Preoperative Prediction of Pathologic Response to Neoadjuvant Chemoradiotherapy in Patients With Esophageal Cancer Using 18F-FDG PET/CT and DW-MRI: a prospective multicenter study
Borggreve, Alicia S; Goense, Lucas; van Rossum, Peter S N; Heethuis, Sophie E; van Hillegersberg, Richard; Lagendijk, Jan J W; Lam, Marnix G E H; van Lier, Astrid L H M W; Mook, Stella; Ruurda, Jelle P; van Vulpen, Marco; Voncken, Francine E M; Aleman, Berthe M P; Bartels-Rutten, Annemarieke; Ma, Jingfei; Fang, Penny; Musall, Benjamin C; Lin, Steven H; Meijer, Gert J
(2020) International Journal of Radiation Oncology Biology Physics, volume 106, issue 5, pp. 998 - 1009
(Article)
Abstract
PURPOSE: Accurate preoperative prediction of pathologic response to neoadjuvant chemoradiotherapy (nCRT) in patients with esophageal cancer could enable omission of esophagectomy in patients with a pathologic complete response (pCR). This study aimed to evaluate the individual and combined value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography ( 18F-FDG
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PET/CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) during and after nCRT to predict pathologic response in patients with esophageal cancer. METHODS AND MATERIALS: In this multicenter prospective study, patients scheduled to receive nCRT followed by esophagectomy for esophageal cancer underwent 18F-FDG PET/CT and DW-MRI scanning before the start of nCRT, during nCRT, and before esophagectomy. Response to nCRT was based on histopathologic evaluation of the resection specimen. Relative changes in 18F-FDG PET/CT and DW-MRI parameters were compared between patients with pCR and non-pCR groups. Multivariable ridge regression analyses with bootstrapped c-indices were performed to evaluate the individual and combined value of 18F-FDG PET/CT and DW-MRI. RESULTS: pCR was found in 26.1% of 69 patients. Relative changes in 18F-FDG PET/CT parameters after nCRT (Δ standardized uptake value [SUV] mean,postP = .016, and Δ total lesion glycolysis postP = .024), as well as changes in DW-MRI parameters during nCRT (Δ apparent diffusion coefficient [ADC] duringP = .008) were significantly different between pCR and non-pCR. A c-statistic of 0.84 was obtained for a model with ΔADC during, ΔSUV mean,post, and histology in classifying patients as pCR (versus 0.82 for ΔADC during and 0.79 for ΔSUV mean,post alone). CONCLUSIONS: Changes on 18F-FDG PET/CT after nCRT and early changes on DW-MRI during nCRT can help identify pCR to nCRT in esophageal cancer. Moreover, 18F-FDG PET/CT and DW-MRI might be of complementary value in the assessment of pCR.
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Keywords: Radiation, Oncology, Radiology Nuclear Medicine and imaging, Cancer Research, Journal Article
ISSN: 0360-3016
Publisher: Elsevier
Note: Funding Information: This research was partially funded by Elekta Inc and by National Institutes of Health / National Cancer Institute Cancer Center support grant P30CA016672 . Funding Information: Disclosures: R.v.H. and J.P.R. are proctoring surgeons for Intuitive Surgical Inc and train other surgeons in robot-assisted minimally invasive esophagectomy. J.J.W. receives research funding from Elekta Inc. S.H.L. receives research funding from Elekta Inc, Genentech, Hitachi Chemicals, New River Labs, and Beyond Spring Pharmaceuticals and is a member of the Advisory Board of AstraZeneca. All of the above are not in conflict with the research in question. All other authors have nothing to disclose. Funding Information: This research was partially funded by Elekta Inc and by National Institutes of Health/National Cancer Institute Cancer Center support grant P30CA016672. Disclosures: R.v.H. and J.P.R. are proctoring surgeons for Intuitive Surgical Inc and train other surgeons in robot-assisted minimally invasive esophagectomy. J.J.W. receives research funding from Elekta Inc. S.H.L. receives research funding from Elekta Inc, Genentech, Hitachi Chemicals, New River Labs, and Beyond Spring Pharmaceuticals and is a member of the Advisory Board of AstraZeneca. All of the above are not in conflict with the research in question. All other authors have nothing to disclose. Publisher Copyright: © 2020 Elsevier Inc.
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