Document Detail


Locally advanced esophageal adenocarcinoma: response to neoadjuvant chemotherapy and survival predicted by ([18F])FDG-PET/CT.
MedLine Citation:
PMID:  22208782     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: ([18F])fluorodeoxyglycose-Positron Emission Tomography/Computer Tomography (([18F])FDG-PET/CT) is commonly used in staging of locally advanced esophageal cancer. Its predictive value for response to neoadjuvant therapy and survival after multimodality therapy is controversial.
METHODS: Sixty-six consecutive patients with locally advanced adenocarcinoma of the esophagus or esophagogastric junction underwent surgery after neoadjuvant chemotherapy. Staging was done prospectively with ([18F])FDG-PET/CT, before and after completion of neoadjuvant therapy. Pre- and post-therapy maximal standardized uptake values for the primary tumor (SUV1 and SUV2) were determined, and their relative change (SUV∆%) calculated. Percentage change in SUV1 was compared with histopathologic response (HPR, complete or subtotal histologic remission), disease-free- (DFS) and overall survival (OS).
RESULTS: Resection with negative margins was achieved in 60 patients. HPR rate was 14 of 66 (21.2%). Median follow-up was 16 months (range 4-72). For all patients, OS probability at three years was 59% and DFS 50%. In receiver operating characteristics (ROC) analysis, HPR was optimally predicted by a > 67% change in baseline maximal SUV (sensitivity 79% and specificity 75%). In univariate survival analysis (Cox regression proportional hazards), HPR associated with improved DFS (HR 0.208, p = 0.033) but not OS (HR 0.030, p = 0.101), SUV % > 67% associated with improved OS (HR 0.249, p = 0.027) and DFS (HR 0.383, p = 0.040). In a multivariate model (adjusted by age, sex, and ASA score), neither HPR nor SUV∆% > 67% was predictive of improved OS and DFS. However, SUV∆% as a continuous variable was an independent predictor of OS (HR 0.966, p < 0.0001) or DFS (HR 0.973, p < 0.0001).
CONCLUSION: Our results support previous results showing that ([18F])FDG-PET/CT can distinguish a group of patients with worse prognosis after neoadjuvant chemotherapy in adenocarcinoma of the esophagus or esophagogastric junction. This information could offer a new independent preoperative marker of prognosis.
Authors:
Juha T Kauppi; Niku Oksala; Jarmo A Salo; Heikki Helin; Lauri Karhumäki; Jukka Kemppainen; Eero I Sihvo; Jari V Räsänen
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-01-02
Journal Detail:
Title:  Acta oncologica (Stockholm, Sweden)     Volume:  51     ISSN:  1651-226X     ISO Abbreviation:  Acta Oncol     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-15     Completed Date:  2012-09-27     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  8709065     Medline TA:  Acta Oncol     Country:  England    
Other Details:
Languages:  eng     Pagination:  636-44     Citation Subset:  IM    
Affiliation:
Helsinki University Central Hospital, Division of General Thoracic and Esophageal Surgery, Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki, Finland.
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MeSH Terms
Descriptor/Qualifier:
Adenocarcinoma / diagnosis,  drug therapy,  mortality*
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Cisplatin / administration & dosage
Combined Modality Therapy
Deoxycytidine / administration & dosage,  analogs & derivatives
Epirubicin / administration & dosage
Esophageal Neoplasms / diagnosis,  drug therapy,  mortality*
Esophagectomy
Esophagogastric Junction / drug effects,  pathology,  surgery
Female
Fluorodeoxyglucose F18 / diagnostic use*
Fluorouracil / administration & dosage,  analogs & derivatives
Follow-Up Studies
Humans
Male
Middle Aged
Neoadjuvant Therapy*
Neoplasm Grading
Neoplasm Staging
Organoplatinum Compounds / administration & dosage
Positron-Emission Tomography and Computed Tomography*
Prognosis
Prospective Studies
Radiopharmaceuticals / diagnostic use
Survival Rate
Taxoids / administration & dosage
Chemical
Reg. No./Substance:
0/Organoplatinum Compounds; 0/Radiopharmaceuticals; 0/Taxoids; 15663-27-1/Cisplatin; 15H5577CQD/docetaxel; 51-21-8/Fluorouracil; 56420-45-2/Epirubicin; 63121-00-6/oxaliplatin; 63503-12-8/Fluorodeoxyglucose F18; 6804DJ8Z9U/capecitabine; 951-77-9/Deoxycytidine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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