Detection of distant interval metastases after neoadjuvant therapy for esophageal cancer with 18F-FDG PET(/CT): a systematic review and meta-analysis

Abstract Background After curatively intended neoadjuvant chemoradiotherapy (nCRT) according to CROSS plus surgery for esophageal cancer, 29% of patients have a pathologic complete response. Active surveillance after nCRT, in which patients undergo frequent clinical examinations and where esophagectomy is only offered to those with a locoregional regrowth without distant metastases, has been proposed as novel treatment option. This study provides a systematic review and meta-analysis of the literature regarding the accuracy of endoscopic biopsies, endoscopic ultrasound (EUS) and 18F-FDG PET(-CT) for detecting residual disease after nCRT for esophageal cancer. Methods A systematic literature search in Embase, Medline, Cochrane and Web of Science was performed. Two reviewers independently collected studies on the diagnostic accuracy of endoscopic biopsies, EUS and 18F-FDG PET(-CT) for detecting residual disease after nCRT at the primary tumor site or in regional lymph nodes for potentially curable esophageal adenocarcinoma (AC) or squamous cell carcinoma (SCC). Histopathological examination of the resection specimen was the reference standard. Study quality was appraised with the QUADAS-2 tool. Sensitivity and specificity values were calculated and pooled using meta-analyses. Subgroup analyses were performed to investigate possible sources of heterogeneity. Results 60 studies were included for qualitative analysis and 40 for quantitative analysis. For detecting residual disease at the primary tumor site, 11 studies evaluated endoscopic biopsies, 11 described EUS qualitatively, 14 evaluated PET qualitatively, 12 evaluated PET quantitatively, 6 of them using SUVmax and 6 of them using DSUVmax. Summary sensitivity values were 0.36 (95%CI 0.27–0.45), 0.97 (95%CI 0.94–0.98), 0.74 (95%CI 0.66–0.81), 0.68 (95%CI 0.61–0.74) and 0.68 (95%CI 0.54–0.79), respectively. Summary specificity values were 0.93 (95%CI 0.85–0.97), 0.09 (95%CI 0.04–0.19), 0.52 (95%CI 0.40–0.63), 0.70 (95%CI 0.61–0.78), 0.70 (95%CI 0.60–0.78) and respectively. For detecting residual malignant lymph nodes, 11 studies evaluated EUS with a summary sensitivity of 0.68 (95%CI 0.54–0.80) and a summary specificity of 0.58 (95%CI 0.45–0.70). Subgroup analyses demonstrated that sensitivity of endoscopic biopsy, PET DSUVmax and EUS for nodal was higher in SCC than in AC. Conclusion Current literature suggests insufficient accuracy of endoscopic biopsies, EUS and 18F-FDG PET(-CT) as individual modalities for detecting residual disease after nCRT for potentially curable esophageal cancer. Disclosure All authors have declared no conflicts of interest.

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160 SURVIVAL ANALYSIS OF 18F-FDG PET/CT QUANTITATIVE PARAMETERS MEASURED IN PRIMARY TUMOR AND SUSPICIOUS LYMPH NODES IN PATIENTS WITH ESOPHAGEAL CARCINOMA

Diseases of the Esophagus ◽

10.1093/dote/doaa087.28 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

F Tustumi ◽

F Takeda ◽

P Duarte ◽

D Albenda ◽

R Sallum ◽

...

Keyword(s):

Esophageal Cancer ◽

Neoadjuvant Therapy ◽

Burden Of Disease ◽

Primary Tumor ◽

Fdg Pet ◽

Trimodal Therapy ◽

Pet Ct ◽

Medicine Physician ◽

18F Fdg ◽

Fdg Pet Ct

Abstract 18F-FDG PET/CT quantitative techniques have been described as prognostic indicators in esophageal cancer. Objective: To evaluate the prognostic value of the maximal Standardized Uptake Value (SUVmax), the Metabolic Tumor Value (MTV) and the Total Lesion Glycolysis (TLG) measured in the primary tumor and in the suspicious lymph node. Methods A cohort study was performed to assess the association of SUVmax, MTV and TLG measured prior and post to neoadjuvant therapy, as well as the variation of these values between the two studies, with overall survival (OS) in patients with esophageal cancer submitted to trimodal therapy. The quantitative techniques were applied in the primary tumor (PT) and in the suspicious nodes (LN) by a nuclear medicine physician. The OS rates were analysed. Before neoadjuvant therapy, 106 patients had PET/CT, and 39 patients had post neoadjuvant PET/CT exams. Results Before neoadjuvant period all the variables related to LN were able to predict OS. MTV of primary (HR: 1.89; 95%CI: 1.01–3.52) tumor were also able to predict OS. On post neoadjuvant period and the variation pre-to-post neoadjuvant periods, none of the PET/CT variables related to LN were related to prognosis. All primary tumor volumetric variables were related to OS. MTV (HR: 4.66; 95%CI: 1.54–14.08) and TLG (HR: 4.86; 95%CI: 1.66–14.26) of PT of post neoadjuvant period; and the variation of MTV (HR: 2.95; 95%CI: 1.01–3.52) and TLG (HR: 3.49; 95%CI: 1.01–3.52) of the PT pre-to-post neoadjuvant periods were prognostic variables. Conclusion In patients with esophageal cancer, the burden of disease in the suspicious nodes and primary tumor prior to therapy and the residual burden of disease in PT in post therapy 18F-FDG PET/CT were associated with dismal prognosis.

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