PTU-183 Ineffectiveness of 18F-Fluorodeoxyglucose positron emission tomography in the evaluation of tumour response after completion of neoadjuvant chemoradiation in oesophageal cancer. (28th May 2012)

• Record Type: Journal Article
• Authors: Piessen, G; Robb, W B; Petyt, G; Duhamel, A; Mirabel, X; Huglo, D; Mariette, C
• Is Part Of: Gut. Volume 61(2012)Supplement 2
• Page Start: A259
• Page End: A260
• Publication Date: 2012-05-28
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2012-302514c.183
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: After primary CRT, a non-invasive evaluation of the tumour response could help in the treatment decision to identify patients who may benefit from surgery. Whether FDG-PET provides clinically relevant information remains questionable. The objective of this prospective trial was to evaluate the role of 18F-Fluorodeoxyglucose-positron emission tomography (FDG-PET) in the assessment of tumour response after the completion of neoadjuvant chemoradiation (CRT) in patients with locally advanced resectable oesophageal cancer. Methods: Operable patients with locally advanced oesophageal cancer (clinically staged T3 N0-1 M0) were enrolled. The complete treatment plan included neoadjuvant CRT (cisplatin + 5-Fluorouracil/45 Gy) followed 6–8 weeks later by a transthoracic en bloc oesophagectomy. Morphological evaluations combined with FDG-PET results were performed 2 weeks before and 4–6 weeks after the completion of CRT. Intratumoural pre- and post-treatment FDG-standardised uptake values were assessed (SUV1, SUV2, percentage change). These variables were correlated with pathologic and morphologic responses and survival. Investigators were blinded to the FDG-PET results unless metastatic disease was suspected. Results: Out of 60 total patients, 46 underwent the complete treatment plan (median age: 60.1 years; adenocarcinoma: 25 patients; squamous cell cancer: 21 patients). A major pathological response occurred in 19.6% of patients and was associated with a favourable outcome (p = 0.057). Neoadjuvant CRT led to a significant reduction in intratumoral FDG-uptake (p < 0.001). No significant association was seen between a pathologic response (either complete or major) and the FDG-PET results (p > 0.280). The SUV2 value was correlated with a morphological response and the possibility to perform an R0 resection (p < 0.018; ROC analysis: SUV2 threshold = 5.5). No significant association was found between metabolic imaging and recurrence or survival. Conclusion: FDG-PET does not effectively correlate with pathologic response and long-term survival in patients with locally advanced oesophageal cancer undergoing neoadjuvant CRT followed by surgery (registered on http://www.e-cancer.fr website, RECF0350, 2002-1936R). Funding: Funded by the French ministry of Health – Programme Hospitalier de Recherche Clinique 2002. Competing interests: None declared.