Early response evaluation of neoadjuvant therapy with PET/MRI to predict resectability in patients with adenocarcinoma of the esophagogastric junction
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Study design and purpose
Positron emission tomography (PET)/magnetic resonance imaging (MRI) is a new modality that has showed promising results for various clinical indications. Currently, evaluation of neoadjuvant therapy (NT) among patients with adenocarcinoma of the esophagogastric junction has primarily been reserved for PET/computed tomography. Our aim was to evaluate if early response evaluation by PET/MRI is a feasible method to predict resectability.
Methods and materials
Patients with untreated adenocarcinoma of the esophagogastric junction (Siewert types I/II) and fit for NT with no contraindications for PET/MRI were considered eligible. A baseline scan was performed prior to NT induction and an evaluation scan 3 weeks later. For histopathological response evaluation, the Mandard tumor regression grade score was applied. Response on PET/MRI was evaluated with Response Evaluation Criteria in Solid Tumors (RECIST 1.1), and change in ADC and SUVmax values.
Twenty-eight patients were enrolled, and 22 completed both scans and proceeded to final analyses. Seventeen patients were found resectable versus five who were found unresectable. PET/MRI response evaluation had a sensitivity 94%, specificity 80%, and AUC = 0.95 when predicting resectability in patients with adenocarcinoma of the esophagogastric junction. No association with histopathological response (tumor regression grade) was found nor was RECIST correlated with resectability.
Response evaluation using PET/MRI was a feasible method to predict resectability in patients with adenocarcinoma of the esophagogastric junction in this pilot study. However, larger studies are warranted to justify the use of the modality for this indication.
KeywordsPositron emission tomography Magnetic resonance imaging Gastroesophageal junction cancer Chemotherapy Resectability Response evaluation
We acknowledge the grant support from The Danish Cancer Society. We would also like to recognize the statistical support from The Data Science Laboratory, Department of Mathematical Science and the Department for Computer Science, University of Copenhagen.
This study was funded by the Danish Cancer Society (Kræftens Bekæmpelse), No. R136-A8486-15-S7.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.Gillies RS, Middleton MR, Maynard ND, Bradley KM, Gleeson FV (2011) Additional benefit of (1)(8)F-fluorodeoxyglucose integrated positron emission tomography/computed tomography in the staging of oesophageal cancer. Eur Radiol 21:274–280. https://doi.org/10.1007/s00330-010-1943-z CrossRefGoogle Scholar
- 7.Giganti F, De Cobelli F, Canevari C, et al. (2014) Response to chemotherapy in gastric adenocarcinoma with diffusion-weighted MRI and (18) F-FDG-PET/CT: correlation of apparent diffusion coefficient and partial volume corrected standardized uptake value with histological tumor regression grade. J Magn Reson Imaging 40:1147–1157. https://doi.org/10.1002/jmri.24464 CrossRefGoogle Scholar
- 8.Weber MA, Bender K, von Gall CC, et al. (2013) Assessment of diffusion-weighted MRI and 18F-fluoro-deoxyglucose PET/CT in monitoring early response to neoadjuvant chemotherapy in adenocarcinoma of the esophagogastric junction. J Gastrointestin Liver Dis 22:45–52Google Scholar
- 13.Rudiger Siewert J, Feith M, Werner M, Stein HJ (2000) Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1002 consecutive patients. Ann Surg 232:353–361. https://doi.org/10.1097/00000658-200009000-00007 CrossRefGoogle Scholar
- 16.Mandard AM, Dalibard F, Mandard JC, et al. (1994) Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 73:2680–2686. https://doi.org/10.1002/1097-0142(19940601)73:11<2680::AID-CNCR2820731105>3.0.CO;2-C CrossRefGoogle Scholar
- 23.Kim SJ, Koo PJ, Chang S (2016) Predictive value of repeated F-18 FDG PET/CT parameters changes during preoperative chemoradiotherapy to predict pathologic response and overall survival in locally advanced esophageal adenocarcinoma patients. Cancer Chemother Pharmacol 77:723–731. https://doi.org/10.1007/s00280-016-2988-8 CrossRefGoogle Scholar
- 24.van Heijl M, Omloo JM, van Berge Henegouwen MI, et al. (2011) Fluorodeoxyglucose positron emission tomography for evaluating early response during neoadjuvant chemoradiotherapy in patients with potentially curable esophageal cancer. Ann Surg 253:56–63. https://doi.org/10.1097/SLA.0b013e3181f66596 CrossRefGoogle Scholar
- 25.Roedl JB, Colen RR, Holalkere NS, et al. (2008) Adenocarcinomas of the esophagus: response to chemoradiotherapy is associated with decrease of metabolic tumor volume as measured on PET-CT. Comparison to histopathologic and clinical response evaluation. Radiother Oncol 89:278–286. https://doi.org/10.1016/j.radonc.2008.06.014 CrossRefGoogle Scholar
- 28.Piessen G, Petyt G, Duhamel A, et al. (2013) Ineffectiveness of (1)(8)F-fluorodeoxyglucose positron emission tomography in the evaluation of tumor response after completion of neoadjuvant chemoradiation in esophageal cancer. Ann Surg 258:66–76. https://doi.org/10.1097/SLA.0b013e31828676c4 CrossRefGoogle Scholar
- 29.De Cobelli F, Giganti F, Orsenigo E, et al. (2013) Apparent diffusion coefficient modifications in assessing gastro-oesophageal cancer response to neoadjuvant treatment: comparison with tumour regression grade at histology. Eur Radiol 23:2165–2174. https://doi.org/10.1007/s00330-013-2807-0 CrossRefGoogle Scholar