Home HOME Neoplasma 2021 Neoplasma Vol.68, No.2, p.423–433, 2021

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Neoplasma Vol.68, No.2, p.423–433, 2021

Title: Prognostic role of early 18-FDG PET/CT during neoadjuvant chemotherapy for resectable adenocarcinoma of the esophagus and esophagogastric junction
Author: Tomas Harustiak, Milada Zemanova, Pavel Fenc, Alexandr Pazdro, Martin Snajdauf, Hana Faltova, Robert Lischke, Alan Stolz

Abstract: We prospectively investigated whether metabolic response assessed by 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET/CT) early in the course of neoadjuvant chemotherapy is predictive of survival in patients with adenocarcinoma of the esophagus and esophagogastric junction. PET/CT was performed before and in the third week after the initiation of the first cycle of neoadjuvant chemotherapy, which consisted of epirubicin, cisplatin, and 5-fluorouracil or capecitabine.
The metabolic response was defined as a relative decrease in the peak standardized uptake value (SUL) of the tumor by ≥ 35% or total lesion glycolysis (TLG) by ≥ 66%. The associations of metabolic response with overall survival (OS) and disease-free survival (DFS) were investigated using Kaplan-Meier curves and multivariable Cox regression analysis. Among 126 recruited patients, the early metabolic response was assessed in 107 patients (90 of them underwent surgical resection). The five-year OS and DFS rates of all patients were 28% and 27%, respectively. No difference was found in OS (p = 0.10 for SUL, p = 0.08 for TLG) or DFS (p = 0.50 for SUL, p = 0.20 for TLG) between metabolic responders and non-responders. Post hoc analysis of the patients with a follow-up PET/CT within 16 days showed that metabolic response reflected by SUL predicted OS (p = 0.03). We concluded that metabolic response assessed by PET/CT after the first cycle of neoadjuvant chemotherapy does not predict survival in patients with adenocarcinoma of the esophagus and esophagogastric junction. However, proper timing of the follow-up PET/CT may affect the prognostic ability of the early metabolic response.

Keywords: adenocarcinoma of the esophagus and esophago-gastric junction; neoadjuvant chemotherapy; FDG-PET/CT; early metabolic response; overall survival; disease-free survival
Published online: 14-Jan-2021
Year: 2021, Volume: 68, Issue: 2 Page From: 423, Page To: 433

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