Clinical response assessment on DW-MRI compared with FDG-PET/CT after neoadjuvant chemoradiotherapy in patients with oesophageal cancer

Vollenbrock, Sophie E; Voncken, Francine E.M.; Lambregts, Doenja M. J.; Maas, Monique; Donswijk, Maarten L.; Vegt, Erik; Beek, Leon C. ter; Dieren, Jolanda M. van; Sandick, Johanna W. van; Aleman, Berthe M.P.; Bartels‐Rutten, Annemarieke

doi:10.1007/s00259-020-04917-5

Cited by 7 publications

(5 citation statements)

References 44 publications

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“…However, in recent years, more studies have shown its potential in clinical staging and nCRT efficacy evaluation. MRI reached higher diagnostic accuracies than FDG-PET/CT for the detection of residual tumor in esophageal cancer patients after nCRT [25]. Adding DW-MRI to gastroscopy and endosonographic ultrasound could improve the detection of residual tumor after neoadjuvant chemoradiotherapy [26].…”

Section: Discussionmentioning

confidence: 98%

Diffusion-weighted MRI and 18F-FDG PET/CT in assessing the response to neoadjuvant chemoradiotherapy in locally advanced esophageal squamous cell carcinoma

Sun²,

et al. 2021

Radiat Oncol

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Background Neoadjuvant chemoradiotherapy (nCRT) followed by surgery is a currently widely used strategy for locally advanced esophageal cancer (EC). However, the conventional imaging methods have certain deficiencies in the evaluation and prediction of the efficacy of nCRT. This study aimed to explore the value of functional imaging in predicting the response to neoadjuvant chemoradiotherapy (nCRT) in locally advanced esophageal squamous cell carcinoma (ESCC). Methods Fifty-four patients diagnosed with locally advanced ESCC from August 2017 to September 2019 and treated with nCRT were retrospectively analyzed. DW-MRI scanning was performed before nCRT, at 10–15 fractions of radiotherapy, and 4–6 weeks after the completion of nCRT. 18F-FDG PET/CT scans were performed before nCRT and 4–6 weeks after the completion of nCRT. These 18F-FDG PET/CT and DW-MRI parameters and relative changes were compared between patients with pathological complete response (pCR) and non-pCR. Results A total of 8 of 54 patients (14.8%) were evaluated as disease progression in the preoperative assessment. The remaining forty-six patients underwent operations, and the pathological assessments of the surgical resection specimens demonstrated pathological complete response (pCR) in 10 patients (21.7%) and complete response of primary tumor (pCR-T) in 16 patients (34.8%). The change of metabolic tumor volume (∆MTV) and change of total lesion glycolysis (∆TLG) were significantly different between patients with pCR and non-pCR. The SUVmax-Tpost, MTV-Tpost, and TLG-Tpost of esophageal tumors in 18F-FDG PET/CT scans after neoadjuvant chemoradiotherapy and the ∆ SUVmax-T and ∆MTV-T were significantly different between pCR-T versus non-pCR-T patients. The esophageal tumor apparent diffusion coefficient (ADC) increased after nCRT; the ADCduring, ADCpost and ∆ADCduring were significantly different between pCR-T and non-pCR-T groups. ROC analyses showed that the model that combined ADCduring with TLG-Tpost had the highest AUC (0.914) for pCR-T prediction, with 90.0% and 86.4% sensitivity and specificity, respectively. Conclusion 18F-FDG PET/CT is useful for re-staging after nCRT and for surgical decision. Integrating parameters of 18F-FDG PET/CT and DW-MRI can identify pathological response of primary tumor to nCRT more accurately in ESCC.

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Section: Discussionmentioning

confidence: 98%

Diffusion-weighted MRI and 18F-FDG PET/CT in assessing the response to neoadjuvant chemoradiotherapy in locally advanced esophageal squamous cell carcinoma

Sun²,

et al. 2021

Radiat Oncol

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“…The full‐text publications for the remaining 191 studies were reviewed. Of these, 84 studies 7,26–108 met the inclusion and exclusion criteria and were included in this systematic review and meta‐analysis, yielding a total of 6451 patients who received neoadjuvant therapy and had tumor response measured pathologically after surgery. Of the 84 included trials, 13 (15%) were published between 1992 and 2001, 31 (37%) between 2002 and 2011, and 41 (49%) between 2012 and 2022.…”

Section: Resultsmentioning

confidence: 99%

Pathologic complete response in patients with esophageal cancer receiving neoadjuvant chemotherapy or chemoradiation: A systematic review and meta‐analysis

Gaber,

Sarker,

Abdelaziz

et al. 2024

Cancer Medicine

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BackgroundNeoadjuvant chemoradiation and chemotherapy are recommended for the treatment of nonmetastatic esophageal cancer. The benefit of neoadjuvant treatment is mostly limited to patients who exhibit pathologic complete response (pCR). Existing estimates of pCR rates among patients receiving neoadjuvant therapy have not been synthesized and lack precision.MethodsWe conducted an independently funded systematic review and meta‐analysis (PROSPERO CRD42023397402) of pCR rates among patients diagnosed with esophageal cancer treated with neoadjuvant chemo(radiation). Studies were identified from Medline, EMBASE, and CENTRAL database searches. Eligible studies included trials published from 1992 to 2022 that focused on nonmetastatic esophageal cancer, including the gastroesophageal junction. Histology‐specific pooled pCR prevalence was determined using the Freeman–Tukey transformation and a random effects model.ResultsAfter eligibility assessment, 84 studies with 6451 patients were included. The pooled prevalence of pCR after neoadjuvant chemotherapy in squamous cell carcinomas was 9% (95% CI: 6%–14%), ranging from 0% to 32%. The pooled prevalence of pCR after neoadjuvant chemoradiation in squamous cell carcinomas was 32% (95% CI: 26%–39%), ranging from 8% to 66%. For adenocarcinoma, the pooled prevalence of pCR was 6% (95% CI: 1%–12%) after neoadjuvant chemotherapy, and 22% (18%–26%) after neoadjuvant chemoradiation.ConclusionsUnder one‐third of patients with esophageal cancer who receive neoadjuvant chemo(radiation) experience pCR. Patients diagnosed with squamous cell carcinomas had higher rates of pCR than those with adenocarcinomas. As pCR represents an increasingly utilized endpoint in neoadjuvant trials, these estimates of pooled pCR rates may serve as an important benchmark for future trial design.

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“…; specificity: 57/43% vs. 43/43%, resp.) after nCRT [6]. MRI has thus been shown to achieve high sensitivity at the cost of low specificity [16].…”

Section: Discussionmentioning

confidence: 99%

“…First, team members independently assessed the scans, allowing them to study the scans before the subsequent consensus meeting per team. Independent assessments included confidence scores (CS) for the presence of residual tumor, tumor-involved lymph nodes and distant metastases [4,6]: 1 = benign; 2 = probably benign; 3 = equivocal; 4 = probably malignant; 5 = malignant. During team consensus, the two members assessed the scan together.…”

Section: Qualitative Assessmentsmentioning

confidence: 99%

“…MRI is hypothesized to enhance primary tumor detection after nCRT. This is primarily due to higher soft tissue contrast compared to CT and also to the potential to differentiate postradiation inflammation from tumor using the apparent diffusion coefficient (ADC) on diffusion-weighted imaging (DWI) [5,6]. Integrated PET/ MRI is a relatively new imaging technique that has the advantage of perfect alignment of PET and MR images.…”

Section: Introductionmentioning

confidence: 99%

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18F-FDG PET/MRI for restaging esophageal cancer after neoadjuvant chemoradiotherapy

Valkema,

de Lussanet de la Sablonière,

Valkema

et al. 2023

Nuclear Medicine Communications

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Purpose The purpose of this study was to investigate whether 18F-fluorodeoxyglucose (18F-FDG) PET/MRI may potentially improve tumor detection after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer. Methods This was a prospective, single-center feasibility study. At 6–12 weeks after nCRT, patients underwent standard 18F-FDG PET/computed tomography (CT) followed by PET/MRI, and completed a questionnaire to evaluate burden. Two teams of readers either assessed the 18F-FDG PET/CT or the 18F-FDG PET/MRI first; the other scan was assessed 1 month later. Maximum standardized uptake value corrected for lean body mass (SULmax) and mean apparent diffusion coefficient (ADCmean) were measured at the primary tumor location. Histopathology of the surgical resection specimen served as the reference standard for diagnostic accuracy calculations. When patients had a clinically complete response and continued active surveillance, response evaluations until 9 months after nCRT served as a proxy for ypT and ypN (i.e. ‘ycT’ and ‘ycN’). Results In the 21 included patients [median age 70 (IQR 62–75), 16 males], disease recurrence was found in the primary tumor in 14 (67%) patients (of whom one ypM+, detected on both scans) and in locoregional lymph nodes in six patients (29%). Accuracy (team 1/team 2) to detect yp/ycT+ with 18F-FDG PET/MRI vs. 18F-FDG PET/CT was 38/57% vs. 76/61%. For ypN+, accuracy was 63/53% vs. 63/42%, resp. Neither SULmax (both scans) nor ADCmean were discriminatory for yp/ycT+ . Fourteen of 21 (67%) patients were willing to undergo a similar 18F-FDG PET/MRI examination in the future. Conclusion 18F-FDG PET/MRI currently performs comparably to 18F-FDG PET/CT. Improvements in the scanning protocol, increasing reader experience and performing serial scans might contribute to enhancing the accuracy of tumor detection after nCRT using 18F-FDG PET/MRI. Trial registration Netherlands Trial Register NL9352.

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Clinical response assessment on DW-MRI compared with FDG-PET/CT after neoadjuvant chemoradiotherapy in patients with oesophageal cancer

Cited by 7 publications

References 44 publications

Diffusion-weighted MRI and 18F-FDG PET/CT in assessing the response to neoadjuvant chemoradiotherapy in locally advanced esophageal squamous cell carcinoma

Diffusion-weighted MRI and 18F-FDG PET/CT in assessing the response to neoadjuvant chemoradiotherapy in locally advanced esophageal squamous cell carcinoma

Pathologic complete response in patients with esophageal cancer receiving neoadjuvant chemotherapy or chemoradiation: A systematic review and meta‐analysis

18F-FDG PET/MRI for restaging esophageal cancer after neoadjuvant chemoradiotherapy

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