Increased FDG uptake on late-treatment PET in non-tumour-affected oesophagus is prognostic for pathological complete response and disease recurrence in patients undergoing neoadjuvant radiochemotherapy
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Early side effects including oesophagitis are potential prognostic factors in patients undergoing radiochemotherapy (RCT) for locally advanced oesophageal cancer (LAEC). We assessed the prognostic value of 18F-fluorodeoxyglucose (FDG) uptake within irradiated non-tumour-affected oesophagus (NTO) during restaging positron emission tomography (PET) as a surrogate for inflammation/oesophagitis.
This retrospective evaluation included 64 patients with LAEC who had completed neoadjuvant RCT and had successful oncological resection. All patients underwent FDG PET/CT before and after RCT. In the restaging PET scan maximum and mean standardized uptake values (SUVmax, SUVmean) were determined in the tumour and NTO. Univariate Cox regression with respect to overall survival, local control, distant metastases and treatment failure was performed. Independence of clinically relevant parameters was tested in a multivariate Cox regression analysis.
Increased FDG uptake, measured in terms of SUVmean in NTO during restaging was significantly associated with complete pathological remission (p = 0.002) and did not show a high correlation with FDG response of the tumour (rho < 0.3). In the univariate analysis, increased SUVmax and SUVmean in NTO was associated with improved overall survival (p = 0.011, p = 0.004), better local control (p = 0.051, p = 0.044), a lower rate of treatment failure (p < 0.001 for both) and development of distant metastases (p = 0.012, p = 0.001). In the multivariate analysis, SUVmax and SUVmean in NTO remained a significant prognostic factor for treatment failure (p < 0.001, p = 0.004) and distant metastases (p = 0.040, p = 0.011).
FDG uptake in irradiated normal tissues measured on restaging PET has significant prognostic value in patients undergoing neoadjuvant RCT for LAEC. This effect may potentially be of use in treatment personalization.
KeywordsOesophageal cancer Radiochemotherapy Side effects Inflammation FDG pet
Falk Tillner is acknowledged for providing screenshots of treatment planning.
S.Z. provided ideas for the study; S.Z. and F.H. performed the analysis, and drafted the manuscript, designed the figures and calculated the underlying statistics, and together with S.L.. C.J., K.Z., J.K., G.B. and J.W. were responsible for treatment, histology and imaging of patients. R.B., J.S. and S.Z. collected patient data and performed the follow-up examinations. M.K., K.Z., F.H. and M.B. provided ideas, supervised the analysis and interpretation of the data, and reviewed the manuscript. All authors read and approved the final manuscript.
Compliance with ethical standards
The study was partly supported by the German Federal Ministry of Education and Research (BMBF contract 03ZIK42/OncoRay). The funding source had no influence on data acquisition, evaluation or writing of the manuscript.
Conflicts of interest
The study was approved by the Institutional Ethics Committee and all patients signed written informed consent.
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