scholarly journals Correlation Between Standardized Uptake Value in Preneoadjuvant and Postneoadjuvant Chemoradiotherapy and Tumor Regression Grade in Patients With Locally Advanced Esophageal Cancer

2015 ◽  
pp. 1 ◽  
Author(s):  
Kathryn Baksh ◽  
Gopi Prithviraj ◽  
Youngchul Kim ◽  
Sarah Hoffe ◽  
Ravi Shridhar ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Tumor Regression ◽  
Locally Advanced ◽  
Standardized Uptake Value ◽  
Tumor Regression Grade ◽  
Advanced Esophageal Cancer ◽  
Regression Grade ◽  
Locally Advanced Esophageal Cancer

Trimodality treatment (TMT) for locally advanced esophageal cancer in Pakistan; Analysis of prognostic factors influencing survival

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15185-15185
Author(s):  
A. A. Syed ◽  
A. Jamshed ◽  
B. Muhammad ◽  
R. Azhar ◽  
M. A. Yusuf ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Tumor Regression ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Tumor Regression Grade ◽  
Advanced Esophageal Cancer ◽  
Free Survival ◽  
Regression Grade ◽  
Disease Free ◽  
Locally Advanced Esophageal Cancer

15185 Background: The prognosis of patients with locally advanced esophageal cancer is poor. TMT for locally advanced esophageal cancer is being utilized with increasing frequency. In this study, we investigate the prognostic factors influencing survival in patients with locally advanced esophageal cancer following TMT. Methods: The study included 22 patients with esophageal carcinoma treated between January 2003 and December 2005 at Shaukat Khanum Memorial Hospital and Research Centre. Median age was 49 years (range 26 - 68). There were 15 (68%) males and 7 (32%) females. All patients had EGD with biopsy and CT chest. Twelve (54.5%) had squamous cell carcinoma and 10 (45.5%) patients had adenocarcinoma. Five patients (23%) had tumour in the middle third and 17 (77%) had lower/gastroesophageal lesions. Preoperative radiation consisted of 50.4 Gy / 28 fractions with concomitant chemotherapy day 1 and 29 (Cisplatin 75 mg/m2 day 1 and infusional 5FU 1000 mg/m2 day 1–5). Esophagectomy was done at 6 - 12 weeks following chemoradiation. The pathologic down-staging was evaluated by the 5-score tumor regression grade (TRG) of Mandard. Results: Post TMT pathologic TNM stage was; Stage 0 in 8 pts (36%), stage II in 5 pts (23%) and stage III in 9 pts (41%). 13 (59%) pts had R0 and 9 (41%) pts had R1 resection. The 4-year disease free survival was 29% with a median survival of 19 months. The number of patients with TRG score 1, 2, 3, 4 and 5 were 7 (32%), 4 (18%), 5 (23%), 2 (9%) and 4 (18%) respectively. Tumor regression grade 1–2 (p=.0016) and negative circumferential margins >2 mm (p=.0019) had a positive influence on DFS. Age (< 50 vs ≥ 50 years), sex, hemoglobin at presentation (≤ 12 vs > 12 gm/dl), tumor site (middle vs lower/GE junction), pathological nodal status (node positive vs node negative) and histological subtype (squamous cell vs adenocarcinoma) did not influence survival (p= 0.92, p= 0.82, p= 0.69, p= 0.79, p= 0.41 and p= 0.32 respectively). Conclusions: TMT results in prolonged disease free survival in patients with complete response or microscopic residual foci (TRG 1–2). Positive or circumferential margins <2mm is associated with poor prognosis. No significant financial relationships to disclose.

Correlation between standardized uptake value in pre- and post-neoadjuvant chemoradiotherapy and tumor regression grade in patients with locally advanced esophageal cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 150-150
Author(s):  
Kathryn Baksh ◽  
Khaldoun Almhanna
Keyword(s):  
Esophageal Cancer ◽  
Tumor Regression ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Tumor Regression Grade ◽  
P Value ◽  
Advanced Esophageal Cancer ◽  
Pet Scans ◽  
Regression Grade ◽  
Locally Advanced Esophageal Cancer

150 Background: A multimodality approach with neoadjuvant chemotherapy and radiation is the standard of care in the United States in the treatment of patients with locally advanced esophageal cancer. It is well established that neoadjuvant chemoradiotherapy (CRT) in these patients can facilitate downstaging, correlating with pathologic response, and improving overall survival. Our clinical practice involves the use of positron emission tomography (PET) to assist with staging in patients prior to undergoing neoadjuvant CRT and surgery. While there has been evidence showing correlation between tumor regression grade (TRG) and increased overall survival in these patients, the relationship between standardized uptake values on PET scans and TRG has not been discerned. The purpose of this study was to determine whether pre and post-chemoradiotherapy SUV on PET scans correlate with TRG in esophageal cancer patients receiving neoadjuvant chemoradiotherapy. Methods: A retrospective review of 56 patients with stage II-III esophageal cancer treated with neo-adjuvant CRT followed by surgery was performed. Pre- and post- treatment PET scans were reviewed. Maximum SUV at the site of the primary tumor was recorded. Upon completion of surgery, tumor regression grade was determined by a specialized pathologist. Spearman correlation was used to compare pre, post, and change in max SUV, to the 4 level TRG variables. Results: The median follow-up was 24 months. No significant correlation was found between pre-treatment or post treatment SUV and TRG with p value of 0.73 and 0.94 respectively. There was no significant correlation between decreased FDG uptake following CRT and TRG with p value of 0.82. Consistent with previous data, TRG predicted the therapeutic efficacy and prognosis for patients with locally advanced esophageal carcinoma treated by neoadjuvant chemotherapy. Conclusions: Our results are preliminary and retrospective in nature. A larger sample is needed to confirm these findings. Decreased FDG uptake in sequential PET scans strongly correlates with tumor response, but is not accurate enough to predict pathological response.

Prognostic value of 18F-FDG PET/CT metabolic tumor volume for complete pathologic response and clinical outcomes after neoadjuvant chemoradiation therapy for locally advanced esophageal cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 150-150
Author(s):  
Puja Venkat ◽  
Jasmine A Oliver ◽  
Will Jin ◽  
Joshua Dault ◽  
Jessica M. Frakes ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Value ◽  
Tumor Volume ◽  
Locally Advanced ◽  
Standardized Uptake Value ◽  
Metabolic Tumor Volume ◽  
Neoadjuvant Chemoradiation ◽  
Advanced Esophageal Cancer ◽  
Pet Ct ◽  
Locally Advanced Esophageal Cancer

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.

Preoperative induction chemotherapy with docetaxel-cisplatin followed by concurrent docetaxel-cisplatin and radiation therapy in patients with locally advanced esophageal cancer: A prospective, multicenter phase ll trial of the Swiss Group for Clinical Cancer Research

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4562-4562
Author(s):  
T. Ruhstaller ◽  
L. Widmer ◽  
S. Balmer Majno ◽  
W. Mingrone ◽  
V. Hess ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Preoperative Therapy ◽  
Tumor Regression Grade ◽  
Thoracic Esophagus ◽  
Advanced Esophageal Cancer ◽  
Community Based ◽  
Locally Advanced Esophageal Cancer

4562 Background: The role of preoperative therapy in patients (pts) with locally advanced esophageal cancer remains unclear. Non-randomized and randomized studies were often performed in single and highly specialized centers. The purpose of this study was to investigate 1) the efficacy and toxicity of preoperative docetaxel-cisplatin together with radiation therapy (RT) 2) the feasibility of a complex preoperative strategy in a community-based multicenter setting. Methods: Eligibility criteria: resectable, locally advanced (uT3 or uN1, T4 if deemed resectable) squamous cell carcinoma (SCC) or adenocarcinoma (AC) of the thoracic esophagus or gastroesophageal junction (Siewert type l); staged by EUS, CT and PET scan; age 18–70y; PS <2; normal organ functions. Treatment: 2 cycles of docetaxel 75mg/m2 and cisplatin 75mg/m2 q3w, followed by weekly x5 docetaxel 20mg/m2 and cisplatin 25mg/m2 with concomitant 45 Gy RT in 25 fractions; surgery 3- 8 weeks after RT. A two stage-design was used with two primary endpoints: 1) efficacy (TRG : tumor regression grade ); 2) feasibility (successful completion of entire therapy and being alive 30 days after surgery). Results: 66 pts, 56 males, were included from 11 institutions; median age 61y (35–70y); AC 53%; SCC 46%; 53 pts (80%) completed the preoperative therapy, underwent resection and were alive 30 days after surgery; 10 pts (15%) had no resection (4 progressive disease, 4 medical reasons, 2 patient’s refusal). Of 56 (85%) pts who had surgery, 51 pts had RO-resection (91%), 5 pts (9%) died due to complications after surgery (3 after > 30 days). Conclusion: Our trimodality treatment shows encouraging antineoplastic activity with 57% histopathological responders (TRG1 and 2) and acceptable feasibility in a community-based multicenter setting. [Table: see text] No significant financial relationships to disclose.

Factors associated with local-regional failure after definitive chemoradiation for locally advanced esophageal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14669-e14669
Author(s):  
Arya Amini ◽  
James Welsh ◽  
Pamela Allen ◽  
Lianchun Xiao ◽  
Akihiro Suzuki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Treatment ◽  
Locally Advanced ◽  
Significant Proportion ◽  
Standardized Uptake Value ◽  
Disease Recurrence ◽  
Post Treatment ◽  
Advanced Esophageal Cancer ◽  
Definitive Chemoradiation ◽  
Locally Advanced Esophageal Cancer

e14669 Background: Esophageal cancer is often treated with a trimodality approach (chemotherapy and radiation followed by surgery). However a significant proportion of such patients achieve a clinical complete response (cCR) following chemoradiation alone. We retrospectively analyzed patients who reached cCR after definitive chemoradiation for locally advanced esophageal cancer to identify clinical predictors of local disease recurrence. Methods: We identified 141 patients who obtained initial cCR after definitive chemoradiation for esophageal cancer from January 2002 through January 2009. The initial response to treatment was assessed by endoscopic evaluation and biopsy results, with cCR defined as having no evidence of disease present. Patterns of failure were categorized as in-field (within the planned treatment volume [PTV]), outside the radiation treatment field, or both. Results: At a median follow-up of 22 months (range 6-87 months), 77 patients (55%) had experienced disease recurrence. Most first failures (32, or 23%) were outside the radiation field, followed by 30 (21%) within the field and 15 (11%) were both. In multivariate analysis, in-field failure after cCR was associated with a post-treatment standardized uptake value (SUV) on positron emission tomography of >3.5 (odds ratio [OR] 4.93, p=0.022), squamous histology (OR 0.07, p=0.010), and borderline for T3/T4 disease (OR 10.25, p=0.055). All failures, in-field and out-of-field, correlated with T3/T4 disease (OR 11.61, p=0.015), N1 disease (OR 5.07, p=0.010), pretreatment SUV >10 (OR 4.00, p=0.048), and post-treatment SUV >3.5 (OR 3.59, p=0.052). Conclusions: Clinical characteristics can be used to predict failure patterns after definitive chemoradiation. Such risk-assessment strategies can help individualize therapy.

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