Squires M Hart, Gower Nicole, Benbow Jennifer H, Donahue Erin E, Bohl Casey E, Prabhu Roshan S, Hill Joshua S, Salo Jonathan C
Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
LCI Research Support, Clinical Trials Office, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.
Ann Surg Oncol. 2022 Feb;29(2):1327-1333. doi: 10.1245/s10434-021-10644-4. Epub 2021 Oct 9.
For locally advanced esophageal squamous cell carcinoma (ESCC), chemoradiation (ChemoRT) followed by surgery offers the best chance of cure, with a 35-50% pathologic complete response (pCR) rate. Given the morbidity of esophagectomy and the possibility of pCR with ChemoRT, a 'watch and wait' strategy has been proposed, particularly for squamous cell carcinoma. The ability to accurately predict which patients will have pCR from ChemoRT is critical in treatment decision making. This study assessed positron emission tomography (PET) in predicting pCR after neoadjuvant ChemoRT for ESCC.
ESCC patients treated with ChemoRT followed by surgery were identified. Maximum standard uptake value (SUV), metabolic tumor volume, total lesion glycolysis, and first-order textual features of standard deviation, kurtosis and skewness were measured from PET. Univariable and multivariable generalized linear method analyses were performed. A metabolic complete response (mCR) was defined as a post-therapy PET scan with maximum SUV < 4.0.
Twenty-seven patients underwent ChemoRT followed by surgery, with overall pCR seen in 11 (41%) patients and radiographic mCR seen in 12 (44%) patients. Final pathology for these 12 patients revealed pCR (ypT0N0M0) in 5 (42%) patients and persistent disease in 7 (58%) patients. Univariate analysis did not reveal PET parameters predictive of pCR.
Treatment of ESCC with ChemoRT often results in a robust clinical response. Among patients with an mCR after ChemoRT, disease persistence was found in 58%. The inability of PET to predict pCR is important in the context of a 'watch and wait' strategy for ESCC treated with ChemoRT.
对于局部晚期食管鳞状细胞癌（ESCC），化疗联合放疗（ChemoRT）后行手术提供了最佳的治愈机会，病理完全缓解（pCR）率为35%-50%。鉴于食管切除术的发病率以及ChemoRT实现pCR的可能性，已提出一种“观察等待”策略，尤其是对于鳞状细胞癌。准确预测哪些患者将从ChemoRT中获得pCR的能力在治疗决策中至关重要。本研究评估了正电子发射断层扫描（PET）在预测ESCC新辅助ChemoRT后pCR中的作用。
确定接受ChemoRT后行手术治疗的ESCC患者。从PET测量最大标准摄取值（SUV）、代谢肿瘤体积、总病变糖酵解以及标准差、峰度和偏度的一阶纹理特征。进行单变量和多变量广义线性方法分析。代谢完全缓解（mCR）定义为治疗后PET扫描最大SUV<4.0。
27例患者接受了ChemoRT后行手术，11例（41%）患者出现总体pCR，12例（44%）患者出现影像学mCR。这12例患者的最终病理显示5例（42%）患者为pCR（ypT0N0M0），7例（58%）患者为疾病持续存在。单变量分析未发现预测pCR的PET参数。
用ChemoRT治疗ESCC通常会产生显著的临床反应。在ChemoRT后出现mCR的患者中，58%发现疾病持续存在。在对接受ChemoRT治疗的ESCC采用“观察等待”策略的背景下，PET无法预测pCR这一点很重要。
