The prognostic value of residual nodal disease following neoadjuvant chemoradiation for esophageal cancer in patients with complete primary tumor response

150 Background: The prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) has not yet been defined in locally advanced esophageal cancer (LAEC). This study aims to elucidate the prognostic role of PET/CT for patients treated with neoadjuvant chemoradiation (CRT) followed by esophagectomy. Methods: We retrospectively evaluated patients with LAEC treated from 2006 to 2014 with neoadjuvant CRT followed by esophagectomy. 86 patients had pre-CRT and post CRT PET/CT scans performed at our institution. These scans were imported into an image analysis program. PET parameters maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), mean standardized uptake value (SUVmean), and peak standardized uptake value (SUVpeak) were recorded for both pre-CRT and post-CRT scans. MTV was defined using a previously described liver method. The correlation of these parameters with pathologic complete response (pCR) and clinical outcomes was analyzed using binomial logistic regression and cox regression. Results: Pre-CRT MTV < 33.6 (median value) was significantly predictive of pCR (p = 0.019, OR = 3.064). An ROC curve was produced to determine a binary cutoff of 35.8, yielding a higher specificity (62.3% vs. 59%) and the same sensitivity (72.7%), increasing the significance to p = 0.010, OR = 3.378. The ratio of postMTV/preMTV (MTVr) was calculated. MTVr > 0.2857 (median value) was significantly predictive of distant metastasis (DM) after esophagectomy (p = 0.018, OR = 3.680). An ROC curve was produced to determine a binary cutoff of 0.301, which increased specificity from 57.1% to 60.3%, and maintained the same sensitivity at 81.3%, increasing the significance to p = 0.014, OR = 3.815. SUVmax, mean and peak were not predictive. Conclusions: Pre CRT MTV was predictive of pCR and MTVr was predictive of DM. Our data suggests that MTV is superior to SUVmax, mean and peak in predicting for response to treatment in LAEC. Further study is needed to determine if Pre CRT MTV and change in MTV can help define which patients will most benefit from esophagectomy and/ or adjuvant chemotherapy.

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Surgery following neoadjuvant chemoradiation therapy in clinical N3 esophageal cancer results in improved survival: a propensity-matched analysis

Diseases of the Esophagus ◽

10.1093/dote/doaa118 ◽

2020 ◽

Author(s):

Christine E Alvarado ◽

Stephanie G Worrell ◽

Katelynn C Bachman ◽

Kelsey Gray ◽

Yaron Perry ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymphovascular Invasion ◽

Neoadjuvant Chemoradiotherapy ◽

Neoadjuvant Chemoradiation ◽

Chemoradiation Therapy ◽

Nodal Metastases ◽

Inclusion Criteria ◽

Nodal Disease ◽

Poor Outcomes ◽

Multiagent Chemotherapy

Summary Esophageal cancer patients with extensive nodal metastases have poor survival, and benefit of surgery in this population is unclear. The aim of this study is to determine if surgery after neoadjuvant chemoradiotherapy (nCRT) improves overall survival (OS) in patients with clinical N3 (cN3) esophageal cancer relative to chemoradiation therapy (CRT) alone. The National Cancer Database was queried for all patients with cN3 esophageal cancer between 2010 and 2016. Patients who met inclusion criteria (received multiagent chemotherapy and radiation dose ≥30 Gy) were divided into two cohorts: CRT alone and nCRT + surgery. 769 patients met inclusion criteria, including 560 patients who received CRT alone, and 209 patients who received nCRT + surgery. The overall 5-year survival was significantly lower in the CRT alone group compared to the nCRT + surgery group (11.8% vs 18.0%, P < 0.001). A 1:1 propensity matched cohort of CRT alone and nCRT + surgery patients also demonstrated improved survival associated with surgery (13.11 mo vs 23.1 mo, P < 0.001). Predictors of survival were analyzed in the surgery cohort, and demonstrated that lymphovascular invasion was associated with worse survival (HR 2.07, P = 0.004). Despite poor outcomes of patients with advanced nodal metastases, nCRT + surgery is associated with improved OS. Of those with cN3 disease, only 27% underwent esophagectomy. Given the improved OS, patients with advanced nodal disease should be considered for surgery. Further investigation is warranted to determine which patients with cN3 disease would benefit most from esophagectomy, as 5-year survival remains low (18.0%).

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Prognostic Value of Quantitative 18F-FDG PET/CT Parameters Measured in Primary Tumors and Suspicious Lymph Nodes in Patients With Esophageal Carcinoma

10.21203/rs.3.rs-32577/v1 ◽

2020 ◽

Author(s):

Francisco Tustumi ◽

Flávio Roberto Takeda ◽

Paulo Schiavom Duarte ◽

David Gutiérrez Albenda ◽

Rubens Antonio Aissar Sallum ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Nodes ◽

Neoadjuvant Therapy ◽

Burden Of Disease ◽

Primary Tumor ◽

Fdg Pet ◽

Prognostic Value ◽

Primary Tumors ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Objective:Quantitative 18F-FDG PET/CT parameters have been described as prognostic indicators in esophageal cancer. The objective of this study isto evaluate the prognostic value of the maximum standardized uptake value (SUVmax), metabolic tumor value (MTV) and total lesion glycolysis (TLG) measured in the primary tumor and suspicious lymph nodes.Methods: A cohort study was performed to assess the association of SUVmax, MTV and TLG measured prior to and post neoadjuvant therapywithoverall survival (OS) of patients with esophageal cancer who received trimodal therapy. The quantitative techniques were applied in the primary tumor and suspicious lymph nodes. The OS rates were analyzed. Results: Before neoadjuvant therapy, 106 patients underwent PET/CT, and 39 patients underwent post-neoadjuvant therapy PET/CT exams. Before neoadjuvanttherapy, PET/CT showed that all the variables of the evaluated lymph nodes were statistically significant in predicting OS. Postneoadjuvanttherapy, none of the PET/CT variables of lymph nodes were related to prognosis. On the other hand, all primary tumor volumetric variables were related to overall survival. The MTV (HR: 4.66; 95% CI: 1.54-14.08) and TLG (HR: 4.86; 95% CI: 1.66-14.26) of the primary tumor post neoadjuvanttherapy and the variations in MTV (HR: 2.95; 95% CI: 1.01-3.52) and TLG (HR: 3.49; 95% CI: 1.01-3.52) of the primary tumor pre-to-post-neoadjuvanttherapy were prognostic variables. Conclusion: In patients with esophageal cancer, the burden of disease in suspicious lymph nodes and the primary tumor prior to therapy and the residual burden of disease in the primary tumor post therapy assessed by PET/CT were associated with prognosis.

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Prognostic value of lymph node to primary tumor standardized uptake value ratio in unresectable esophageal cancer

BMC Cancer ◽

10.1186/s12885-020-07044-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Po-Jui Chen ◽

Wing-Keen Yap ◽

Yu-Chuan Chang ◽

Chen-Kan Tseng ◽

Yin-Kai Chao ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Primary Tumor ◽

Prognostic Value ◽

Standardized Uptake Value

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Pathologic Tumor Response to Neoadjuvant Chemoradiation Predicts Survival in Esophageal Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2018.07.531 ◽

2018 ◽

Vol 102 (3) ◽

pp. e35-e36

Author(s):

A. Moeller ◽

M.M. Qureshi ◽

S.X. Yan ◽

M.A. Dyer ◽

K. Suzuki ◽

...

Keyword(s):

Esophageal Cancer ◽

Tumor Response ◽

Neoadjuvant Chemoradiation

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Pathologically Complete Response after Triple Therapy in Locally Advanced Esophageal Cancer in a Hereditary Hemorrhagic Telangiectasia Patient

Case Reports in Oncology ◽

10.1159/000505832 ◽

2020 ◽

Vol 13 (1) ◽

pp. 176-181

Author(s):

Robin Park ◽

Alisdair Philp ◽

Alykhan S. Nagji ◽

Anup Kasi

Keyword(s):

Esophageal Cancer ◽

Hereditary Hemorrhagic Telangiectasia ◽

Tumor Response ◽

Locally Advanced ◽

Complete Response ◽

Neoadjuvant Chemoradiation ◽

Advanced Esophageal Cancer ◽

Endoscopic Screening ◽

Hereditary Hemorrhagic Telangiectasia Patient ◽

Locally Advanced Esophageal Cancer

Hereditary hemorrhagic telangiectasia (HHT) is a disorder characterized by vascular manifestations including mucocutaneous and visceral telangiectasias and arteriovenous malformations. Herein we present the case of a relatively young patient with HHT with an incidentally discovered locally advanced esophageal cancer on endoscopic screening and pathologically complete response after neoadjuvant chemoradiation. This case highlights an unusual tumor response to chemoradiation in locally advanced esophageal cancer, and the surveillance care of HHT patients.

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Prognostic Value of Quantitative 18F-FDG PET/CT Parameters Measured in Primary Tumors and Suspicious Lymph Nodes in Patients with Esophageal Carcinoma.

10.21203/rs.3.rs-34345/v1 ◽

2020 ◽

Author(s):

Francisco Tustumi ◽

Flávio Roberto Takeda ◽

Paulo Schiavom Duarte ◽

David Gutiérrez Albenda ◽

Rubens Antonio Aissar Sallum ◽

...

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Lymph Nodes ◽

Neoadjuvant Therapy ◽

Burden Of Disease ◽

Primary Tumor ◽

Fdg Pet ◽

Prognostic Value ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Background: Quantitative 18F-FDG PET/CT parameters have been described as prognostic indicators in esophageal cancer. The aim of this study was to evaluate the prognostic value of the maximum standardized uptake value (SUVmax), metabolic tumor value (MTV) and total lesion glycolysis (TLG) measured in the primary tumor and suspicious lymph nodes. A cohort study was performed to assess the association of SUVmax, MTV and TLG measured prior to and post neoadjuvant therapy with overall survival (OS) of patients with esophageal cancer who received trimodal therapy. The quantitative techniques were applied in the primary tumor and suspicious lymph nodes. The OS rates were analyzed. Results: Before neoadjuvant therapy, 106 patients underwent PET/CT, and 39 patients underwent post-neoadjuvant therapy PET/CT exams. Before neoadjuvant therapy, PET/CT showed that all the variables of the evaluated lymph nodes were statistically significant in predicting OS. Post neoadjuvant therapy, none of the PET/CT variables of lymph nodes were related to prognosis. On the other hand, all primary tumor volumetric variables were related to overall survival. The MTV (HR: 4.66; 95% CI: 1.54-14.08) and TLG (HR: 4.86; 95% CI: 1.66-14.26) of the primary tumor post neoadjuvant therapy and the variations in MTV (HR: 2.95; 95% CI: 1.01-3.52) and TLG (HR: 3.49; 95% CI: 1.01-3.52) of the primary tumor pre-to-post-neoadjuvant therapy were prognostic variables. Conclusion: In patients with esophageal cancer, the burden of disease in suspicious lymph nodes and the primary tumor prior to therapy and the residual burden of disease in the primary tumor post therapy assessed by PET/CT were associated with prognosis.

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