PET-directed combined modality therapy for gastroesophageal junction cancer: Results of the multicentre prospective MEMORI trial of the German Cancer Consortium (DKTK)

• Published in: European journal of cancer (1990) Vol. 175; pp. 99 - 106
• Main Authors: Lorenzen, Sylvie, Quante, Michael, Rauscher, Isabel, Slotta-Huspenina, Julia, Weichert, Wilko, Feith, Marcus, Friess, Helmut, Combs, Stefanie E., Weber, Wolfgang A., Haller, Bernhard, Angele, Martin, Albertsmeier, Markus, Blankenstein, Christiane, Kasper, Stefan, Schmid, Roland M., Bassermann, Florian, Schwaiger, Markus, Liffers, Sven-Thorsten, Siveke, Jens T.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.11.2022; Elsevier Science Ltd
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Cancer; Chemoradiotherapy; Chemotherapy; Combined Modality Therapy; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophagogastric Junction - diagnostic imaging; Esophagogastric Junction - pathology; Fluorodeoxyglucose F18; Gastroesophageal junction adenocarcinoma; Humans; Neoadjuvant Therapy; Patients; PET response; Positron emission; Positron emission tomography; Positron-Emission Tomography - methods; Prospective Studies; Radiopharmaceuticals; Radiotherapy; Tumors; Neoadjuvant therapy; Chemotherapy; Radiotherapy; Gastroesophageal junction adenocarcinoma; PET response
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2022.07.027

Positron emission tomography (PET) may differentiate responding and non-responding tumours early in the treatment of locally advanced gastroesophageal junction adenocarcinomas. Early PET non-responders (P-NR) after induction CTX might benefit from changing to chemoradiation (CRT). Patients underwent baseline 18F-FDG PET followed by 1 cycle of CTX. PET was repeated at day 14–21 and responders (P-R), defined as ≥35% decrease in SUVmean from baseline, continued with CTX. P-NR switched to CRT (CROSS). Patients underwent surgery 4–6 weeks post-CTX/CRT. The primary objective was an improvement in R0 resection rates in P-NR above a proportion of 70%. In total, 160 patients with resectable gastroesophageal junction adenocarcinomas were prospectively investigated by PET scanning. Eighty-five patients (53%) were excluded. Seventy-five eligible patients were enrolled in the study. Based on PET criteria, 50 (67.6%)/24 (32.4%) were P-R and P-NR, respectively. Resection was performed on 46 responders, including one patient who withdrew the ICF, and 22 non-responders (per-protocol population). R0 resection rates were 95.6% (43/45) for P-R and 86.4% (19/22) for P-NR. No treatment related deaths occurred. With a median follow-up time of 24.5 months, estimated 18 months DFS was 75.4%/64.2% for P-R/P-NR, respectively. The estimated 18 months OS was 95.5% for P-R and 68.2% for P-NR. The primary endpoint of the study to increase the R0 resection rate in metabolic NR was not met. PET response after induction CTX is prognostic for outcome with a prolonged OS and DFS in PET responders. NCT 2014-000860-16. •MEMORI confirms that early metabolic response is associated with favourable survival.•Radiation to neoadjuvant chemotherapy improves tumour response in metabolic non-responders.•PET/CT-guided preoperative treatment adaptation seems to be feasible and safe.