Outcomes of patients with esophageal cancer staged with [ 18F]fluorodeoxyglucose positron emission tomography (FDG-PET): Can postchemoradiotherapy FDG-PET predict the utility of resection?

Arta M Monjazeb, Greg Riedlinger, Mebea Aklilu, Kim R. Geisinger, Girish Mishra, Scott Isom, Paige Clark, Edward A. Levine, A. William Blackstock

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine whether [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) can delineate patients with esophageal cancer who may not benefit from esophagectomy after chemoradiotherapy. Patients and Methods: We reviewed records of 163 patients with histologically confirmed stage I to IVA esophageal cancer receiving chemoradiotherapy with or without resection with curative intent. All patients received surgical evaluation. Initial and postchemoradiotherapy FDG-PET scans and prognostic/ treatment variables were analyzed. FDG-PET complete response (PET-CR) after chemoradiotherapy was defined as standardized uptake value ≤ 3. Results: Eighty-eight patients received trimodality therapy and 75 received chemoradiotherapy. Surgery was deferred primarily due to medical inoperability or unresectable/metastatic disease after chemoradiotherapy. A total of 105 patients were evaluable for postchemoradiotherapy FDG-PET response. Thirty-one percent achieved a PET-CR. PET-CR predicted for improved outcomes for chemoradiotherapy (2-year overall survival, 71% v 11%, P < .01; 2-year freedom from local failure [LFF], 75% v 28%, P < .01), but not trimodality therapy. On multivariate analysis of patients treated with chemoradiotherapy, PET-CR is the strongest independent prognostic variable (survival hazard ratio [HR], 9.82, P < .01; LFF HR, 14.13, P < .01). PET-CR predicted for improved outcomes regardless of histology, although patients with adenocarcinoma achieved a PET-CR less often. Conclusion: Patients treated with trimodality therapy found no benefit with PET-CR, likely because FDG-PET residual disease was resected. Definitive chemoradiotherapy patients achieving PET-CR had excellent outcomes equivalent to trimodality therapy despite poorer baseline characteristics. Patients who achieve a PET-CR may not benefit from added resection given their excellent outcomes without resection. These results should be validated in a prospective trial of FDG-PET - directed therapy for esophageal cancer.

Original languageEnglish (US)
Pages (from-to)4714-4721
Number of pages8
JournalJournal of Clinical Oncology
Volume28
Issue number31
DOIs
StatePublished - Nov 1 2010
Externally publishedYes

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Fluorodeoxyglucose F18
Esophageal Neoplasms
Positron-Emission Tomography
Chemoradiotherapy
Therapeutics
Esophagectomy
Survival
Histology
Adenocarcinoma
Multivariate Analysis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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Outcomes of patients with esophageal cancer staged with [ 18F]fluorodeoxyglucose positron emission tomography (FDG-PET) : Can postchemoradiotherapy FDG-PET predict the utility of resection? / Monjazeb, Arta M; Riedlinger, Greg; Aklilu, Mebea; Geisinger, Kim R.; Mishra, Girish; Isom, Scott; Clark, Paige; Levine, Edward A.; Blackstock, A. William.

In: Journal of Clinical Oncology, Vol. 28, No. 31, 01.11.2010, p. 4714-4721.

Research output: Contribution to journalArticle

Monjazeb, Arta M ; Riedlinger, Greg ; Aklilu, Mebea ; Geisinger, Kim R. ; Mishra, Girish ; Isom, Scott ; Clark, Paige ; Levine, Edward A. ; Blackstock, A. William. / Outcomes of patients with esophageal cancer staged with [ 18F]fluorodeoxyglucose positron emission tomography (FDG-PET) : Can postchemoradiotherapy FDG-PET predict the utility of resection?. In: Journal of Clinical Oncology. 2010 ; Vol. 28, No. 31. pp. 4714-4721.
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abstract = "Purpose: To determine whether [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) can delineate patients with esophageal cancer who may not benefit from esophagectomy after chemoradiotherapy. Patients and Methods: We reviewed records of 163 patients with histologically confirmed stage I to IVA esophageal cancer receiving chemoradiotherapy with or without resection with curative intent. All patients received surgical evaluation. Initial and postchemoradiotherapy FDG-PET scans and prognostic/ treatment variables were analyzed. FDG-PET complete response (PET-CR) after chemoradiotherapy was defined as standardized uptake value ≤ 3. Results: Eighty-eight patients received trimodality therapy and 75 received chemoradiotherapy. Surgery was deferred primarily due to medical inoperability or unresectable/metastatic disease after chemoradiotherapy. A total of 105 patients were evaluable for postchemoradiotherapy FDG-PET response. Thirty-one percent achieved a PET-CR. PET-CR predicted for improved outcomes for chemoradiotherapy (2-year overall survival, 71{\%} v 11{\%}, P < .01; 2-year freedom from local failure [LFF], 75{\%} v 28{\%}, P < .01), but not trimodality therapy. On multivariate analysis of patients treated with chemoradiotherapy, PET-CR is the strongest independent prognostic variable (survival hazard ratio [HR], 9.82, P < .01; LFF HR, 14.13, P < .01). PET-CR predicted for improved outcomes regardless of histology, although patients with adenocarcinoma achieved a PET-CR less often. Conclusion: Patients treated with trimodality therapy found no benefit with PET-CR, likely because FDG-PET residual disease was resected. Definitive chemoradiotherapy patients achieving PET-CR had excellent outcomes equivalent to trimodality therapy despite poorer baseline characteristics. Patients who achieve a PET-CR may not benefit from added resection given their excellent outcomes without resection. These results should be validated in a prospective trial of FDG-PET - directed therapy for esophageal cancer.",
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