Xi Mian, Liao Zhongxing, Hofstetter Wayne L, Komaki Ritsuko, Ho Linus, Lin Steven H
Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, Guangdong, China.
Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
J Nucl Med. 2017 Nov;58(11):1756-1763. doi: 10.2967/jnumed.117.192591. Epub 2017 May 18.
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.
本研究旨在确定同步放化疗前诱导化疗后的F-FDG PET反应是否能够识别可能从后续食管切除术获益的食管腺癌患者。我们识别并分析了220例接受过放化疗前诱导化疗、有或无手术且有治愈意图的食管腺癌患者；所有患者在诱导化疗前后均接受了F-FDG PET扫描。F-FDG PET反应者定义为诱导化疗后达到完全缓解（CR）（最大SUV≤3.0）的患者。评估了F-FDG PET反应对患者预后的预测价值。总体而言，86例患者接受了双峰治疗（BMT；诱导化疗+放化疗），134例患者接受了三峰治疗（TMT；诱导化疗+放化疗联合手术）。48例患者（21.8%）在诱导化疗后达到F-FDG PET CR。发现F-FDG PET CR与BMT患者的总生存期（OS）和无进展生存期（PFS）相关。对于TMT患者，F-FDG PET CR可预测病理反应（P = 0.003），但不能预测生存期。在F-FDG PET无反应者中，TMT患者的生存期明显优于BMT患者（P < 0.001）。然而，在F-FDG PET反应者中，BMT患者的OS（P = 0.201）和PFS（P = 0.269）与TMT患者相似。在倾向评分匹配分析后，接受BMT与TMT治疗的F-FDG PET反应者的OS和PFS仍然相当，但TMT与更好的局部区域控制相关。F-FDG PET对诱导化疗的反应可能是一种有用的影像学生物标志物，用于识别在放化疗后可能从后续食管切除术中获益的食管腺癌患者。与BMT相比，TMT可显著提高F-FDG PET无反应者的生存期。然而，两种治疗（BMT或TMT）后F-FDG PET反应者的结局相似。这些发现有待前瞻性验证。
