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Combined tumor plus nontumor interim FDG-PET parameters are prognostic for response to chemoradiation in squamous cell esophageal cancer |
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| Authors: | Sebastian Zschaeck Yimin Li Rebecca Bütof Chen Lili Wu Hua Esther CG Troost Marcus Beck Holger Amthauer David Kaul Jörg Kotzerke Alexander DJ Baur Pirus Ghadjar Michael Baumann Mechthild Krause Frank Hofheinz |
| Affiliation: | 1. Department of Radiation Oncology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany;2. Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China;3. Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
OncoRay – National Center for Radiation Research in Oncology, Dresden, Germany National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany;4. Department of Nuclear Medicine, The Xiamen First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China;5. Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany OncoRay – National Center for Radiation Research in Oncology, Dresden, Germany German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK) partner site Dresden, Dresden, Germany National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany Helmholtz-Zentrum Dresden – Rossendorf, Institute of Radiooncology OncoRay, Dresden, Germany;6. Department of Nuclear Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany;7. OncoRay – National Center for Radiation Research in Oncology, Dresden, Germany German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK) partner site Dresden, Dresden, Germany Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany;8. Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Radiologie, Berlin, Germany;9. Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany OncoRay – National Center for Radiation Research in Oncology, Dresden, Germany German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK) partner site Dresden, Dresden, Germany National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany Helmholtz-Zentrum Dresden – Rossendorf, Institute of Radiooncology OncoRay, Dresden, Germany German Cancer Research Center (DKFZ), Heidelberg, Germany;10. Helmholtz-Zentrum Dresden-Rossendorf, PET Center, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany |
| Abstract: | We have investigated the prognostic value of two novel interim 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) parameters in patients undergoing chemoradiation (CRT) for esophageal squamous cell carcinoma (ESCC): one tumor parameter (maximal standardized uptake ratio rSUR) and one normal tissue parameter (change of FDG uptake within irradiated nontumor-affected esophagus ?SUVNTO). PET data of 134 European and Chinese patients were analyzed. Parameter establishment was based on 36 patients undergoing preoperative CRT plus surgery, validation was performed in 98 patients receiving definitive CRT. Patients received PET imaging prior and during fourth week of CRT. Clinical parameters, baseline PET parameters, and interim PET parameters (rSUR and ?SUVNTO) were analyzed and compared to event-free survival (EFS), overall survival (OS), loco-regional control (LRC) and freedom from distant metastases (FFDM). Combining rSUR and ?SUVNTO revealed a strong prognostic impact on EFS, OS, LRC and FFDM in patients undergoing preoperative CRT. In the definitive CRT cohort, univariate analysis with respect to EFS revealed several staging plus both previously established interim PET parameters as significant prognostic factors. Multivariate analyses revealed only rSUR and ?SUVNTO as independent prognostic factors (p = 0.003, p = 0.008). Combination of these parameters with the cutoff established in preoperative CRT revealed excellent discrimination of patients with a long or short EFS (73% vs. 17% at 2 years, respectively) and significantly discriminated all other endpoints (OS, p < 0.001; LRC, p < 0.001; FFDM, p = 0.02), even in subgroups. Combined use of interim FDG-PET derived parameters ?SUVNTO and rSUR seems to have predictive potential, allowing to select responders for definitive CRT and omission of surgery. |
| Keywords: | esophageal cancer interim PET standardized uptake ratio normal tissue FDG uptake chemoradiation personalized treatment |
