Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer.
Ann Thorac Surg
; 78(4): 1152-60; discussion 1152-60, 2004 Oct.
Article
en En
| MEDLINE
| ID: mdl-15464463
ABSTRACT
BACKGROUND:
This study evaluates the utility of positron emission tomography (PET), endoscopic ultrasonography (EUS), and computed tomographic (CT) scans to predict pathologic response and survival following preoperative chemoradiation (CRT) in esophageal cancer.METHODS:
One hundred three sequential patients with locoregionally advanced esophageal cancer, who were treated with CRT and esophageal resection between May 2001 and November 2003 at the University of Texas M.D. Anderson Cancer Center, were retrospectively reviewed. PET, EUS, and CT were performed before (pre) or after (post) CRT and before surgical resection. PET standardized uptake value (SUV) was defined as maximal uptake in primary tumor.RESULTS:
Most patients were male (91 [88%]) with adenocarcinoma (90 [87%]). Pretreatment clinical stages were IIA (42 [41%]), IIB (5 [5%]), III (50 [49%]), and IVA (6 [6%]). At the time of surgery, 58 patients (56%) had a pathologic response to CRT (< or =10% viable cells). Post-CRT measurements that correlated with pathologic response were CT esophageal wall thickness (13.3 vs 15.3 mm, p = 0.04), EUS mass size (0.7 vs 1.7 cm, p = 0.01) and PET SUV (3.1 vs 5.8, p = 0.01). Post-CRT PET SUV equal to or greater than 4 had the highest accuracy for pathologic response (76%). Univariate and multivariate Cox regression analysis demonstrated that a post-CRT PET SUV equal to or greater than 4 was an independent predictor of survival (HR, 3.5, p = 0.04).CONCLUSIONS:
The FDG-PET SUV is the most accurate noninvasive test to predict long-term survival after preoperative CRT and before surgical resection. Post-CRT FDG-PET cannot, however, rule out residual microscopic disease so esophagectomy should remain a therapeutic option even if the post-CRT imaging modalities are normal.
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Bases de datos:
MEDLINE
Asunto principal:
Camptotecina
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Neoplasias Esofágicas
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Carcinoma de Células Escamosas
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Adenocarcinoma
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Tomografía Computarizada por Rayos X
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Endosonografía
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Terapia Neoadyuvante
/
Tomografía de Emisión de Positrones
Tipo de estudio:
Diagnostic_studies
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Evaluation_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Revista:
Ann Thorac Surg
Año:
2004
Tipo del documento:
Article
País de afiliación:
Estados Unidos