Neoadjuvant Therapy of Esophageal Squamous Cell Carcinoma:... : Annals of Surgery (original) (raw)

This Month's Feature

Neoadjuvant Therapy of Esophageal Squamous Cell Carcinoma: Response Evaluation by Positron Emission Tomography

Brücher, Björn L.D.M. MD*; Weber, Wolfgang MD†; Bauer, Markus MD‡; Fink, Ullrich MD*; Avril, Norbert MD†; Stein, Hubert J. MD*; Werner, Martin MD‡; Zimmerman, Frank MD§; Siewert, J. Rüdiger MD, FACS (Hon), FRCS (Edinb)*; Schwaiger, Markus MD†

From the *Chirurgische Klinik und Poliklinik, †Nuklearmedizinische Klinik und Poliklinik, ‡Institut für Allgemeine Pathologie und Pathologische Anatomie, and the §Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar der Technischen Universität, Munich, Germany

Part of the preliminary results of this study were presented at the 23rd German Cancer Congress in 1999 (published as an abstract in the Journal of Cancer Research and Clinical Oncology, Supplement to Vol. 124, page 26) and at the 116th Annual Meeting of the German Society of Surgery in 1999.

Correspondence: Dr. Björn L.D.M. Brücher, Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TUM, Ismaninger Strasse 22, D-81675 München, Germany.

E-mail: [email protected]

Abstract

Objective

To evaluate the use of positron emission tomography using [18F]-fluorodeoxyglucose (FDG-PET) to assess the response to neoadjuvant radiotherapy and chemotherapy in patients with locally advanced esophageal cancer.

Summary Background Data

Imaging modalities, including endoscopy, endoscopic ultrasound, computed tomography, and magnetic resonance imaging, currently used to evaluate response to neoadjuvant treatment in esophageal cancer do not reliably differentiate between responders and nonresponders.

Methods

Twenty-seven patients with histopathologically proven squamous cell carcinoma of the esophagus, located at or above the tracheal bifurcation, underwent neoadjuvant therapy consisting of external-beam radiotherapy and 5-fluorouracil as a continuous infusion. FDG-PET was performed before and 3 weeks after the end of radiotherapy and chemotherapy (before surgery). Quantitative measurements of tumor FDG uptake were correlated with histopathologic response and patient survival.

Results

After neoadjuvant therapy, 24 patients underwent surgery. Histopathologic evaluation revealed less than 10% viable tumor cells in 13 patients (responders) and more than 10% viable tumor cells in 11 patients (nonresponders). In responders, FDG uptake decreased by 72% ± 11%; in nonresponders, it decreased by only 42% ± 22%. At a threshold of 52% decrease of FDG uptake compared with baseline, sensitivity to detect response was 100%, with a corresponding specificity of 55%. The positive and negative predictive values were 72% and 100%. Nonresponders to PET scanning had a significantly worse survival after resection than responders.

Conclusion

FDG-PET is a valuable tool for the noninvasive assessment of histopathologic tumor response after neoadjuvant radiotherapy and chemotherapy.