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The value of 18 F-FDG PET before and after induction chemotherapy for the early prediction of a poor pathologic response to subsequent preoperative chemoradiotherapy in oesophageal adenocarcinoma

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: The purpose of our study was to determine the value of 18F-FDG PET before and after induction chemotherapy in patients with oesophageal adenocarcinoma for the early prediction of a poor pathologic response to subsequent preoperative chemoradiotherapy (CRT).

Methods: In 70 consecutive patients receiving a three-step treatment strategy of induction chemotherapy and preoperative chemoradiotherapy for oesophageal adenocarcinoma, 18F-FDG PET scans were performed before and after induction chemotherapy (before preoperative CRT). SUVmax, SUVmean, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were determined at these two time points. The predictive potential of (the change in) these parameters for a poor pathologic response, progression-free survival (PFS) and overall survival (OS) was assessed.

Results: A poor pathologic response after induction chemotherapy and preoperative CRT was found in 27 patients (39 %). Patients with a poor pathologic response experienced less of a reduction in TLG after induction chemotherapy (p < 0.01). The change in TLG was predictive for a poor pathologic response at a threshold of −26 % (sensitivity 67 %, specificity 84 %, accuracy 77 %, PPV 72 %, NPV 80 %), yielding an area-under-the-curve of 0.74 in ROC analysis. Also, patients with a decrease in TLG lower than 26 % had a significantly worse PFS (p = 0.02), but not OS (p = 0.18).

Conclusions: 18F-FDG PET appears useful to predict a poor pathologic response as well as PFS early after induction chemotherapy in patients with oesophageal adenocarcinoma undergoing a three-step treatment strategy. As such, the early 18F-FDG PET response after induction chemotherapy could aid in individualizing treatment by modification or withdrawal of subsequent preoperative CRT in poor responders.

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Scatter plot demonstrating the percentage of change in the logarithmically transformed total lesion glycolysis (∆TLG) after induction chemotherapy before preoperative chemoradiotherapy for oesophageal cancer in 27 poor versus 43 good pathologic responders. Horizontal continuous lines represent group means and the dotted line represents the optimal discriminatory cut-off level for ∆TLG of −26 %
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Fig1: Scatter plot demonstrating the percentage of change in the logarithmically transformed total lesion glycolysis (∆TLG) after induction chemotherapy before preoperative chemoradiotherapy for oesophageal cancer in 27 poor versus 43 good pathologic responders. Horizontal continuous lines represent group means and the dotted line represents the optimal discriminatory cut-off level for ∆TLG of −26 %

Mentions: The ideal cut-off value for ∆TLG to distinguish poor pathologic responders from good responders was statistically determined at −26 % (i.e., a 26 % decrease). Patients with a ∆TLG above (n = 25) versus below (n = 45) this threshold had a poor pathologic response in 72 % versus 20 % of cases, respectively. At the threshold of −26 %, the ∆TLG yielded a sensitivity of 67 % (95 % CI: 51-79 %), specificity of 84 % (95 % CI: 74-91 %), accuracy of 77 % (95 % CI: 65-86 %), PPV of 72 % (95 % CI: 55-85 %), and NPV of 80 % (95 % CI: 71-87 %) for predicting a poor pathologic response (Fig. 1). Of note, the threshold for the relative change in the logarithmically transformed TLG values of −26 % compared best to a threshold for the relative change in the originally scaled TLG values of −74 %. However, this originally scaled ∆TLG yielded a slightly lower predictive performance (AUC 0.71, with sensitivity 70 % [95 % CI: 54-83 %], specificity 74 % [95 % CI: 64-83 %], accuracy 73 % [95 % CI: 60-83 %], PPV 63 % [95 % CI: 49-75 %], and NPV 80 % [95 % CI: 69-89 %]).Fig. 1


The value of 18 F-FDG PET before and after induction chemotherapy for the early prediction of a poor pathologic response to subsequent preoperative chemoradiotherapy in oesophageal adenocarcinoma
Scatter plot demonstrating the percentage of change in the logarithmically transformed total lesion glycolysis (∆TLG) after induction chemotherapy before preoperative chemoradiotherapy for oesophageal cancer in 27 poor versus 43 good pathologic responders. Horizontal continuous lines represent group means and the dotted line represents the optimal discriminatory cut-off level for ∆TLG of −26 %
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5121174&req=5

Fig1: Scatter plot demonstrating the percentage of change in the logarithmically transformed total lesion glycolysis (∆TLG) after induction chemotherapy before preoperative chemoradiotherapy for oesophageal cancer in 27 poor versus 43 good pathologic responders. Horizontal continuous lines represent group means and the dotted line represents the optimal discriminatory cut-off level for ∆TLG of −26 %
Mentions: The ideal cut-off value for ∆TLG to distinguish poor pathologic responders from good responders was statistically determined at −26 % (i.e., a 26 % decrease). Patients with a ∆TLG above (n = 25) versus below (n = 45) this threshold had a poor pathologic response in 72 % versus 20 % of cases, respectively. At the threshold of −26 %, the ∆TLG yielded a sensitivity of 67 % (95 % CI: 51-79 %), specificity of 84 % (95 % CI: 74-91 %), accuracy of 77 % (95 % CI: 65-86 %), PPV of 72 % (95 % CI: 55-85 %), and NPV of 80 % (95 % CI: 71-87 %) for predicting a poor pathologic response (Fig. 1). Of note, the threshold for the relative change in the logarithmically transformed TLG values of −26 % compared best to a threshold for the relative change in the originally scaled TLG values of −74 %. However, this originally scaled ∆TLG yielded a slightly lower predictive performance (AUC 0.71, with sensitivity 70 % [95 % CI: 54-83 %], specificity 74 % [95 % CI: 64-83 %], accuracy 73 % [95 % CI: 60-83 %], PPV 63 % [95 % CI: 49-75 %], and NPV 80 % [95 % CI: 69-89 %]).Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: The purpose of our study was to determine the value of 18F-FDG PET before and after induction chemotherapy in patients with oesophageal adenocarcinoma for the early prediction of a poor pathologic response to subsequent preoperative chemoradiotherapy (CRT).

Methods: In 70 consecutive patients receiving a three-step treatment strategy of induction chemotherapy and preoperative chemoradiotherapy for oesophageal adenocarcinoma, 18F-FDG PET scans were performed before and after induction chemotherapy (before preoperative CRT). SUVmax, SUVmean, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were determined at these two time points. The predictive potential of (the change in) these parameters for a poor pathologic response, progression-free survival (PFS) and overall survival (OS) was assessed.

Results: A poor pathologic response after induction chemotherapy and preoperative CRT was found in 27 patients (39 %). Patients with a poor pathologic response experienced less of a reduction in TLG after induction chemotherapy (p < 0.01). The change in TLG was predictive for a poor pathologic response at a threshold of −26 % (sensitivity 67 %, specificity 84 %, accuracy 77 %, PPV 72 %, NPV 80 %), yielding an area-under-the-curve of 0.74 in ROC analysis. Also, patients with a decrease in TLG lower than 26 % had a significantly worse PFS (p = 0.02), but not OS (p = 0.18).

Conclusions: 18F-FDG PET appears useful to predict a poor pathologic response as well as PFS early after induction chemotherapy in patients with oesophageal adenocarcinoma undergoing a three-step treatment strategy. As such, the early 18F-FDG PET response after induction chemotherapy could aid in individualizing treatment by modification or withdrawal of subsequent preoperative CRT in poor responders.

No MeSH data available.


Related in: MedlinePlus