DOI: 10.1007/s00259-017-3901-3Pages: 1-10

Favorable versus unfavorable prognostic groups by post-chemoradiation FDG-PET imaging in node-positive esophageal squamous cell carcinoma patients treated with definitive chemoradiotherapy

1. Chang Gung Memorial Hospital-Linkou Medical Center and Chang Gung University, Department of Radiation Oncology

2. Chang Gung Memorial Hospital-Linkou Medical Center and Chang Gung University, Department of Nuclear Medicine and Molecular Imaging Center

3. Chang Gung University, Department of Medical Imaging and Radiological Sciences, College of Medicine

4. Chang Gung Memorial Hospital-Linkou Medical Center and Chang Gung University, Circulating Tumor Cell Lab, Division of Medical Oncology, Department of Internal Medicine

5. Chang Gung University, Department of Chemical and Materials Engineering

6. Chang Gung Memorial Hospital-Linkou Medical Center and Chang Gung University, Division of Thoracic Surgery, Department of Surgery

7. Chang Gung Memorial Hospital-Linkou Medical Center and Chang Gung University, Department of Diagnostic Radiology

8. National Taiwan University, Institute of Epidemiology and Preventive Medicine, College of Public Health

Correspondence to:
Tsung-Min Hung
Tel: (+886) 3-3281200-7000
Email: min7363@gmail.com

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Abstract

Purpose

Our purpose was to examine the prognostic value of post-CRT PET based on the presence or absence of FDG-avid metastatic lymph node(s) and metabolic response of the primary tumor in patients with clinically node-positive ESCC treated with definitive chemoradiotherapy (dCRT).

Methods

We identified 108 eligible patients treated by chemoradiotherapy (CRT) with or without resection from our prospectively collected database. Absence of FDG-avid metastatic lymph node with at least partial response of the primary tumor on PET scan after initial CRT was defined as the Post-CRT PET favorable group (yPET-F), and otherwise as unfavorable group (yPET-U). The Kaplan-Meier method and Cox regression were performed for survival analyses and multivariable analysis, respectively.

Results

The study cohort was comprised of 59 patients receiving dCRT. Forty-five patients receiving trimodality therapy (TMT) comprised the comparative group and four patients were excluded from further analyses for developing interval distant metastasis detected on post-CRT PET scan. The median follow-up for the study cohort was 41 months. On K-M analysis of the study cohort, yPET-F was found to have significantly better OS (2-year: 72.5% vs 13.7%, p < 0.01) and DMFS (2-year: 71.6% vs 36.6%, p = 0.01) than yPET-U. In multivariable analysis, yPET-F remained as a strong independent favorable prognosticator on both OS (HR 0.08, p < 0.01) and DMFS (HR 0.14, p = 0.02) for the dCRT cohort. Compared with TMT cohort, for yPET-U patients, TMT had better OS (p = 0.03) than dCRT-Operable and dCRT-Operable had superior OS (p = 0.04) than dCRT-Unresectable. For yPET-F patients, there was no difference in both OS (p > 0.99) and DMFS (p = 0.92) between these three groups.

Conclusions

Absence of FDG-avid metastatic lymph node with at least partial response of the primary tumor on PET scan after CRT (i.e., yPET-F status) prognosticate for excellent OS and DMFS in cN+ ESCC patients treated with dCRT, and might be comparable to TMT.

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  • Accepted: Nov 24, 2017
  • Online: Nov 30, 2017

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