F-FDG PET Response After Induction Chemotherapy Can Predict Who Will Benefit from Subsequent Esophagectomy After Chemoradiotherapy for Esophageal Adenocarcinoma.

This study aimed to determine whether F-FDG PET response after induction chemotherapy before concurrent chemoradiotherapy can identify patients with esophageal adenocarcinoma who may benefit from subsequent esophagectomy. We identified and analyzed 220 patients with esophageal adenocarcinoma who had received induction chemotherapy before chemoradiotherapy, with or without surgery, with curative intent; all underwent F-FDG PET scanning before and after induction chemotherapy. F-FDG PET responders were defined as patients who achieved complete response (CR) after induction chemotherapy (maximum SUV ≤ 3.0). The predictive value of F-FDG PET response for patient outcomes was evaluated. Overall, 86 patients had bimodality therapy (BMT; induction chemotherapy + chemoradiotherapy) and 134 had trimodality therapy (TMT; induction chemotherapy + chemoradiotherapy with surgery). Forty-eight patients (21.8%) achieved an F-FDG PET CR after induction chemotherapy. F-FDG PET CR was found to correlate with overall survival (OS) and progression-free survival (PFS) in BMT patients. For TMT patients, F-FDG PET CR predicted pathologic response ( = 0.003) but not survival. Among F-FDG PET nonresponders, TMT patients had significantly better survival than did BMT patients ( < 0.001). However, among F-FDG PET responders, BMT patients had OS ( = 0.201) and PFS ( = 0.269) similar to that of TMT patients. After propensity score-matched analysis, F-FDG PET responders treated with BMT versus TMT still had comparable OS and PFS, but TMT was associated with better locoregional control. F-FDG PET response to induction chemotherapy could be a useful imaging biomarker to identify patients with esophageal adenocarcinoma who could benefit from subsequent esophagectomy after chemoradiotherapy. Compared with BMT, TMT can significantly improve survival in F-FDG PET nonresponders. However, outcomes for F-FDG PET responders were similar after either treatment (BMT or TMT). Prospective validation of these findings is warranted.