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.
18F-FDG PET/CT Predicts Response to HER2-directed Neoadjuvant Therapy
