Favorable versus unfavorable prognostic groups by post-chemoradiation FDG-PET imaging in node-positive esophageal squamous cell carcinoma patients treated with definitive chemoradiotherapy
- 265 Downloads
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).
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.
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.
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.
KeywordsFdg-pet Prognosis Escc Chemoradiotherapy Esophageal cancer
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
- 1.Piessen G, Petyt G, Duhamel A, Mirabel X, Huglo D, Mariette C. 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. 2013;258:66–76. https://doi.org/10.1097/SLA.0b013e31828676c4.CrossRefPubMedGoogle Scholar
- 2.Shapiro J, van Lanschot JJ, Hulshof MC, van Hagen P, van Berge Henegouwen MI, Wijnhoven BP, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16:1090–8. https://doi.org/10.1016/s1470-2045(15)00040-6.CrossRefPubMedGoogle Scholar
- 4.Kim MK, Ryu JS, Kim SB, Ahn JH, Kim SY, Park SI, et al. Value of complete metabolic response by (18)F-fluorodeoxyglucose-positron emission tomography in oesophageal cancer for prediction of pathologic response and survival after preoperative chemoradiotherapy. Eur J Cancer. 2007;43:1385–91. https://doi.org/10.1016/j.ejca.2007.04.001.CrossRefPubMedGoogle Scholar
- 5.Dewan A, Sharma SK, Dewan AK, Khurana R, Gupta M, Pahuja A, et al. Impact on radiological and pathological response with neoadjuvant chemoradiation and its effect on survival in squamous cell carcinoma of thoracic esophagus. J Gastrointest Cancer. 2017;48:42–9. https://doi.org/10.1007/s12029-016-9870-0.CrossRefPubMedGoogle Scholar
- 9.Javeri H, Xiao L, Rohren E, Lee JH, Liao Z, Hofstetter W, et al. The higher the decrease in the standardized uptake value of positron emission tomography after chemoradiation, the better the survival of patients with gastroesophageal adenocarcinoma. Cancer. 2009;115:5184–92. https://doi.org/10.1002/cncr.24604.CrossRefPubMedGoogle Scholar
- 10.Yap WK, Chang YC, Tseng CK, Hsieh CH, Chao YK, Su PJ, et al. Predictive value of nodal maximum standardized uptake value of pretreatment [18F]fluorodeoxyglucose positron emission tomography imaging in patients with esophageal cancer. Dis Esophagus. 2017;30:1–10. https://doi.org/10.1093/dote/dox021.CrossRefPubMedGoogle Scholar
- 11.Yasuda T, Higuchi I, Yano M, Miyata H, Yamasaki M, Takiguchi S, et al. The impact of (1)(8)F-fluorodeoxyglucose positron emission tomography positive lymph nodes on postoperative recurrence and survival in resectable thoracic esophageal squamous cell carcinoma. Ann Surg Oncol. 2012;19:652–60. https://doi.org/10.1245/s10434-011-1928-4.CrossRefPubMedGoogle Scholar
- 12.Miyata H, Yamasaki M, Takahashi T, Murakami K, Kurokawa Y, Nakajima K, et al. Relevance of [18F]fluorodeoxyglucose positron emission tomography-positive lymph nodes after neoadjuvant chemotherapy for squamous cell oesophageal cancer. Br J Surg. 2013;100:1490–7. https://doi.org/10.1002/bjs.9253.CrossRefPubMedGoogle Scholar
- 13.Yasuda T, Yano M, Miyata H, Yamasaki M, Takiguchi S, Fujiwara Y, et al. Prognostic significance of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET)-positive lymph nodes following neoadjuvant chemotherapy and surgery for Resectable thoracic Esophageal Squamous cell carcinoma. Ann Surg Oncol. 2015;22:2599–607. https://doi.org/10.1245/s10434-014-4299-9.CrossRefPubMedGoogle Scholar
- 18.Findlay JM, Bradley KM, Wang LM, Franklin JM, Teoh EJ, Gleeson FV, et al. Predicting pathologic response of Esophageal cancer to Neoadjuvant chemotherapy: the implications of metabolic nodal response for personalized therapy. J Nucl Med. 2017;58:266–75. https://doi.org/10.2967/jnumed.116.176313.CrossRefPubMedGoogle Scholar
- 23.Rice TW, Ishwaran H, Kelsen DP, Hofstetter WL, Apperson-Hansen C, Blackstone EH. Recommendations for neoadjuvant pathologic staging (ypTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals. Dis Esophagus. 2016;29:906–12. https://doi.org/10.1111/dote.12538.CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Conroy T, Galais MP, Raoul JL, Bouche O, Gourgou-Bourgade S, Douillard JY, et al. Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): final results of a randomised, phase 2/3 trial. Lancet Oncol. 2014;15:305–14. https://doi.org/10.1016/s1470-2045(14)70028-2.CrossRefPubMedGoogle Scholar
- 26.Minsky BD, Pajak TF, Ginsberg RJ, Pisansky TM, Martenson J, Komaki R, et al. INT 0123 (radiation therapy oncology group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol. 2002;20:1167–74. https://doi.org/10.1200/jco.2002.20.5.1167.CrossRefPubMedGoogle Scholar