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The Change in the maxSUV on Repeat PET Scan After Chemoradiotherapy Identifies Patient with Esophageal Cancer Who are Complete Responders
R. J. Cerfolio*, A. Bryant, A. Talati, T. Winokur. University of Alabama at Birmingham, Birmingham, AL,
BACKGROUND:
Some have suggested that a prospective study which randomizes complete responders after chemoradiotherapy for esophageal cancer to receive observation compared to surgical resection is needed. However, the identification of complete responders prior to surgery has been elusive.
METHODS:
A retrospective cohort study using a prospective database of patients with esophageal cancer. All patients underwent an initial and repeat PET scan and EUS-FNA (at the same institution), neo-adjuvant chemoradiotherapy, and Ivor Lewis esophagogastrectomy with complete nodal resection. Pathologic specimens were reviewed for percent of tumor death.
RESULTS:
Seventy-one of the two-hundred and five patients who underwent esophageal resection had their initial and repeat PET scan at the same center. Of these 61 patients thirty (42%) were complete responders. The median maxSUV of their esophageal cancer decreased 75%. The median maxSUV decreased only 50% in the twenty-seven patients who were partial responders and only 19% in the 14 patients who were non-responders. The repeat EUS-FNA also was predictive of pathology in complete responders however its accuracy was only 54%. ROC analysis showed that when the maxSUV fell by 78% or more (85% sensitivity, 76% specificity) the patient was likely to be a complete responder (p=0.039).
CONCLUSIONS:
When the initial and repeat PET scan are performed on the same machine using similar techniques at least 30 days after the completion of the pre-operative chemoradiation, the percent change in the maxSUV is the best predictor of the amount of tumor death and thus of patient’s response to neoadjuvant chemoradiotherapy for esophageal cancer. When the maxSUV falls by 78% there is a high likelihood that the patient is a complete responder. These data may help guide neoadjuvant therapy and may also help identify patients for a future randomized study that compares observation to surgical resection in patients with esophageal cancer who appear to be complete responders after neoadjuvant therapy.
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