18F-FDG PET/CT as predictive and prognostic factor in esophageal cancer treated with combined modality treatment

• Published in: Annals of nuclear medicine Vol. 36; no. 5; pp. 450 - 459
• Main Authors: Krengli, Marco, Ferrara, Eleonora, Guaschino, Riccardo, Puta, Erinda, Turri, Lucia, Luciani, Ilaria, Sacchetti, Gian Mauro, Franco, Pierfrancesco, Brambilla, Marco
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.05.2022; Springer Nature B.V
• Subjects: Cancer; Carcinoma, Squamous Cell; Chemoradiotherapy; Chemotherapy; Computed tomography; Esophageal cancer; Esophageal carcinoma; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - therapy; Esophagus; Evaluation; Fluorine isotopes; Fluorodeoxyglucose F18; Glycolysis; Humans; Imaging; Medical prognosis; Medicine; Medicine & Public Health; Nuclear Medicine; Original; Original Article; Parameters; Patients; Positron emission; Positron emission tomography; Positron Emission Tomography Computed Tomography; Pretreatment; Prognosis; Radiology; Radiopharmaceuticals; Retrospective Studies; Squamous cell carcinoma; Surgery; Survival; Tomography; Tumor Burden; Tumors; 18F-FDG PET/CT; Radio-chemotherapy; Predictive/prognostic factors; Surgery; Esophageal cancer
• ISSN: 0914-7187; 1864-6433
• DOI: 10.1007/s12149-022-01733-9

Purpose [18F] fluorodeoxyglucose positron emission tomography/computed tomography ([18F] FDG-PET/CT) is used for diagnosis, staging, response assessment and prognosis prediction in different tumors, but its role in esophageal cancer is still debated. The aim of this study was to evaluate the role of semiquantitative baseline PET parameters as possible prognostic and predictive factors in a series of esophageal carcinomas treated with combined modalities. Methods 43 patients with esophageal carcinoma were treated with chemoradiotherapy (CRT) followed by surgery in 20 cases and underwent pre-treatment 18F-FDG-PET/CT. Semiquantitative PET parameters were evaluated including Standardized Uptake Value (SUVmax e SUVmean), Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG) with isocontour of 41 and 50%. Further variables analyzed were gender, primary tumor site, histological type, use of surgery, achievement of a radical resection and the type of chemotherapy regimen. The correlation of all variables with treatment response, loco-regional control (LR), Overall survival (OS) and Disease-Free Survival (DFS) was evaluated. Results SUVmax, SUVmean50 and SUVmean41 were significantly higher in node-positive cases and in squamous cell carcinomas. With respect to prognostic factors, MTV was found to be correlated with OS: patients with MTV41 < 11.32 cm 3 and MTV50 < 8.07 cm 3 (both p values = 0.04) showed better 3-year OS rates (33 vs. 20%). Further factors predicting a better prognosis were the use of surgery and radical resection (R0) (both p values < 0.01). Conclusions Pre-treatment MTV values were significant prognostic factors for OS, together with the use of surgery and R0 resection in esophageal cancers treated with multimodal therapies.