Use of 18 F Fluorodeoxyglucose Positron Emission Tomography Computed Tomography in Assessing Response to Neoadjuvant Che
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ORIGINAL RESEARCH
Use of 18F Fluorodeoxyglucose Positron Emission Tomography Computed Tomography in Assessing Response to Neoadjuvant Chemoradiation and Its Impact on Survival in Esophageal Squamous Cell Carcinoma Sayed Assif Iqbal 1 & Shaifali Goel 1 & Abhishek Aggarwal 1 & Nikhil Gupta 1 & Manoj Gupta 2 & Garima Durga 3 & Vineet Talwar 4 & Shivendra Singh 1 Accepted: 19 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background To determine the accuracy of 18F-Fluorodeoxyglucose positron emission tomography computed tomography (FDG-PET CT) in predicting response to neoadjuvant chemoradiation (NACRT) in esophageal squamous cell cancer (SCC) and impact of such response on survival. Methods Retrospective analysis of patients with esophageal SCC (cT2-4N0-N+M0) who underwent PET CT before and 6 weeks after NACRT followed by surgery was carried out in this study. Metabolic response was assessed by change in standardized uptake value (ΔSUVmax) after NACRT and the pathological response was graded. A receiver operating characteristic curve (ROC) was used to identify the optimal cut off value of SUVmax to predict histopathological response. The impact of metabolic response and pathological response on survival was determined. Results Of the 73 patients analyzed, 27 had complete metabolic response, while 24 had pathological complete response (PCR). However, only 14 of the 27 complete metabolic responders actually had PCR. At 67% ΔSUVmax, the optimum balance between sensitivity (70.83%) and specificity (69.23%) was achieved and the correlation between metabolic response and pathological complete response achieved statistical significance (p = 0.0009). However, ΔSUVmax of 67% was found to have no significant association with survival (p = 0.51). PCR was the only significant determinant of improved survival (p = 0.04). Conclusion PCR which is a significant determinant of survival is not ideally predicted by ΔSUVmax on PET CT. Keywords Neoadjuvant chemoradiotherapy . PET scan . Complete pathological response . Esophageal carcinoma
Introduction Esophageal carcinoma ranks among the top six cancers worldwide. Patients with early disease may benefit from upfront * Shivendra Singh [email protected] 1
Department of GI and HPB Oncosurgery, Rajiv Gandhi Cancer Institute and Research Centre, Sector -5, Rohini, Delhi 110085, India
2
Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, Sector -5, Rohini, Delhi 110085, India
3
Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, Sector -5, Rohini, Delhi 110085, India
4
Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector -5, Rohini, Delhi 110085, India
surgery, but most of the patients tend to present late in the natural course of their disease. Locally advanced esophageal cancers receive neo-adjuvant chemo-radiation (NACRT) followed by surgery as the standard of care because there has been accumulating evidence in favor of NACRT [1–5]. Convers
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