Utility of PET, CT, and EUS to Identify Pathologic Responders in Esophageal Cancer

Swisher, Stephen G.; Maish, Mary S.; Erasmus, Jeremy J.; Correa, Arlene M.; Ajani, Jaffer A.; Bresalier, Robert S.; Komaki, Ritsuko; Macapinlac, Homer A.; Munden, Reginald F.; Putnam, Joe B.; Rice, David C.; Smythe, W. Roy; Vaporciyan, Ara A.; Walsh, Garrett L.; Wu, Tsung Teh; Roth, Jack A.

doi:10.1016/j.athoracsur.2004.04.046

Cited by 272 publications

(213 citation statements)

References 23 publications

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“…Overall, our criteria are in line with the published standard criteria [28]. The largest wall diameter in CT scan as a predictor for response after preoperative therapy has been proven to have prognostic relevance in other studies [29]. In contrast, more technically demanding volume-based evaluations by CT scan have rarely been studied and show conflicting results after 2 weeks of therapy [30,31].…”

Section: Discussionsupporting

confidence: 69%

Post-therapeutic response evaluation by a combination of endoscopy and CT scan in esophagogastric adenocarcinoma after chemotherapy: better than its reputation

Blank

Lordick

Bader³

et al. 2014

Gastric Cancer

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Background Neoadjuvant chemotherapy is an accepted standard of care for locally advanced esophagogastric cancer. As only a subgroup benefits, a response-based tailored treatment would be of interest. The aim of our study was the evaluation of the prognostic and predictive value of clinical response in esophagogastric adenocarcinomas. Methods Clinical response based on a combination of endoscopy and computed tomography (CT) scan was evaluated retrospectively within a prospective database in center A and then transferred to center B. A total of 686/740 (A) and 184/210 (B) patients, staged cT3/4, cN0/1 underwent neoadjuvant chemotherapy and were then restaged by endoscopy and CT before undergoing tumor resection. Of 184 patients, 118 (B) additionally had an interim response assessment 4-6 weeks after the start of chemotherapy. Results In A, 479 patients (70 %) were defined as clinical nonresponders, 207 (30 %) as responders. Median survival was 38 months (nonresponders: 27 months, responders: 108 months, log-rank, p \ 0.001). Clinical and histopathological response correlated significantly (p \ 0.001). In multivariate analysis, clinical response was an independent prognostic factor (HR for death 1.4, 95 %CI 1.0-1.8, p = 0.032). In B, 140 patients (76 %) were nonresponders and 44 (24 %) responded. Median survival was 33 months, (nonresponders: 27 months, responders: not reached, Electronic supplementary material The online version of this article

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Section: Discussionsupporting

confidence: 69%

Post-therapeutic response evaluation by a combination of endoscopy and CT scan in esophagogastric adenocarcinoma after chemotherapy: better than its reputation

Blank

Lordick

Bader³

et al. 2014

Gastric Cancer

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“…[15][16][17][18] However, the initial results and subsequent changes in positron emission tomography (PET) show promise. [19][20][21][22][23][24][25] Many investigators have demonstrated that decrease in metabolic activity as measured by the standardized uptake value (SUV) on PET/computed tomography (CT) as a result of therapy is of prognostic value. [25][26][27][28] In addition, PET/CT images obtained during therapy have been studied in a limited number of patients and seem to provide useful information regarding the response to therapy and prognosis of patients.…”

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confidence: 99%

The higher the decrease in the standardized uptake value of positron emission tomography after chemoradiation, the better the survival of patients with gastroesophageal adenocarcinoma

Javeri

Xiao

Rohren

et al. 2009

Cancer

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BACKGROUND:Postchemoradiation percentage decrease in standardized uptake value (SUV) of positron emission tomography (PET) from baseline correlates with overall survival (OS) and pathologic response. Analyses of dichotomized data are commonly reported. The authors analyzed percentage SUV decrease as both dichotomized and continuous variables.METHODS:The authors assessed 151 consecutive patients with gastroesophageal adenocarcinoma who had chemoradiation and surgery. Baseline and postchemoradiation PET/computed tomography imaging was performed. The log‐rank test and Cox proportional hazards models were used to associate percentage SUV changes and OS, and logistic regression models were used to detect the association between percentage SUV changes and pathologic response.RESULTS:A >52% SUV decrease (dichotomized analysis) was associated with a longer OS (log‐rank test, P = .023). The univariate Cox proportional hazards model indicated that greater percentage SUV decrease (as a continuous variable) was associated with a lower risk of death (hazard ratio [HR], 0.99; P = .01). Pathologic response (≤50% residual cancer) was associated with longer OS (P = .003). Patients with chemoradiation resistance (>50% residual cancer) tended to have a higher risk of death than those with chemoradiation sensitivity (0‐50% residual cancer; HR, 2.12; P = .099). In the multivariate model, the percentage SUV decrease (as a continuous variable) was the only prognosticator of OS (P = .01). The percentage SUV decrease was nonsignificantly associated with pathologic complete response (univariate odds ratio [OR], 1.01; P = .06 and multivariate OR, 1.03; P = .07).CONCLUSIONS:The greater the decline in SUV after chemoradiation, the longer is the OS of gastroesophageal adenocarcinoma patients. The percentage SUV decrease as a continuous variable is a better prognosticator of OS than its dichotomized assessments. Cancer 2009. © 2009 American Cancer Society.

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“…These data support the idea that changes in FDG uptake predict long-term and disease-free survival. [29][30][31][32] Similar to findings for other cancers, decreases in FDG uptake between 50% and 60% from baseline indicated clinically significant treatment responses. 33,34 Early in treatment, responses also have been identified in patients who have locally advanced disease.…”

Section: Gastrointestinal Cancersmentioning

confidence: 80%

PET Imaging for Treatment Response in Cancer

Eary

2008

PET Clinics

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KeywordsPET; FDG; Cancer imaging; Response imaging PET tumor surveys have become widely used in clinical practice. [F-18] fluorodeoxyglucose (FDG) is the most commonly used radiotracer for clinical indication of tumor staging and restaging after treatment. FDG PET consistently has exhibited better diagnostic performance than conventional imaging in adults and pediatric populations. [1][2][3][4] More recently, a growing body of literature is reporting the use of FDG and other PET imaging agents in treatment response assessment. [5][6][7] In many cases, FDG PET has proved to be a reliable means of noninvasively observing response in various treatments.Additionally, reliable determination of past treatment changes, including recurrent tumors and differentiation of benign and malignant lesions, will reduce morbidity and the cost of care in anatomic imaging. The Response Evaluation Criteria in Solid Tumors (RECIST) are a useful means to report quantitative changes in tumor size on CT scans in many different tumors in response to treatment. 8,9,10 Many tumor types, however, do not change size appreciably in response to treatment. Early changes that may indicate treatment regimen effectiveness also may not result in tumor change in size. FDG PET is a relatively sensitive indicator of treatment response in many tumors, indicating changes in metabolism that often precede or take the place of tumor size change. Fig. 1 shows some examples of FDG PET tumor response.Recently, several cooperative groups have addressed the use of FDG PET as a biomarker for cancer treatment response. An early report by the European Organization for Research and Treatment of Cancer (EORTC) set criteria for treatment response according to changes in tumor FDG uptake compared to baseline. 2 These criteria include:Complete response (CR)- [F-18] fluorodeoxyglucose uptake is comparable to baseline activity in all lesions Partial response (PR)-all target lesions have greater than 25% decrease in standardized uptake variable (SUV) Stable disease (SD)-target lesions have less than 25% increase or decrease in SUV Progressive disease (PD)-at least one target lesion has greater than 25% increase in SUV, or new lesions appear (regardless of SUV changes in target lesions)These criteria are in wide use today for clinical FDG PET imaging. A set of criteria for clinically significant changes in tumor FDG uptake, however, is based on consistent parameters for the FDG PET acquisition between studies in the same patient, and between patient imaging groups at different institutions. Development and evaluation of new cancer therapies could be enhanced by a set of validated biomarkers for treatment response. FDG PET meets these criteria in clinical studies, if imaging studies are conducted with patients on clinical therapeutic trials in a reliable and consistent manner. 3 To address the consistency in FDG PET data for use as NIH Public Access A review of cancer treatment response begins with consideration of the pathological basis of the tumor process. Tumors are c...

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Utility of PET, CT, and EUS to Identify Pathologic Responders in Esophageal Cancer

Cited by 272 publications

References 23 publications

Post-therapeutic response evaluation by a combination of endoscopy and CT scan in esophagogastric adenocarcinoma after chemotherapy: better than its reputation

Post-therapeutic response evaluation by a combination of endoscopy and CT scan in esophagogastric adenocarcinoma after chemotherapy: better than its reputation

The higher the decrease in the standardized uptake value of positron emission tomography after chemoradiation, the better the survival of patients with gastroesophageal adenocarcinoma

PET Imaging for Treatment Response in Cancer

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