-fluoro-2-deoxy-glucose uptake positron emission tomography (FDG-PET) for the prediction of outcome in definitive chemoradiotherapy (CRT) for esophageal cancer. We enrolled 56 patients with esophageal cancer treated with definitive CRT and examined by FDG-PET before treatment. We examined the correlation of the maximum standardized uptake value (SUVmax) in FDG-PET of the primary tumor with overall survival (OS), progression-free survival (PFS), local control (LC) and response of the primary tumor. After definitive CRT, 30 patients had a clinical complete response (CR), making the CR rate 54%. For all 56 patients, the 2-year OS rate, PFS rate and LC rates were 64%, 38% and 51%, respectively. We divided the patients into two groups according to SUVmax: SUVmax < 10 (low-SUV) and ≥10 (high-SUV). The 2-year OS rates in the low- and high-SUV groups were 100% and 41%, the PFS rates were 73% and 19%, the LC rates were 71% and 39%, and the CR rates were 100% and 32%, respectively. A univariate analysis revealed significant differences between the low- and high-SUV group in OS, PFS, LC and response (P = 0.0005, 0.0002, 0.048, and <0.0001, respectively). SUVmax and T stage were significantly associated with OS, PFS, LC and response. A multivariate analysis showed significant differences between the SUVmax <10 and ≥10 groups in overall survival and response (P < 0.05). Our result suggests that the SUVmax in FDG-PET of the primary tumor before treatment may have prognostic value for esophageal cancer.
    Journal of Radiation Research 03/2013; 54(5). DOI:10.1093/jrr/rrt021 · 1.80 Impact Factor
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    • "Metabolic changes measured by PET have been shown to be more sensitive in detecting response early in the course of chemotherapy as compared with both conventional imaging techniques (EUS and CT) and endoscopy [11]. Various studies have demonstrated that 18-fluorodeoxyglucose-positron emission tomography (FDG-PET), measuring early changes in tumor glucose uptake after only two weeks of induction therapy, is a promising tool in the prediction of clinical and histopathologic response as well as prognosis to neoadjuvant treatment in adenocarcinomas of the oesophagogastric junction (AEG) type I and II [6,12]. "
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    ABSTRACT: 18-Fluorodeoxyglucose-PET (18F-FDG-PET) can be used for early response assessment in patients with locally advanced adenocarcinomas of the oesophagogastric junction (AEG) undergoing neoadjuvant chemotherapy. It has been recently shown in the MUNICON trials that response-guided treatment algorithms based on early changes of the FDG tumor uptake detected by PET are feasible and that they can be implemented into clinical practice. Only 40%-50% of the patients respond metabolically to therapy. As metabolic non-response is known to be associated with a dismal prognosis, metabolic non-responders are increasingly treated with alternative neoadjuvant chemotherapies or chemoradiation in order to improve their clinical outcome. We plan to investigate whether PET can be used as response assessment during radiochemotherapy given as salvage treatment in early metabolic non-responders to standard chemotherapy. The HICON trial is a prospective, non-randomized, explorative imaging study evaluating the value of PET as a predictor of histopathological response in metabolic non-responders. Patients with resectable AEG type I and II according to Siewerts classification, staged cT3/4 and/or cN+ and cM0 by endoscopic ultrasound, spiral CT or MRI and FDG-PET are eligible. Tumors must be potentially R0 resectable and must have a sufficient FDG-baseline uptake. Only metabolic non-responders, showing a < 35% decrease of SUV two weeks after the start of neoadjuvant chemotherapy are eligible for the study and are taken to intensified taxane-based RCT (chemoradiotherapy (45 Gy) before surgery. 18FDG-PET scans will be performed before ( = Baseline) and after 14 days of standard neoadjuvant therapy as well as after the first cycle of salvage docetaxel/cisplatin chemotherapy (PET 1) and at the end of radiochemotherapy (PET2). Tracer uptake will be assessed semiquantitatively using standardized uptake values (SUV). The percentage difference ΔSUV = 100 (SUV Baseline - SUV PET1)/SUV Baseline will be calculated and assessed as an early predictor of histopathological response. In a secondary analysis, the association between the difference SUV PET1 - SUV PET2 and histopathological response will be evaluated. The aim of this study is to investigate the potential of sequential 18FDG-PET in predicting histopathological response in AEG tumors to salvage neoadjuvant radiochemotherapy in patients who do not show metabolic response to standard neoadjuvant chemotherapy.
    BMC Cancer 06/2011; 11(1):266. DOI:10.1186/1471-2407-11-266 · 3.36 Impact Factor
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    • "FDG-PET (fluor-18-deoxyglucose-positronemission-tomography) has proven to be a highly sensitive method to detect response after 2 weeks following chemotherapy [36-38]. The measurement of the glucose uptake of the primary tumor after induction of neoadjuvant chemotherapy compared with the standard uptake values before chemotherapy represents differentely differently if the patient was a responder or not. "
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    ABSTRACT: Both locally advanced adenocarcinoma of the stomach and gastro-esophageal junction are associated with poor prognosis due to the lack of effective treatment. Recently multimodal treatment consisting of neoadjuvant chemotherapy in combination with radiotherapy is reported to improve survival when compared to surgery alone. Neoadjuvant therapy in these locally advanced tumors allows for early tumor responses and the extent of tumor regression that can be achieved is considered a significant prognostic factor. This, in turn, increases the resectability of these tumors. Also due to the high frequency of lymph node metastasis, patients with locally advanced adenocarcinoma should undergo a D2 lymphadenectomy. Postoperative chemo?radiation and perioperative chemotherapy have been studied in gastric adenocarcinomas and showed a survival benefit. However, the surgical techniques used in these trials are no longer considered to be standard by today's surgical practice. In addition, there are no standard recommendations for adjuvant chemotherapy or chemoradiation after R0 resection and adequate lymph node dissection.
    European journal of medical research 06/2011; 16(6):265-74. DOI:10.1186/2047-783X-16-6-265 · 1.50 Impact Factor
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