PET-guided prognosis: a promising role of metabolic imaging in oesophageal cancer

Congress:

ECR 2012

Poster Number:

B-0657

Type:

Scientific Paper

Keywords:

Stomach (incl. Oesophagus), Oncology, Nuclear medicine, PET-CT, Diagnostic procedure, Neoplasia

Authors:

L. Evangelista, A. R. Cervino, R. Alfieri, C. Castoro, P. C. Muzzio, F. Pomerri; Padova/IT

DOI:

10.1594/ecr2012/B-0657

DOI-Link:

https://dx.doi.org/10.1594/ecr2012/B-0657

Fig. 1: Distribution of PET/CT findings and the patients management.

Fig. 2: Overall survival in all patients, based on PET/CT findings

Fig. 3: Prevalence of recurrence of disease or death and disease-free in surgical and...

Purpose

The poor prognosis of esophageal cancer (EC) has encouraged many Researchers to find several quantitative or semi-quantitative PET/CT parameters significantly related to the prognosis. As demonstrated by Lordick et al. (Lordick, Annals of Oncology 2010), PET/CT is the most important independent prognostic factor in evaluating the effectiveness of neoadjuvant therapy; in particular, it results able to differentiate patients who show a significant response to therapy from the patients do not. This latter result is correlated with a poor prognosis. The response to neoadjuvant treatment is...

Methods and Materials

Among 108 EC patients who underwent FDG-PET/CT after neo-adjuvant treatment, we selected 56 patients without evidence or suspicious for distant metastases. All patients were followed for a mean period of 13±9 months from nuclear imaging. FDG PET/CT findings were correlated with patient management and long-term prognosis. Chi-square test was used for categorical variables and t-Student test for continuous data. Survival curves were computed using Kaplan Meier method and log-renk test for the comparison. A p value < 0.05 was considered statistically significant.

Results

15 patients had negative and 41 positive (27 vs. 73%) FDG PET/CT after neo-adjuvant therapy. 6/15 underwent radical-intent surgery and 9/15 did not, whereas 31/41 performed surgery and 10/41 did not (p<0.05) (Figure 1). After a median time of 10 months, 28 patients were disease-free, 15 relapsed and 11 died. Disease-free survival was significantly better in patients with negative than positive FDG PET/CT (83 vs. 11%; p>0.05). Similarly, the overall survival was significantly higher in patients with negative than with positive FDG PET/CT after neo-adjuvant...

Conclusion

FDG PET/CT could stratify the recurrence risk of EC patients based on treatment efficacy; after 13 months from PET/CT, 89% of patients with negative FDG PET/CT scan who did not undergo surgery, resulted disease free. A positive FDG PET/CT after neo-adjuvant therapy should be followed by surgery for improving the event-free survival and overall survival.

References

1. F, Ott K, Krause BJ.New trends for staging and therapy for localized gastroesophageal cancer: the role of PET.Ann Oncol.2010;21 Suppl 7:294S-9S 2.Krause BJ, Herrmann K, Wieder H, zum Büschenfelde CM.18F-FDG PET and 18F-FDG PET/CT for assessing response to therapy in esophageal cancer.J Nucl Med. 2009;50 Suppl 1:89S-96S.