Combined tumor plus nontumor interim FDG-PET parameters are prognostic for response to chemoradiation in squamous cell esophageal cancer

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

Abstract

We have investigated the prognostic value of two novel interim 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) parameters in patients undergoing chemoradiation (CRT) for esophageal squamous cell carcinoma (ESCC): one tumor parameter (maximal standardized uptake ratio rSUR) and one normal tissue parameter (change of FDG uptake within irradiated nontumor-affected esophagus ∆SUVNTO ). PET data of 134 European and Chinese patients were analyzed. Parameter establishment was based on 36 patients undergoing preoperative CRT plus surgery, validation was performed in 98 patients receiving definitive CRT. Patients received PET imaging prior and during fourth week of CRT. Clinical parameters, baseline PET parameters, and interim PET parameters (rSUR and ∆SUVNTO ) were analyzed and compared to event-free survival (EFS), overall survival (OS), loco-regional control (LRC) and freedom from distant metastases (FFDM). Combining rSUR and ∆SUVNTO revealed a strong prognostic impact on EFS, OS, LRC and FFDM in patients undergoing preoperative CRT. In the definitive CRT cohort, univariate analysis with respect to EFS revealed several staging plus both previously established interim PET parameters as significant prognostic factors. Multivariate analyses revealed only rSUR and ∆SUVNTO as independent prognostic factors (p = 0.003, p = 0.008). Combination of these parameters with the cutoff established in preoperative CRT revealed excellent discrimination of patients with a long or short EFS (73% vs. 17% at 2 years, respectively) and significantly discriminated all other endpoints (OS, p < 0.001; LRC, p < 0.001; FFDM, p = 0.02), even in subgroups. Combined use of interim FDG-PET derived parameters ∆SUVNTO and rSUR seems to have predictive potential, allowing to select responders for definitive CRT and omission of surgery.

Details

Original languageEnglish
Pages (from-to)1427-1436
Number of pages10
JournalInternational journal of cancer
Volume147
Issue number5
Publication statusPublished - 1 Sept 2020
Peer-reviewedYes

External IDs

Scopus 85079808994
ORCID /0000-0003-1776-9556/work/171065761

Keywords

Sustainable Development Goals

Keywords

  • Aged, Chemoradiotherapy, Esophageal Neoplasms/diagnostic imaging, Esophageal Squamous Cell Carcinoma/diagnostic imaging, Female, Fluorodeoxyglucose F18/metabolism, Follow-Up Studies, Humans, Male, Middle Aged, Positron-Emission Tomography, Prognosis, Progression-Free Survival, Radiopharmaceuticals/metabolism, Retrospective Studies, Survival Rate