Lack of fludeoxyglucose F 18 uptake in posttreatment positron emission tomography as a significant predictor of survival after subsequent surgery in multimodality treatment for patients with locally advanced esophageal squamous cell carcinoma

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• 作者：Ichirou Higuchi ; Takushi Yasuda ; Masahiko Yano ; Yuichirou Doki ; Hiroshi Miyata ; Mitsuaki Tatsumi ; Hironori Fukunaga ; Shuji Takiguchi ; Yoshiyuki Fujiwara ; Jun Hatazawa ; Morito Monden
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2008
• 出版时间：July 2008
• 年：2008
• 卷：136
• 期：1
• 页码：205-212.e3
• 全文大小：326 K

文摘

Objective

Patients with advanced esophageal squamous cell carcinoma receive neoadjuvant chemotherapy or chemoradiotherapy to improve survival, but benefits are observed only in those with histologic response. Positron emission tomography with fludeoxyglucose F 18 (INN fludeoxyglucose [¹⁸F]) detects accumulation of glucose analog in viable cancer cells. This study investigated the usefulness of positron emission tomography with fludeoxyglucose F 18 in assessment of response of advanced esophageal squamous cell carcinoma to neoadjuvant treatment to establish new criteria to predict postoperative long-term survival.

Methods

Fifty patients with locally advanced esophageal squamous cell carcinoma who received neoadjuvant therapy (chemotherapy 35, chemoradiotherapy 15) underwent positron emission tomography with fludeoxyglucose F 18 before surgical resection in evaluation of posttreatment maximum standardized uptake value, residual tumor size (maximum square area of longitudinal axis), histologic response, and postoperative survival.

Results

After treatment, uptake was not noted in 21 patients (posttreatment maximum standardized uptake value <2.5, negative) but was detected in 29 (≥2.5, positive). Residual tumor size ranged from 0 to 54.0 mm² for negative results and 55.0 to 676.0 mm² for positive, clearly distinguishing histologic major response from nonresponse. The negative group demonstrated significantly higher 5-year cause-specific survival (67.7 % ) and lower hematogenous recurrence (4.8 % ) than the 36.5 % and 37.0 % values in the positive group, (P < .0042 and P = .0083, respectively). Univariate Cox regression analyses identified posttreatment maximum standardized uptake value (cutoff 2.5) as the only preoperative prognostic factor (P = .0071).

Conclusion

Posttreatment positron emission tomography with fludeoxyglucose F 18 reliably predicted histologic response and postoperative survival in advanced esophageal squamous cell carcinoma. This tool could potentially be used to tailor optimal treatment according to individual responses.