Fluorodeoxyglucose Positron Emission Tomography for Evaluating Early Response During Neoadjuvant Chemoradiotherapy in Patients With Potentially Curable Esophageal Cancer
Fluorodeoxyglucose Positron Emission Tomography for Evaluating Early Response During Neoadjuvant Chemoradiotherapy in Patients With Potentially Curable Esophageal Cancer
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DOI：
10.1097/sla.0b013e3181f66596
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发表时间：
2011-01-01
影响因子：
9
通讯作者：
van Lanschot, J. Jan
中科院分区：
文献类型：
--
作者：
van Heijl, Mark;Omloo, Jikke M.;van Lanschot, J. Jan
背景资料：术前新辅助放化疗可以提高有潜在治愈可能的食管癌患者的生存率，但并非所有患者都有反应。氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）已被提议用于识别新辅助放化疗早期无反应者。本研究的目的是确定FDG-PET是否可以区分响应和无响应的食管肿瘤的早期过程中的新辅助放化疗。方法：本临床试验包括系列FDG-PET前和14天后开始的放化疗患者有可能治愈的食管癌。组织学应答者定义为没有或少于10%活肿瘤细胞的患者（切除标本的Mandard评分）。使用标准化摄取值（SUV）测量PET反应。采用受试者操作特征分析评价SUV区分组织病理学应答者和非应答者的能力。治疗开始后14天，组织病理学应答者的中位SUV下降为30.9%，无应答者为1.7%（P = 0.001）。受试者工作特征分析中，曲线下面积为0.71（95%CI = 0.60-0.82）。使用0%SUV降低截止值，PET正确识别了64例应答者中的58例（灵敏度91%）和36例无应答者中的18例（特异性50%）。相应的阳性和阴性预测值分别为76%和75%，respectively.Conclusions：SUV减少14天后开始的放化疗与组织病理学肿瘤反应显着相关，但其检测无反应者的准确性太低，证明临床使用FDG-PET早期停止新辅助放化疗的患者有潜在的可治愈的食管癌。
Background: Neoadjuvant chemoradiotherapy before surgery can improve survival in patients with potentially curable esophageal cancer, but not all patients respond. Fluorodeoxyglucose positron emission tomography (FDG-PET) has been proposed to identify nonresponders early during neoadjuvant chemoradiotherapy. The aim of the present study was to determine whether FDG-PET could differentiate between responding and nonresponding esophageal tumors early in the course of neoadjuvant chemoradiotherapy.Methods: This clinical trial comprised serial FDG-PET before and 14 days after start of chemoradiotherapy in patients with potentially curable esophageal carcinoma. Histopathologic responders were defined as patients with no or less than 10% viable tumor cells (Mandard score on resection specimen). PET response was measured using the standardized uptake value (SUV). Receiver operating characteristic analysis was used to evaluate the ability of SUV in distinguishing between histopathologic responders and nonresponders.Results: In 100 included patients, 64 were histopathologic responders. The median SUV decrease 14 days after the start of therapy was 30.9% for histopathologic responders and 1.7% for nonresponders (P = 0.001). In receiver operating characteristic analysis, the area under the curve was 0.71 (95% CI = 0.60-0.82). Using a 0% SUV decrease cutoff value, PET correctly identified 58 of 64 responders (sensitivity 91%) and 18 of 36 nonresponders (specificity 50%). The corresponding positive and negative predictive values were 76% and 75%, respectively.Conclusions: SUV decrease 14 days after the start of chemoradiotherapy was significantly associated with histopathologic tumor response, but its accuracy in detecting nonresponders was too low to justify the clinical use of FDG-PET for early discontinuation of neoadjuvant chemoradiotherapy in patients with potentially curable esophageal cancer.