Levine Edward A, Farmer Michael R, Clark Paige, Mishra Girish, Ho Coty, Geisinger Kim R, Melin Susan A, Lovato James, Oaks Tim, Blackstock A William
Surgical Oncology Service and the Department of General Surgery, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC 27157, USA.
Ann Surg. 2006 Apr;243(4):472-8. doi: 10.1097/01.sla.0000208430.07050.61.
To evaluate the utility of F-FDG-PET in predicting response to concomitant chemoradiation in locally-advanced esophageal cancer.
Approximately 25% of esophageal cancer patients experience a pathologic complete response (pCR) to preoperative chemoradiation therapy. Computed tomography, endoscopy, and endoscopic ultrasound are unable to identify patients experiencing a pCR. Growing evidence supports the use of F-FDG-PET in the staging of esophageal cancer in its ability to detect occult metastatic and lymph nodal disease. The identification of patients with a pCR to chemoradiation could potentially spare those patients the morbidity associated with a resection.
Eligibility criteria included T3-T4N0M0 or T1-T4N1M0 esophageal cancer. Patients underwent an initial F-FDG-PET before treatment and then repeated 4 to 6 weeks after chemoradiation, prior to the esophagectomy. Chemoradiation consisted of: cisplatinum, 5-fluorouracil, and radiation to a median dose of 50.4 Gy. Pathologic response was determined from a systematic review of the esophagectomy specimens.
Sixty-four patients have completed therapy to date. Response was as follows: pCR 27%, pathologic residual microscopic (pCRmicro) 14.5%, partial response 19%, and stable or progressive disease 39.5%. A pretreatment standardized uptake value (SUVmax1hour) > or = 15 was associated with an observed 77.8% significant response (pCR + pCRmicro) compared with 24.2% for patients with a pretreatment SUVmax1hour < 15 (P = 0.005). Significant response was observed in 71.4% of patients with a decrease in SUVmax1hour > or = 10 compared with 33.3% when the SUVmax1hour decreased <10 (P = 0.004).
Pretreatment and posttreatment F-FDG-PET can be useful for predicting significant response to chemoradiation in esophageal cancer. These data should be considered in evaluation of patients for esophagectomy after chemoradiation.
评估F-FDG-PET在预测局部晚期食管癌同步放化疗疗效方面的作用。
约25%的食管癌患者对术前放化疗有病理完全缓解（pCR）。计算机断层扫描、内镜检查和内镜超声无法识别出有pCR的患者。越来越多的证据支持使用F-FDG-PET进行食管癌分期，因为它能够检测隐匿性转移和淋巴结疾病。识别出对放化疗有pCR的患者可能会使这些患者避免与手术切除相关的并发症。
纳入标准包括T3-T4N0M0或T1-T4N1M0食管癌患者。患者在治疗前接受首次F-FDG-PET检查，然后在放化疗后4至6周、食管切除术前行重复检查。放化疗方案包括：顺铂、5-氟尿嘧啶，中位放疗剂量为50.4 Gy。通过对食管切除标本的系统检查确定病理反应。
迄今为止，64例患者已完成治疗。反应情况如下：pCR 27%，病理残留微小（pCRmicro）14.5%，部分缓解19%，疾病稳定或进展39.5%。治疗前标准化摄取值（SUVmax1小时）≥15与观察到的77.8%显著反应（pCR + pCRmicro）相关，而治疗前SUVmax1小时<15的患者为24.2%（P =
0.005）。SUVmax1小时下降≥10的患者中71.4%观察到显著反应，而SUVmax1小时下降<10时为33.3%（P = 0.004）。
治疗前和治疗后F-FDG-PET可用于预测食管癌放化疗的显著反应。在评估放化疗后行食管切除术的患者时应考虑这些数据。
