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Favorable versus unfavorable prognostic groups by post-chemoradiation FDG-PET imaging in node-positive esophageal squamous cell carcinoma patients treated with definitive chemoradiotherapy

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Our purpose was to examine the prognostic value of post-CRT PET based on the presence or absence of FDG-avid metastatic lymph node(s) and metabolic response of the primary tumor in patients with clinically node-positive ESCC treated with definitive chemoradiotherapy (dCRT).

Methods

We identified 108 eligible patients treated by chemoradiotherapy (CRT) with or without resection from our prospectively collected database. Absence of FDG-avid metastatic lymph node with at least partial response of the primary tumor on PET scan after initial CRT was defined as the Post-CRT PET favorable group (yPET-F), and otherwise as unfavorable group (yPET-U). The Kaplan-Meier method and Cox regression were performed for survival analyses and multivariable analysis, respectively.

Results

The study cohort was comprised of 59 patients receiving dCRT. Forty-five patients receiving trimodality therapy (TMT) comprised the comparative group and four patients were excluded from further analyses for developing interval distant metastasis detected on post-CRT PET scan. The median follow-up for the study cohort was 41 months. On K-M analysis of the study cohort, yPET-F was found to have significantly better OS (2-year: 72.5% vs 13.7%, p < 0.01) and DMFS (2-year: 71.6% vs 36.6%, p = 0.01) than yPET-U. In multivariable analysis, yPET-F remained as a strong independent favorable prognosticator on both OS (HR 0.08, p < 0.01) and DMFS (HR 0.14, p = 0.02) for the dCRT cohort. Compared with TMT cohort, for yPET-U patients, TMT had better OS (p = 0.03) than dCRT-Operable and dCRT-Operable had superior OS (p = 0.04) than dCRT-Unresectable. For yPET-F patients, there was no difference in both OS (p > 0.99) and DMFS (p = 0.92) between these three groups.

Conclusions

Absence of FDG-avid metastatic lymph node with at least partial response of the primary tumor on PET scan after CRT (i.e., yPET-F status) prognosticate for excellent OS and DMFS in cN+ ESCC patients treated with dCRT, and might be comparable to TMT.

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Authors and Affiliations

  1. Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou Medical Center and Chang Gung University, 5 Fu-Shin Street, Kwei-Shan, Taoyuan, Taiwan

    Wing-Keen Yap & Tsung-Min Hung

  2. Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital-Linkou Medical Center and Chang Gung University, Taoyuan, Taiwan

    Yu-Chuan Chang

  3. Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Yu-Chuan Chang

  4. Circulating Tumor Cell Lab, Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou Medical Center and Chang Gung University, Taoyuan, Taiwan

    Chia-Hsun Hsieh

  5. Department of Chemical and Materials Engineering, Chang Gung University, Taoyuan, Taiwan

    Chia-Hsun Hsieh

  6. Division of Thoracic Surgery, Department of Surgery, Chang Gung Memorial Hospital-Linkou Medical Center and Chang Gung University, Taoyuan, Taiwan

    Yin-Kai Chao

  7. Department of Diagnostic Radiology, Chang Gung Memorial Hospital-Linkou Medical Center and Chang Gung University, Taoyuan, Taiwan

    Chien-Cheng Chen

  8. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

    Ming-Chieh Shih

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  1. Wing-Keen Yap
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Correspondence to Tsung-Min Hung.

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Yap, WK., Chang, YC., Hsieh, CH. et al. Favorable versus unfavorable prognostic groups by post-chemoradiation FDG-PET imaging in node-positive esophageal squamous cell carcinoma patients treated with definitive chemoradiotherapy. Eur J Nucl Med Mol Imaging 45, 689–698 (2018). https://doi.org/10.1007/s00259-017-3901-3

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  • DOI: https://doi.org/10.1007/s00259-017-3901-3

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