PET-directed combined modality therapy for gastroesophageal junction cancer: Results of the multicentre prospective MEMORI trial of the German Cancer Consortium (DKTK)
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...
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Published in | European journal of cancer (1990) Vol. 175; pp. 99 - 106 |
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Main Authors | , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier Ltd
01.11.2022
Elsevier Science Ltd |
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Abstract | 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. |
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AbstractList | 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. 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 F-FDG PET followed by 1 cycle of CTX. PET was repeated at day 14-21 and responders (P-R), defined as ≥35% decrease in SUV 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. NCT00002014-000860-16. Background: 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). Methods: 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%. Results: 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. Conclusion: 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. |
Author | Haller, Bernhard Blankenstein, Christiane Quante, Michael Angele, Martin Schmid, Roland M. Weichert, Wilko Feith, Marcus Combs, Stefanie E. Schwaiger, Markus Friess, Helmut Liffers, Sven-Thorsten Slotta-Huspenina, Julia Rauscher, Isabel Lorenzen, Sylvie Weber, Wolfgang A. Bassermann, Florian Kasper, Stefan Albertsmeier, Markus Siveke, Jens T. |
Author_xml | – sequence: 1 givenname: Sylvie surname: Lorenzen fullname: Lorenzen, Sylvie organization: Technical University of Munich, Klinikum rechts der Isar, III. Medizinische Klinik und Poliklinik, Munich, Germany – sequence: 2 givenname: Michael surname: Quante fullname: Quante, Michael organization: Technical University Munich, Klinikum rechts der Isar, II. Medizinische Klinik und Poliklinik, Munich, Germany – sequence: 3 givenname: Isabel surname: Rauscher fullname: Rauscher, Isabel organization: Technical University Munich, Klinikum rechts der Isar, Department of Nuclear Medicine, Munich, Germany – sequence: 4 givenname: Julia surname: Slotta-Huspenina fullname: Slotta-Huspenina, Julia organization: Technical University Munich, Institute of Pathology, Munich, Germany – sequence: 5 givenname: Wilko surname: Weichert fullname: Weichert, Wilko organization: Technical University Munich, Institute of Pathology, Munich, Germany – sequence: 6 givenname: Marcus surname: Feith fullname: Feith, Marcus organization: Technical University Munich, Klinikum rechts der Isar, Surgical Clinic and Policlinic, Munich, Germany – sequence: 7 givenname: Helmut surname: Friess fullname: Friess, Helmut organization: Technical University Munich, Klinikum rechts der Isar, Surgical Clinic and Policlinic, Munich, Germany – sequence: 8 givenname: Stefanie E. surname: Combs fullname: Combs, Stefanie E. organization: Technical University Munich, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany – sequence: 9 givenname: Wolfgang A. surname: Weber fullname: Weber, Wolfgang A. organization: Technical University Munich, Klinikum rechts der Isar, Department of Nuclear Medicine, Munich, Germany – sequence: 10 givenname: Bernhard surname: Haller fullname: Haller, Bernhard organization: Technical University Munich, Klinikum rechts der Isar, Institute of AI and Informatics in Medicine, Munich, Germany – sequence: 11 givenname: Martin surname: Angele fullname: Angele, Martin organization: Ludwig-Maximilians-Universität (LMU) Munich, LMU University Hospital, Department of General, Visceral and Transplantation Surgery, Munich, Germany – sequence: 12 givenname: Markus surname: Albertsmeier fullname: Albertsmeier, Markus organization: Ludwig-Maximilians-Universität (LMU) Munich, LMU University Hospital, Department of General, Visceral and Transplantation Surgery, Munich, Germany – sequence: 13 givenname: Christiane surname: Blankenstein fullname: Blankenstein, Christiane organization: Technical University Munich, School of Medicine, Münchner Studienzentrum, Munich, Germany – sequence: 14 givenname: Stefan surname: Kasper fullname: Kasper, Stefan organization: Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany – sequence: 15 givenname: Roland M. surname: Schmid fullname: Schmid, Roland M. organization: Technical University Munich, Klinikum rechts der Isar, II. Medizinische Klinik und Poliklinik, Munich, Germany – sequence: 16 givenname: Florian surname: Bassermann fullname: Bassermann, Florian organization: Technical University of Munich, Klinikum rechts der Isar, III. Medizinische Klinik und Poliklinik, Munich, Germany – sequence: 17 givenname: Markus surname: Schwaiger fullname: Schwaiger, Markus organization: Technical University Munich, Klinikum rechts der Isar, Department of Nuclear Medicine, Munich, Germany – sequence: 18 givenname: Sven-Thorsten surname: Liffers fullname: Liffers, Sven-Thorsten organization: German Cancer Consortium (DKTK), Partner Site Essen, Germany – sequence: 19 givenname: Jens T. surname: Siveke fullname: Siveke, Jens T. email: j.siveke@dkfz.de organization: Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany |
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Keywords | Neoadjuvant therapy Chemotherapy Radiotherapy Gastroesophageal junction adenocarcinoma PET response |
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Snippet | Positron emission tomography (PET) may differentiate responding and non-responding tumours early in the treatment of locally advanced gastroesophageal junction... Background: Positron emission tomography (PET) may differentiate responding and non-responding tumours early in the treatment of locally advanced... |
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SubjectTerms | 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 |
Title | PET-directed combined modality therapy for gastroesophageal junction cancer: Results of the multicentre prospective MEMORI trial of the German Cancer Consortium (DKTK) |
URI | https://dx.doi.org/10.1016/j.ejca.2022.07.027 https://www.ncbi.nlm.nih.gov/pubmed/36099671 https://www.proquest.com/docview/2754550307/abstract/ |
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