Pretreatment metabolic tumour volume is predictive of disease-free survival and overall survival in patients with oesophageal squamous cell carcinoma

Lemarignier, Charles; Fiore, Frédéric Di; Marre, Charline; Hapdey, Sébastien; Modzelewski, Romain; Gouel, P.; Michel, Pierre; Dubray, Bernard; Véra, Pierre

doi:10.1007/s00259-014-2839-y

Cited by 47 publications

(34 citation statements)

References 38 publications

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“…TLG and SUV max/mean did not show a significant effect. This result is in agreement with a recent publication by Lemarignier et al (8) in which MTV was prognostic for OS, whereas SUV max was not prognostic. Normalization to blood SUV and scan-time correction of SUV improved the prognostic value in our patient group, leading to comparable HRs and levels of significance for MTV and SUR values.…”

Section: Discussionsupporting

confidence: 93%

Prognostic Value of Pretherapeutic Tumor-to-Blood Standardized Uptake Ratio in Patients with Esophageal Carcinoma

et al. 2015

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Despite ongoing efforts to develop new treatment options, the prognosis for patients with inoperable esophageal carcinoma is still poor and the reliability of individual therapy outcome prediction based on clinical parameters is not convincing. The aim of this work was to investigate whether PET can provide independent prognostic information in such a patient group and whether the tumor-toblood standardized uptake ratio (SUR) can improve the prognostic value of tracer uptake values. Methods: 18 F-FDG PET/CT was performed in 130 consecutive patients (mean age ± SD, 63 ± 11 y; 113 men, 17 women) with newly diagnosed esophageal cancer before definitive radiochemotherapy. In the PET images, the metabolically active tumor volume (MTV) of the primary tumor was delineated with an adaptive threshold method. The blood standardized uptake value (SUV) was determined by manually delineating the aorta in the low-dose CT. SUR values were computed as the ratio of tumor SUV and blood SUV. Uptake values were scan-time-corrected to 60 min after injection. Univariate Cox regression and Kaplan-Meier analysis with respect to overall survival (OS), distant metastases-free survival (DM), and locoregional tumor control (LRC) was performed. Additionally, a multivariate Cox regression including clinically relevant parameters was performed. Results: In multivariate Cox regression with respect to OS, including T stage, N stage, and smoking state, MTV-and SUR-based parameters were significant prognostic factors for OS with similar effect size. Multivariate analysis with respect to DM revealed smoking state, MTV, and all SUR-based parameters as significant prognostic factors. The highest hazard ratios (HRs) were found for scan-time-corrected maximum SUR (HR 5 3.9) and mean SUR (HR 5 4.4). None of the PET parameters was associated with LRC. Univariate Cox regression with respect to LRC revealed a significant effect only for N stage greater than 0 (P 5 0.048). Conclusion: PET provides independent prognostic information for OS and DM but not for LRC in patients with locally advanced esophageal carcinoma treated with definitive radiochemotherapy in addition to clinical parameters. Among the investigated uptake-based parameters, only SUR was an independent prognostic factor for OS and DM. These results suggest that the prognostic value of tracer uptake can be improved when characterized by SUR instead of SUV. Further investigations are required to confirm these preliminary results.

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Section: Discussionsupporting

confidence: 93%

Prognostic Value of Pretherapeutic Tumor-to-Blood Standardized Uptake Ratio in Patients with Esophageal Carcinoma

et al. 2015

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“…In our series, a second cancer (head and neck, lung) was subsequently diagnosed in 12 patients classified in CR when considering their oesophageal cancer. In accordance with other and our previous series [7,25,26,31,32], the initial MTV on baseline PET was significantly higher in subsequently relapsing patients than in locally controlled patients and appeared to be a major prognostic factor. Given the multiplicity of unfavourable outcomes in oesophageal cancer patients, this difference in initial volume could be helpful to select the high-risk patients in whom the investigation of alternative and more aggressive strategies would be legitimate.…”

Section: Discussionsupporting

confidence: 91%

“…The MTV was defined with a threshold at 40 % of tumour SUV max ; this value is widely used to delineate volumes with significant FDG uptake [23] and was previously used in FDG PET/CT for oesophageal cancer [24][25][26].…”

Section: Fdg Pet/ct Analysismentioning

confidence: 99%

High FDG uptake areas on pre-radiotherapy PET/CT identify preferential sites of local relapse after chemoradiotherapy for locally advanced oesophageal cancer

Calais

Dubray

Nkhali

et al. 2015

Eur J Nucl Med Mol Imaging

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“…MTV and total lesion glycolysis (TLG) are volume-based parameters that represent metabolic tumor burden. A number of previous studies have reported the effectiveness of MTV and/or TLG as prognostic factors in esophageal carcinoma (6,(22)(23)(24). Roedl et al (24) reported that a decrease in MTV between pre-and post-treatment PET scans was a better predictor of histopathological response, and survival in comparison with a decrease in the SUV or the clinical response evaluation based on the RECIST 1.1 in adenocarcinomas of the esophagus.…”

Section: Discussionmentioning

confidence: 99%

18F-fluorodeoxyglucose positron emission computed tomography for monitoring tumor response in esophageal carcinoma treated with concurrent chemoradiotherapy

Zhang¹,

Wang

et al. 2017

Oncol Lett

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Abstract. The aim of the present study was to explore the value of 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) in monitoring the early tumor response of esophageal squamous cell carcinoma (ESCC) treated with concurrent chemoradiotherapy (CRT). A total of 48 patients with pathologically proven ESCC were retrospectively analyzed. All patients underwent two serial 18 F-FDG PET scans at baseline (pre-CRT) and 40 Gy/4 weeks of starting radiation therapy (inter-CRT). All patients received intensity-modulated radiotherapy (with a total radiation dose of 59.6 Gy) concurrently with cisplatin-based chemotherapy. The maximum standardized uptake value (SUV max ) and metabolic tumor volume (MTV) were measured using 18 F-FDG PET. The percentage changes (Δ) in SUV max and MTV between two serial scans were calculated and were revealed to be associated with the objective tumor response (oTR), according to the Response Evaluation Criteria in Solid Tumors 1.1. Among the 48 patients, 20.8% achieved a complete response, 68.8% exhibited a partial response and the oTR rate was 89.6%. On the pre-CRT PET scans, the mean SUV max and MTV were 14.1±5.8 and 58.2±25.4 cm . Univariate analysis revealed that ΔSUV max and ΔMTV were significantly associated with oTR (P= 0.010 and P= 0.001, respectively). ΔMTV was used as a predictor and a cut-off value of 54% discriminated responders from non-responders with a sensitivity of 69.8% and a specificity of 100% (P=0.001). The area under the receiver operating characteristic curve was 0.837 (95% confidence interval, 0.702-0.928). The results of the present study indicated that interim 18 F-FDG PET scans may provide early prognostic value for determining oTR in patients with ESCC undergoing treatment with CRT.

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Pretreatment metabolic tumour volume is predictive of disease-free survival and overall survival in patients with oesophageal squamous cell carcinoma

Abstract: Metabolic tumour volume is a major prognostic factor for DFS and OS in patients with oesophageal squamous cell carcinoma. Higher SUVmax values were paradoxically associated with longer survival. The location of the tumour also appeared to affect prognosis.

Cited by 47 publications

References 38 publications

Prognostic Value of Pretherapeutic Tumor-to-Blood Standardized Uptake Ratio in Patients with Esophageal Carcinoma

Prognostic Value of Pretherapeutic Tumor-to-Blood Standardized Uptake Ratio in Patients with Esophageal Carcinoma

High FDG uptake areas on pre-radiotherapy PET/CT identify preferential sites of local relapse after chemoradiotherapy for locally advanced oesophageal cancer

18F-fluorodeoxyglucose positron emission computed tomography for monitoring tumor response in esophageal carcinoma treated with concurrent chemoradiotherapy

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