Limited Predictive Value of FDG-PET for Response Assessment in the Preoperative Treatment of Esophageal Cancer: Results of a Prospective Multi-Center Trial (SAKK 75/02)

作者：Klaeser Bernd^*; Nitzsche Egbert; Schuller Jan C; Koeberle Dieter; Widmer Lucas; Balmer Majno Sabine; Hany Thomas; Cescato Wenger Corinne; Brauchli Peter; Zuend Michael; Pestalozzi Bernhard C; Caspar Clemens; Albrecht Susanne; von Moos Roger; Ruhstaller Thomas

来源：Onkologie, 2009, 32(12): 724-730.

DOI：10.1159/000251842

• Esophageal cancer
• Positron emission tomography (PET)
• Predictive marker
• Response assessment

Background: Only responding patients benefit from preoperative therapy for locally advanced esophageal carcinoma. Early detection of non-responders may avoid futile treatment and delayed surgery. Patients and Methods: In a multi-center phase II trial, patients with resectable, locally advanced esophageal carcinoma were treated with 2 cycles of induction chemotherapy followed by chemoradiotherapy (CRT) and surgery. Positron emission tomography with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG-PET) was performed at baseline and after induction chemotherapy. The metabolic response was correlated with tumor regression grade (TRG). A decrease in FDG tumor uptake of less than 40% was prospectively hypothesized as a predictor for histopathological non-response (TRG > 2) after CRT. Results: 45 patients were included. The median decrease in FDG tumor uptake after chemotherapy correlated well with TRG after completion of CRT (p = 0.021). For an individual patient, less than 40% decrease in FDG tumor uptake after induction chemotherapy predicted histopathological non-response after completion of CRT, with a sensitivity of 68% and a specificity of 52% (positive predictive value 58%, negative predictive value 63%). Conclusions: Metabolic response correlated with histopathology after preoperative therapy. However, FDG-PET did not predict non-response after induction chemotherapy with sufficient clinical accuracy to justify withdrawal of subsequent CRT and selection of patients to proceed directly to surgery.

• 出版日期2009