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).
| Autor: | Klaeser B; Department of Nuclear Medicine, Inselspital Bern, Switzerland. bernd.klaeser@insel.ch, Nitzsche E, Schuller JC, Köberle D, Widmer L, Balmer-Majno S, Hany T, Cescato-Wenger C, Brauchli P, Zünd M, Pestalozzi BC, Caspar C, Albrecht S, von Moos R, Ruhstaller T |
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| Jazyk: | angličtina |
| Zdroj: | Onkologie [Onkologie] 2009 Dec; Vol. 32 (12), pp. 724-30. Date of Electronic Publication: 2009 Nov 09. |
| DOI: | 10.1159/000251842 |
| Abstrakt: | 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. (Copyright 2009 S. Karger AG, Basel.) |
| Databáze: | MEDLINE |
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