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General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 8/2017

01-08-2017 | Original Article

Is 18F-FDG-PET useful for predicting R0 resection after induction therapy for initially unresectable locally advanced esophageal carcinoma?

Authors: Keijiro Sugimura, Hiroshi Miyata, Masahiko Yano, Yoshitomo Yanagimoto, Moon Jeong Ho, Shogo Kobayashi, Hidenori Takahashi, Takeshi Omori, Masayuki Ohue, Masato Sakon

Published in: General Thoracic and Cardiovascular Surgery | Issue 8/2017

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Abstract

Objective

Induction therapy followed by surgery is a promising strategy for esophageal cancer patients with invasion of the trachea/bronchus or aorta. However, no diagnostic criteria have been established to diagnose whether R0 resection can be performed. We investigated whether 18F-2-deoxy-d-glucose positron emission tomography (18F-FDG-PET) and other modalities are useful for predicting R0 resection.

Methods

Fifty-seven patients with esophageal cancer invading the trachea/bronchus or aorta who underwent induction therapy followed by surgery were enrolled. We divided the participants into two groups, an R0 resection group (n = 43) and a non-R0 resection group (n = 14), and then compared the between-group results of three modalities, including computed tomography (CT), endoscopy and 18F-FDG-PET, before and after induction therapy.

Results

The post-maximal standardized uptake value (SUVmax) after induction therapy in the R0 resection group was significantly lower than that in the non-R0 resection group (4.4 vs. 6.6, p = 0.005). The receiver operating characteristic curve analysis showed that the cut-off value for the post-SUVmax based on 18F-FDG-PET prediction of R0 resection was 4.7. Furthermore, a tumor reduction rate of ≥44% on CT, no residual stenosis, and no deep ulcer on endoscopy were associated with R0 resection after induction therapy (p = 0.002, p = 0.091, and p = 0.059, respectively). Multivariate logistic analyses revealed that the tumor reduction rate on CT and post-SUVmax <4.7 in 18F-FDG-PET were independent factors for R0 resection.

Conclusions

The post-SUVmax determined by 18F-FDG-PET and the volume reduction rate based on CT scans were useful for predicting R0 resection after induction therapy for initially unresectable locally advanced esophageal carcinoma.
Appendix
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Metadata
Title
Is 18F-FDG-PET useful for predicting R0 resection after induction therapy for initially unresectable locally advanced esophageal carcinoma?
Authors
Keijiro Sugimura
Hiroshi Miyata
Masahiko Yano
Yoshitomo Yanagimoto
Moon Jeong Ho
Shogo Kobayashi
Hidenori Takahashi
Takeshi Omori
Masayuki Ohue
Masato Sakon
Publication date
01-08-2017
Publisher
Springer Japan
Published in
General Thoracic and Cardiovascular Surgery / Issue 8/2017
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-017-0786-9

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