Early response evaluation of neoadjuvant therapy with PET/MRI to predict resectability in patients with adenocarcinoma of the esophagogastric junction

• Published in: Abdominal imaging Vol. 44; no. 3; pp. 836 - 844
• Main Authors: Belmouhand, Mohamed, Löfgren, Johan, Johannesen, Helle Hjorth, Baeksgaard, Lene, Gutte, Henrik, Tariq, Kiran, Achiam, Michael Patrick
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2019; Springer Nature B.V
• Subjects: Adenocarcinoma; Adenocarcinoma - diagnostic imaging; Adenocarcinoma - therapy; Aged; Alcohol use; CARCINOMAS; CHEMOTHERAPY; Computed tomography; Emission analysis; Esophageal cancer; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - therapy; Esophagogastric Junction - diagnostic imaging; Evaluation; Feasibility studies; Female; Gastroenterology; GASTROINTESTINAL TRACT; Hepatology; Hernias; Hollow Organ GI; Humans; Imaging; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Mucous membrane; Multimodal Imaging - methods; Neoadjuvant Therapy - methods; NMR; NMR IMAGING; Nuclear magnetic resonance; Online advertising; Patients; POSITRON COMPUTED TOMOGRAPHY; Positron emission; Positron emission tomography; Positron-Emission Tomography - methods; Predictive Value of Tests; Prospective Studies; Quality; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Regression analysis; Sensitivity analysis; Solid tumors; Therapy; Treatment Outcome; Tumors; Resectability; Gastroesophageal junction cancer; Chemotherapy; Magnetic resonance imaging; Positron emission tomography; Response evaluation
• ISSN: 2366-004X; 2366-0058; 2366-0058
• DOI: 10.1007/s00261-018-1841-4

Study design and purpose Positron emission tomography (PET)/magnetic resonance imaging (MRI) is a new modality that has showed promising results for various clinical indications. Currently, evaluation of neoadjuvant therapy (NT) among patients with adenocarcinoma of the esophagogastric junction has primarily been reserved for PET/computed tomography. Our aim was to evaluate if early response evaluation by PET/MRI is a feasible method to predict resectability. Methods and materials Patients with untreated adenocarcinoma of the esophagogastric junction (Siewert types I/II) and fit for NT with no contraindications for PET/MRI were considered eligible. A baseline scan was performed prior to NT induction and an evaluation scan 3 weeks later. For histopathological response evaluation, the Mandard tumor regression grade score was applied. Response on PET/MRI was evaluated with Response Evaluation Criteria in Solid Tumors (RECIST 1.1), and change in ADC and SUV max values. Results Twenty-eight patients were enrolled, and 22 completed both scans and proceeded to final analyses. Seventeen patients were found resectable versus five who were found unresectable. PET/MRI response evaluation had a sensitivity 94%, specificity 80%, and AUC = 0.95 when predicting resectability in patients with adenocarcinoma of the esophagogastric junction. No association with histopathological response (tumor regression grade) was found nor was RECIST correlated with resectability. Conclusion Response evaluation using PET/MRI was a feasible method to predict resectability in patients with adenocarcinoma of the esophagogastric junction in this pilot study. However, larger studies are warranted to justify the use of the modality for this indication.