Value of CT–PET after neoadjuvant chemoradiation in the prediction of histological tumour regression, nodal status and survival in oesophageal adenocarcinoma

Elliott, Jessie A; O’Farrell, Naoimh J.; King, Sinéad; Halpenny, Darragh; Malik, Vinod; Muldoon, Cian; Johnston, Ciarán; Reynolds, John V.

doi:10.1002/bjs.9670

Cited by 48 publications

(33 citation statements)

References 41 publications

(92 reference statements)

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“…Large recent studies (n 5 88-284) reported that the predictive value of a clinical complete response based on postchemoradiation 18 F-FDG PET (either or not combined with endoscopic biopsy) for pathCR was low (range, 20%-64%) (11,12,14), a finding that was confirmed in the current study (45%). In other FIGURE 2.…”

Section: Discussionsupporting

confidence: 79%

“…Therefore, seeking more powerful predictors for pathCR is of high relevance to modern personalized cancer care for which the aim is to tailor treatment to the individual patient. 18 F-FDG PET is a well-established imaging modality for the initial staging of esophageal cancer and restaging after preoperative chemoradiotherapy for the detection of distant (interval) metastases (10)(11)(12). The value of 18 F-FDG PET to predict response to preoperative chemoradiotherapy in patients with esophageal cancer has been studied extensively with wide varying methodologies and conflicting results (6,10,13).…”

mentioning

confidence: 99%

“…The value of 18 F-FDG PET to predict response to preoperative chemoradiotherapy in patients with esophageal cancer has been studied extensively with wide varying methodologies and conflicting results (6,10,13). Some investigators examined the value of a (subjective) determination of clinical response by experienced nuclear medicine physicians based on 18 F-FDG PET scanning after chemoradiotherapy (11,12,14). Most other 18 F-FDG PET studies evaluated the value of quantitative metabolic parameters such as the SUV mean or SUV max within a tumor for assessment of response (5,6,12,13,15).…”

mentioning

confidence: 99%

“…Some investigators examined the value of a (subjective) determination of clinical response by experienced nuclear medicine physicians based on 18 F-FDG PET scanning after chemoradiotherapy (11,12,14). Most other 18 F-FDG PET studies evaluated the value of quantitative metabolic parameters such as the SUV mean or SUV max within a tumor for assessment of response (5,6,12,13,15). A few studies evaluated more advanced 18 F-FDG PET-based metabolic parameters such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) for response prediction (16)(17)(18).…”

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confidence: 99%

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The Incremental Value of Subjective and Quantitative Assessment of ¹⁸F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer

et al. 2016

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A reliable prediction of a pathologic complete response (pathCR) to chemoradiotherapy before surgery for esophageal cancer would enable investigators to study the feasibility and outcome of an organ-preserving strategy after chemoradiotherapy. So far no clinical parameters or diagnostic studies are able to accurately predict which patients will achieve a pathCR. The aim of this study was to determine whether subjective and quantitative assessment of baseline and postchemoradiation 18 F-FDG PET can improve the accuracy of predicting pathCR to preoperative chemoradiotherapy in esophageal cancer beyond clinical predictors. Methods: This retrospective study was approved by the institutional review board, and the need for written informed consent was waived. Clinical parameters along with subjective and quantitative parameters from baseline and postchemoradiation 18 F-FDG PET were derived from 217 esophageal adenocarcinoma patients who underwent chemoradiotherapy followed by surgery. The associations between these parameters and pathCR were studied in univariable and multivariable logistic regression analysis. Four prediction models were constructed and internally validated using bootstrapping to study the incremental predictive values of subjective assessment of 18 F-FDG PET, conventional quantitative metabolic features, and comprehensive 18 F-FDG PET texture/geometry features, respectively. The clinical benefit of 18 F-FDG PET was determined using decision-curve analysis. Results: A pathCR was found in 59 (27%) patients. A clinical prediction model (corrected c-index, 0.67) was improved by adding 18 F-FDG PET-based subjective assessment of response (corrected c-index, 0.72). This latter model was slightly improved by the addition of 1 conventional quantitative metabolic feature only (i.e., postchemoradiation total lesion glycolysis; corrected c-index, 0.73), and even more by subsequently adding 4 comprehensive 18 F-FDG PET texture/geometry features (corrected c-index, 0.77). However, at a decision threshold of 0.9 or higher, representing a clinically relevant predictive value for pathCR at which one may be willing to omit surgery, there was no clear incremental value. Conclusion: Subjective and quantitative assessment of 18 F-FDG PET provides statistical incremental value for predicting pathCR after preoperative chemoradiotherapy in esophageal cancer. However, the discriminatory improvement beyond clinical predictors does not translate into a clinically relevant benefit that could change decision making.

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Section: Discussionsupporting

confidence: 79%

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confidence: 99%

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confidence: 99%

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The Incremental Value of Subjective and Quantitative Assessment of ¹⁸F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer

et al. 2016

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“…Cervino et al 29 described a 91% 18-month disease-free survival for patients with a negative FDG PET-CT, who did not undergo surgery postneoadjuvant treatment. However, the reported data are heterogeneous; for example, Elliot et al 30 found that CMR on post-CRT FDG PET-CT and CPR did not correlate. This may partly relate to study timing, as radiation-induced oesophagitis can mimic residual active disease and limit the utility of interim and post-treatment PET-CT.…”

Section: Oesophageal Carcinomamentioning

confidence: 99%

Radiotherapy response evaluation using FDG PET-CT—established and emerging applications

Cliffe

Patel

Prestwich

et al. 2017

The British Journal of Radiology

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Radiation therapy is a common component of curative cancer treatment. However, there is a significant incidence of treatment failure. In these cases, salvage surgical options are sometimes appropriate. Accurate assessment of response and early recognition of treatment success or failure is therefore critical to guide treatment decisions and impacts on survival and the morbidity of treatment. Traditionally, treatment response has depended upon the anatomical measurement of disease. However, this may not correlate well with the presence of disease, especially after radiotherapy. Combined positron emission tomography (PET) and CT imaging employs radioactive tracers to identify molecular characteristics of tissues. PET imaging exploits the fact that malignancies have characteristic molecular profiles which differ compared with surrounding tissues. The complementary anatomical and functional information facilitates accurate non-invasive assessment of surrogate biomarkers of disease activity.This article reviews the rationale for positron emission tomography (PET)-CT response assessment in radiation oncology, describing current uses of 2-[18 F]-fluoro-2-deoxy-D-glucose (FDG) PET-CT in treatment response following radiotherapy in head and neck, oesophageal, rectal and brain tumours. Emerging applications of FDG PET-CT in cervical and lung carcinomas and hepato-pancreatico-biliary tumours, particularly pancreatic carcinoma and liver metastases (post-selective internal radiotherapy treatment), are reviewed. Finally, the limitations of FDG PET-CT are considered, highlighting areas for future development.

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Clinical TNM staging for esophageal, gastric, and colorectal cancers in the era of neoadjuvant therapy: A systematic review of the literature

Shimada

Fukagawa

Haga

et al. 2021

Annals of Gastroent Surgery

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Value of CT–PET after neoadjuvant chemoradiation in the prediction of histological tumour regression, nodal status and survival in oesophageal adenocarcinoma

Abstract: CT-PET following nCRT for OAC has poor prognostic and discriminatory value for clinical application.

Cited by 48 publications

References 41 publications

The Incremental Value of Subjective and Quantitative Assessment of ¹⁸F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer

The Incremental Value of Subjective and Quantitative Assessment of ¹⁸F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer

Radiotherapy response evaluation using FDG PET-CT—established and emerging applications

Clinical TNM staging for esophageal, gastric, and colorectal cancers in the era of neoadjuvant therapy: A systematic review of the literature

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Value of CT–PET after neoadjuvant chemoradiation in the prediction of histological tumour regression, nodal status and survival in oesophageal adenocarcinoma

Abstract: CT-PET following nCRT for OAC has poor prognostic and discriminatory value for clinical application.

Cited by 48 publications

References 41 publications

The Incremental Value of Subjective and Quantitative Assessment of 18F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer

The Incremental Value of Subjective and Quantitative Assessment of 18F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer

Radiotherapy response evaluation using FDG PET-CT—established and emerging applications

Clinical TNM staging for esophageal, gastric, and colorectal cancers in the era of neoadjuvant therapy: A systematic review of the literature

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The Incremental Value of Subjective and Quantitative Assessment of ¹⁸F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer

The Incremental Value of Subjective and Quantitative Assessment of ¹⁸F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer