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NEOadjuvant therapy monitoring with PET and CT in Esophageal Cancer (NEOPEC-trial).

van Heijl M, Omloo JM, van Berge Henegouwen MI, Busch OR, Tilanus HW, Bossuyt PM, Hoekstra OS, Stoker J, Hulshof MC, van der Gaast A, Nieuwenhuijzen GA, Bonenkamp HJ, Plukker JT, Bilgen EJ, Ten Kate FJ, Boellaard R, Pruim J, Sloof GW, van Lanschot JJ - BMC Med Phys (2008)

Bottom Line: These patients suffer from toxic and ineffective neoadjuvant treatment, while appropriate surgical therapy is delayed.Data suggest that metabolic changes in tumor tissue as measured by FDG-PET predict response better.Responders are defined as patients with < 10% viable residual tumor cells (Mandard-score).Difference in accuracy (area under ROC curve) and negative predictive value between FDG-PET and CT-scan are primary endpoints.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. m.vanheijl@amc.uva.nl

ABSTRACT

Background: Surgical resection is the preferred treatment of potentially curable esophageal cancer. To improve long term patient outcome, many institutes apply neoadjuvant chemoradiotherapy. In a large proportion of patients no response to chemoradiotherapy is achieved. These patients suffer from toxic and ineffective neoadjuvant treatment, while appropriate surgical therapy is delayed. For this reason a diagnostic test that allows for accurate prediction of tumor response early during chemoradiotherapy is of crucial importance. CT-scan and endoscopic ultrasound have limited accuracy in predicting histopathologic tumor response. Data suggest that metabolic changes in tumor tissue as measured by FDG-PET predict response better. This study aims to compare FDG-PET and CT-scan for the early prediction of non-response to preoperative chemoradiotherapy in patients with potentially curable esophageal cancer.

Methods/design: Prognostic accuracy study, embedded in a randomized multicenter Dutch trial comparing neoadjuvant chemoradiotherapy for 5 weeks followed by surgery versus surgery alone for esophageal cancer. This prognostic accuracy study is performed only in the neoadjuvant arm of the randomized trial. In 6 centers, 150 consecutive patients will be included over a 3 year period. FDG-PET and CT-scan will be performed before and 2 weeks after the start of the chemoradiotherapy. All patients complete the 5 weeks regimen of neoadjuvant chemoradiotherapy, regardless the test results. Pathological examination of the surgical resection specimen will be used as reference standard. Responders are defined as patients with < 10% viable residual tumor cells (Mandard-score).Difference in accuracy (area under ROC curve) and negative predictive value between FDG-PET and CT-scan are primary endpoints. Furthermore, an economic evaluation will be performed, comparing survival and costs associated with the use of FDG-PET (or CT-scan) to predict tumor response with survival and costs of neoadjuvant chemoradiotherapy without prediction of response (reference strategy).

Discussion: The NEOPEC-trial could be the first sufficiently powered study that helps justify implementation of FDG-PET for response-monitoring in patients with esophageal cancer in clinical practice.

Trial registration: ISRCTN45750457.

No MeSH data available.


Related in: MedlinePlus

integration NEOPEC-trial within CROSS-trial. CRT chemoradiotherapy, PET positron emission tomography, CT computed tomography.
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Figure 1: integration NEOPEC-trial within CROSS-trial. CRT chemoradiotherapy, PET positron emission tomography, CT computed tomography.

Mentions: The present research proposal comprises serial FDG-PET and CT-scan before and during neoadjuvant therapy in the multimodality treatment arm of the randomized trial. Finally, resection specimens will be assessed for tumor response. Figure 1 describes the logistic integration of the NEOPEC-trial within the CROSS-trial.


NEOadjuvant therapy monitoring with PET and CT in Esophageal Cancer (NEOPEC-trial).

van Heijl M, Omloo JM, van Berge Henegouwen MI, Busch OR, Tilanus HW, Bossuyt PM, Hoekstra OS, Stoker J, Hulshof MC, van der Gaast A, Nieuwenhuijzen GA, Bonenkamp HJ, Plukker JT, Bilgen EJ, Ten Kate FJ, Boellaard R, Pruim J, Sloof GW, van Lanschot JJ - BMC Med Phys (2008)

integration NEOPEC-trial within CROSS-trial. CRT chemoradiotherapy, PET positron emission tomography, CT computed tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3301128&req=5

Figure 1: integration NEOPEC-trial within CROSS-trial. CRT chemoradiotherapy, PET positron emission tomography, CT computed tomography.
Mentions: The present research proposal comprises serial FDG-PET and CT-scan before and during neoadjuvant therapy in the multimodality treatment arm of the randomized trial. Finally, resection specimens will be assessed for tumor response. Figure 1 describes the logistic integration of the NEOPEC-trial within the CROSS-trial.

Bottom Line: These patients suffer from toxic and ineffective neoadjuvant treatment, while appropriate surgical therapy is delayed.Data suggest that metabolic changes in tumor tissue as measured by FDG-PET predict response better.Responders are defined as patients with < 10% viable residual tumor cells (Mandard-score).Difference in accuracy (area under ROC curve) and negative predictive value between FDG-PET and CT-scan are primary endpoints.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. m.vanheijl@amc.uva.nl

ABSTRACT

Background: Surgical resection is the preferred treatment of potentially curable esophageal cancer. To improve long term patient outcome, many institutes apply neoadjuvant chemoradiotherapy. In a large proportion of patients no response to chemoradiotherapy is achieved. These patients suffer from toxic and ineffective neoadjuvant treatment, while appropriate surgical therapy is delayed. For this reason a diagnostic test that allows for accurate prediction of tumor response early during chemoradiotherapy is of crucial importance. CT-scan and endoscopic ultrasound have limited accuracy in predicting histopathologic tumor response. Data suggest that metabolic changes in tumor tissue as measured by FDG-PET predict response better. This study aims to compare FDG-PET and CT-scan for the early prediction of non-response to preoperative chemoradiotherapy in patients with potentially curable esophageal cancer.

Methods/design: Prognostic accuracy study, embedded in a randomized multicenter Dutch trial comparing neoadjuvant chemoradiotherapy for 5 weeks followed by surgery versus surgery alone for esophageal cancer. This prognostic accuracy study is performed only in the neoadjuvant arm of the randomized trial. In 6 centers, 150 consecutive patients will be included over a 3 year period. FDG-PET and CT-scan will be performed before and 2 weeks after the start of the chemoradiotherapy. All patients complete the 5 weeks regimen of neoadjuvant chemoradiotherapy, regardless the test results. Pathological examination of the surgical resection specimen will be used as reference standard. Responders are defined as patients with < 10% viable residual tumor cells (Mandard-score).Difference in accuracy (area under ROC curve) and negative predictive value between FDG-PET and CT-scan are primary endpoints. Furthermore, an economic evaluation will be performed, comparing survival and costs associated with the use of FDG-PET (or CT-scan) to predict tumor response with survival and costs of neoadjuvant chemoradiotherapy without prediction of response (reference strategy).

Discussion: The NEOPEC-trial could be the first sufficiently powered study that helps justify implementation of FDG-PET for response-monitoring in patients with esophageal cancer in clinical practice.

Trial registration: ISRCTN45750457.

No MeSH data available.


Related in: MedlinePlus