To compare and determine the diagnostic accuracy of [18F]-fluorodeoxyglucose positron emission tomography scan in predicting pathological response in operated carcinoma esophagus patients after initial neoadjuvant chemoradiation and neoadjuvant chemotherapy

Neelam Sharma; Abhishek Purkayastha; Sundaram Vishwanath; Pradeep Jaiswal

doi:10.4103/wjnm.WJNM_23_17

World Journal of Nuclear Medicine, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · World J Nucl Med 2018; 17(02): 79-85
DOI: 10.4103/wjnm.WJNM_23_17

Original article

To compare and determine the diagnostic accuracy of [¹⁸F]-fluorodeoxyglucose positron emission tomography scan in predicting pathological response in operated carcinoma esophagus patients after initial neoadjuvant chemoradiation and neoadjuvant chemotherapy

Authors

Neelam Sharma

Department of Radiotherapy, Army Hospital Research and Referral, New Delhi
Abhishek Purkayastha

Department of Radiotherapy, Army Hospital Research and Referral, New Delhi
Sundaram Vishwanath

¹Department of Medical Oncology, Army Hospital Research and Referral, New Delhi
Pradeep Jaiswal

²Department of Surgical Oncology, Army Hospital Research and Referral, New Delhi

Abstract

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The objective of this study was to determine whether [¹⁸F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) scan could predict the pathological response in esoph neoadjuvant concurrent chemoradiation (NACCRT) and neoadjuvant chemotherapy (NACT). A randomized prospective study was carried out from March 2014 to October 2016; thirty patients of histopathologically proven, locally advanced, potentially operable carcinoma esophagus comprising both squamous carcinoma and adenocarcinoma were randomized into NACCRT and NACT arms equally. Both groups had pretreatment FDG-PET-computed tomography (CT) scan and repeat scan after 5–6 weeks of neoadjuvant therapy (NAT). The change in mean %Δmaximum standardized uptake value (%ΔSUVmax) was compared with tumor regression grade (TRG) in the postoperative histology. Patients with TRG 1–2 were deemed responders and 3–5 were nonresponders. Pathologic response was correlated with percentage change in [¹⁸F]-FDG uptake (%ΔSUVmax); receiver operating characteristics (ROC) analyses were done to assess sensitivity and specificity of FDG-PET to determine its diagnostic accuracy. The mean SUV in NACCRT group decreased from 15.47 ± 2.92 to 7.31 ± 4.07 (P < 0.001), while in NACT group, mean SUV decreased from 14.74 ± 3.95 to 8.60 ± 3.89 (P < 0.001). Comparison between NACCRT and NACT leads to mean SUV of 57.80 ± 22.40 and 45.92 ± 19.23, respectively (P = 0.13). In NACCRT and NACT, TRG had mean %ΔSUVmax values of 2.53 ± 1.25 and 2.93 ± 1.28 (P = 0.393). However, we found a statistically significant correlation between SUV% reduction and TRG (P = 0.002). ROC curve analysis for FDG-PET-CT suggested an area under the curve of 0.693 and sensitivity and specificity of 80% and 46.7%, respectively. NACCRT and NACT lead to a statistically significant reduction in mean %ΔSUVmax and with statistical significance correlation when compared with pathological response assessment. Hence, PET-CT can be used for differentiating responders and nonresponders to NAT.

Keywords

Esophageal cancer - neoadjuvant chemoradiation - neoadjuvant chemotherapy - positron emission tomography - response

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