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Published in:

01-03-2011

Impact of PET-CT on Primary Staging and Response Control on Multimodal Treatment of Esophageal Cancer

Authors: Kirsten Thurau, Daniel Palmes, Christiane Franzius, Evgeny Minin, Norbert Senninger, Kai Uwe Juergens, Matthias Bruewer

Published in: World Journal of Surgery | Issue 3/2011

Abstract

Background

The predictive value of positron emission tomography-computed tomography (PET-CT) in primary staging and response control in patients with esophageal carcinoma (EC) is under discussion. In the present study initial staging and metabolic response of PET-CT was correlated with tumor regression and survival in patients with multimodal treatment of EC.

Methods

The authors conducted a retrospective analysis on a prospective database for 83 patients with EC (42 squamous cell, 39 adenocarcinoma, 2 anaplastic carcinoma) undergoing PET-CT for primary staging. Twenty-four of the patients underwent primary esophagectomy, 9 had palliative treatment, and 50 neoadjuvant radiochemotherapy (cisplatin, 5-fluorouracil; 50.4 Gy). The PET-CT study was repeated 6 weeks after induction of chemotherapy and compared with endoscopic ultrasound (EUS). For response control, the metabolic response (tumor standardized uptake value [SUV] reduction) was correlated with histopathologic (ypT0-4) and histomorphologic response (tumor regression) and survival.

Results

At primary staging 81 of 83 EC (97.5%) showed an increased SUV uptake correlating with the EUS tumor stage. Suspicious lymph nodes were detected in 51 (61.4%) patients by PET-CT and 66 (79.5%) were detected by EUS. Fifteen patients had additional findings on PET-CT examination leading to a change in therapy in 9 patients (10.3%). Of 50 patients receiving a second PET-CT study, a SUV reduction >50% correlated with major histomorphologic response (tumor regression grade 4, <10% vital tumor cells) and histopathologic response (ypT0 ypN0). Furthermore, these patients showed a significantly increased survival (33.1 ± 3.5 months) compared to non-responders (21.7 ± 3.3 months; p = 0.02) and patients after primary surgery (29 ± 3.2 months; p = 0.05).

Conclusions

The present study shows that PET-CT is a valuable tool for primary staging and response control in multimodal treatment of patients with EC.

Stahl M, Stuschke M, Lehmann N et al (2005) Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 10:2310–2317CrossRef

Bedenne L, Michel P, Bouché O et al (2007) Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol 25:1160–1168CrossRefPubMed

Schneider PM, Metzger R, Schaefer H et al (2008) Response evaluation by endoscopy, rebiopsy, and endoscopic ultrasound does not accurately predict histopathologic regression after neoadjuvant chemoradiation for EC. Ann Surg 248:902–908CrossRefPubMed

Sloof GW (2006) Response monitoring of neoadjuvant therapy using CT, EUS, and FDGPET. Best Pract Res Clin Gastroenterol 5:941–957CrossRef

Williams RN, Ubhi SS, Sutton CD et al (2009) The early use of PET-CT alters the management of patients with esophageal cancer. J Gastrointest Surg 13:868–873CrossRefPubMed

Noble F, Bailey D, SWCIS Upper Gastrointestinal Tumour Panel et al (2009) Impact of integrated PET/CT in the staging of oesophageal cancer: a UK population-based cohort study. Clin Radiol 64:699–705CrossRefPubMed

Roedl JB, Halpern EF, Colen RR et al (2009) Metabolic tumor width parameters as determined on PET/CT predict disease-free survival and treatment response in squamous cell carcinoma of the esophagus. Mol Imaging Biol 11:54–60CrossRefPubMed

Vallböhmer D, Hölscher AH, Dietlein M et al (2009) [18F]-Fluorodeoxyglucose-positron emission tomography for the assessment of histopathologic response and prognosis after completion of neoadjuvant chemoradiation in esophageal cancer. Ann Surg 6:888–894CrossRef

Palmes D, Weilinghoff M, Colombo-Benkmann M et al (2007) Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction. Langenbecks Arch Surg 392:135–144CrossRefPubMed

10.

Juweid ME, Cheson BD (2006) Positron-emission tomography and assessment of cancer therapy. N Engl J Med 5:496–50711CrossRef

11.

Cerfolio RJ, Bryant AS, Ohja B et al (2005) The accuracy of endoscopic ultrasonography with fine-needle aspiration, integrated positron emission tomography with computed tomography, and computed tomography in restaging patients with EC after neoadjuvant chemoradiotherapy. J Thorac Cardiovasc Surg 129:1232–1241CrossRefPubMed

12.

Lowe VJ, Kemp BJ, Jack CR Jr et al (2005) Comparison of positron emission tomography, computed tomography, and endoscopic ultrasound in the initial staging of patients with EC. Mol Imaging Biol 7:422–430CrossRefPubMed

13.

Polkowski M (2009) Endosonographic staging of upper intestinal malignancy. Best Pract Res Clin Gastroenterol 23:649–661CrossRefPubMed

14.

Van Vliet EP, Heijenbrok-Kal MH, Hunink MG et al (2008) Staging investigations for EC: a meta-analysis. Br J Cancer 98:547–557CrossRefPubMed

15.

Rosenbaum SJ, Stergar H, Antoch G et al (2006) Staging and follow-up of gastrointestinal tumors with PET-CT. Abdom Imaging 31:25–35CrossRefPubMed

16.

Cerfolio RJ, Bryant AS (2006) Maximum standardized uptake values on positron emission tomography of esophageal cancer predicts stage, tumor biology, and survival. Ann Thorac Surg 2:391–394CrossRef

17.

Rizk NP, Tang L, Adusumilli PS et al (2009) Predictive value of initial PET-SUVmax in patients with locally advanced esophageal and gastroesophageal junction adenocarcinoma. J Thorac Oncol 7:875–879CrossRef

18.

Salavati A, Basu S, Heidari P et al (2009) Impact of fluorodeoxyglucose PET on the management of EC. Nucl Med Commun 30:95–116CrossRefPubMed

19.

Antoch G, Saoudi N, Kuehl H et al (2004) Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET-CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol 21:4357–4368CrossRef

20.

Swisher SG, Maish M, Erasmus JJ et al (2004) Utility of PET, CT, and EUS to identify pathologic responders in EC. Ann Thorac Surg 4:1152–1160CrossRef

21.

Song SY, Kim JH, Ryu JS et al (2005) FDG/PET in the prediction of pathologic response after neoadjuvant chemoradiotherapy in locally advanced, resectable EC. Int J Radiat Oncol Biol Phys 4:1053–1059

22.

Klaeser B, Nitzsche E, Schuller JC et al (2009) Limited predictive value of FDG-PET for response assessment in the preoperative treatment of esophageal cancer: results of a prospective multi-center. Onkologie 12:724–730CrossRef

23.

Geh JI, Bond SJ, Bentzen SM et al (2006) Systematic overview of preoperative (neoadjuvant) chemoradiotherapy trials in oesophageal cancer: evidence of a radiation and chemotherapy dose response. Radiother Oncol 3:236–244CrossRef

24.

De Manzoni G, Pedrazzani C, Laterza E et al (2005) Induction chemoradiotherapy for squamous cell carcinoma of the thoracic esophagus: impact of increased dosage on long-term results. Ann Thorac Surg 4:1176–1183CrossRef

25.

Flamen P, Van Cutsem E, Lerut A et al (2002) Positron emission tomography for assessment of the response to induction radiochemotherapy in locally advanced EC. Ann Oncol 3:361–368CrossRef

26.

Kroep JR, Van Groeningen CJ, Cuesta MA et al (2003) Positron emission tomography using 2-deoxy-2-[18F]-fluoro-D-glucose for response monitoring in locally advanced gastroesophageal cancer: a comparison of different analytical methods. Mol Imaging Biol 5:337–346CrossRefPubMed

27.

Wieder HA, Brücher BL, Zimmermann F et al (2004) Time course of tumor metabolic activity during chemoradiotherapy of esophageal squamous cell carcinoma and response to treatment. J Clin Oncol 5:900–908CrossRef

28.

Levine EA, Farmer MR, Clark P et al (2006) Predictive value of 18-fluoro-deoxy-glucose positron emission tomography (18F-FDG-PET) in the identification of responders to chemoradiation therapy for the treatment of locally advanced EC. Ann Surg 4:472–478CrossRef

29.

Ott K, Weber W, Siewert JR (2006) The importance of PET in the diagnosis and response evaluation of EC. Dis Esophagus 6:433–442CrossRef

30.

Lordick F, Ott K, Krause BJ et al (2007) PET to assess early metabolic response and to guide treatment of adenocarcinoma of the oesophagogastric junction: the MUNICON phase II trial. Lancet Oncol 9:797–805CrossRef

31.

Mamede M, Abreu-E-Lima P, Oliva MR et al (2007) FDG-PET-CT tumor segmentation derived indices of metabolic activity to assess response to neoadjuvant therapy and progression-free survival in EC: correlation with histopathology results. Am J Clin Oncol 4:377–388CrossRef

Title: Impact of PET-CT on Primary Staging and Response Control on Multimodal Treatment of Esophageal Cancer
Authors: Kirsten Thurau
Daniel Palmes
Christiane Franzius
Evgeny Minin
Norbert Senninger
Kai Uwe Juergens
Matthias Bruewer
Publication date: 01-03-2011
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 3/2011
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-010-0946-x

At a glance: The STEP trials

Springer Medicine

Impact of PET-CT on Primary Staging and Response Control on Multimodal Treatment of Esophageal Cancer

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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