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Limited predictive value of FDG-PET for response assessment in the preoperative treatment of esophageal cancer : results of a prospective multi-center trial (SAKK 75/02)

Klaeser, Bernd and Nitzsche, Egbert and Schuller, Jan C. and Köberle, Dieter and Widmer, Lucas and Balmer-Majno, Sabine and Hany, Thomas and Cescato-Wenger, Corinne and Brauchli, Peter and Zünd, Michael and Pestalozzi, Bernhard C. and Caspar, Clemens and Albrecht, Susanne and von Moos, Roger and Ruhstaller, Thomas. (2009) Limited predictive value of FDG-PET for response assessment in the preoperative treatment of esophageal cancer : results of a prospective multi-center trial (SAKK 75/02). Onkologie, 32 (12). pp. 724-730.

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Official URL: http://edoc.unibas.ch/dok/A6006699

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Abstract

BACKGROUND: Only responding patients benefit from preoperative therapy for locally advanced esophageal carcinoma. Early detection of non-responders may avoid futile treatment and delayed surgery. PATIENTS AND METHODS: In a multi-center phase ll trial, patients with resectable, locally advanced esophageal carcinoma were treated with 2 cycles of induction chemotherapy followed by chemoradiotherapy (CRT) and surgery. Positron emission tomography with 2[fluorine-18]fluoro-2-deoxy-d-glucose (FDG-PET) was performed at baseline and after induction chemotherapy. The metabolic response was correlated with tumor regression grade (TRG). A decrease in FDG tumor uptake of less than 40% was prospectively hypothesized as a predictor for histopathological non-response (TRG < 2) after CRT. RESULTS: 45 patients were included. The median decrease in FDG tumor uptake after chemotherapy correlated well with TRG after completion of CRT (p = 0.021). For an individual patient, less than 40% decrease in FDG tumor uptake after induction chemotherapy predicted histopathological non-response after completion of CRT, with a sensitivity of 68% and a specificity of 52% (positive predictive value 58%, negative predictive value 63%). CONCLUSIONS: Metabolic response correlated with histopathology after preoperative therapy. However, FDG-PET did not predict non-response after induction chemotherapy with sufficient clinical accuracy to justify withdrawal of subsequent CRT and selection of patients to proceed directly to surgery.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Onkologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Onkologie
UniBasel Contributors:Ruhstaller, Thomas
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Karger Publishers
ISSN:0378-584X
e-ISSN:1423-0240
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
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Last Modified:24 Oct 2017 10:03
Deposited On:24 May 2013 09:00

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