Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer |
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Authors: | Swisher Stephen G Maish Mary Erasmus Jeremy J Correa Arlene M Ajani Jaffer A Bresalier Robert Komaki Ritsuko Macapinlac Homer Munden Reginald F Putnam Joe B Rice David Smythe W Roy Vaporciyan Ara A Walsh Garrett L Wu Tsung T Roth Jack A |
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Institution: | a Departments of Thoracic and Cardiovascular Surgery, Houston, TX, USA b Radiology, Houston, TX, USA c Gastrointestinal Oncology, Houston, TX, USA d GI Medicine and Nutrition, Houston, TX, USA e Radiation Oncology, Houston, TX, USA f Nuclear Medicine, Houston, TX, USA g Pathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA |
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Abstract: | BackgroundThis study evaluates the utility of positron emission tomography (PET), endoscopic ultrasonography (EUS), and computed tomographic (CT) scans to predict pathologic response and survival following preoperative chemoradiation (CRT) in esophageal cancer.MethodsOne hundred three sequential patients with locoregionally advanced esophageal cancer, who were treated with CRT and esophageal resection between May 2001 and November 2003 at the University of Texas M.D. Anderson Cancer Center, were retrospectively reviewed. PET, EUS, and CT were performed before (pre) or after (post) CRT and before surgical resection. PET standardized uptake value (SUV) was defined as maximal uptake in primary tumor.ResultsMost patients were male (91 88%]) with adenocarcinoma (90 87%]). Pretreatment clinical stages were: IIA (42 41%]), IIB (5 5%]), III (50 49%]), and IVA (6 6%]). At the time of surgery, 58 patients (56%) had a pathologic response to CRT (≤10% viable cells). Post-CRT measurements that correlated with pathologic response were: CT esophageal wall thickness (13.3 vs 15.3 mm, p = 0.04), EUS mass size (0.7 vs 1.7 cm, p = 0.01) and PET SUV (3.1 vs 5.8, p = 0.01). Post-CRT PET SUV equal to or greater than 4 had the highest accuracy for pathologic response (76%). Univariate and multivariate Cox regression analysis demonstrated that a post-CRT PET SUV equal to or greater than 4 was an independent predictor of survival (HR, 3.5, p = 0.04).ConclusionsThe FDG-PET SUV is the most accurate noninvasive test to predict long-term survival after preoperative CRT and before surgical resection. Post-CRT FDG-PET cannot, however, rule out residual microscopic disease so esophagectomy should remain a therapeutic option even if the post-CRT imaging modalities are normal. |
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Keywords: | 7 |
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