Predicting pathological response of esophageal cancer to neoadjuvant chemotherapy: the implications of metabolic nodal response for personalised therapy
INTRODUCTION<br/> Only a minority of esophageal cancers demonstrates a pathological tumor response (pTR) to neoadjuvant chemotherapy (NAC). 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is often used for restaging after NAC and to assess response. Incre...
| Main Authors: | , , , , , , , , |
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| Format: | Journal article |
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Society of Nuclear Medicine
2016
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| _version_ | 1826279552451608576 |
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| author | Findlay, J Bradley, K Mun Wang, L Franklin, J Teoh, E Gleeson, F Maynard, N Gilies, R Middleton, M |
| author_facet | Findlay, J Bradley, K Mun Wang, L Franklin, J Teoh, E Gleeson, F Maynard, N Gilies, R Middleton, M |
| author_sort | Findlay, J |
| collection | OXFORD |
| description | INTRODUCTION<br/> Only a minority of esophageal cancers demonstrates a pathological tumor response (pTR) to neoadjuvant chemotherapy (NAC). 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is often used for restaging after NAC and to assess response. Increasingly, it is used during therapy to identify unresponsive tumors and predict pTR , using avidity of the primary tumor alone. However, definitions of such metabolic tumor response (mTR) vary. We aimed to comprehensively re-evaluate metabolic response assessment using accepted parameters, as well as novel concepts of metabolic nodal stage (mN) and nodal response (mNR). <br/><br/> PATIENTS AND METHODS<br/> This was a single-center retrospective UK cohort study. All patients with esophageal cancer staged before NAC with PET-CT and after with CT or PET-CT and undergoing resection from 2006-2014 were identified. pTR was defined as Mandard tumor regression grade 1-3; imaging parameters included metrics of tumor avidity (standardized uptake value [SUV]max/mean/peak), composites of avidity and volume (including metabolic tumor volume), nodal SUVmax, and our new concepts of mN stage and mNR. <br/><br/> RESULTS<br/> Eighty-two (27.2%) of 301 patients demonstrated pTR. No pre-NAC PET parameters predicted pTR. In 220 patients re-staged by PET-CT, The optimal tumor ΔSUVmax threshold was a 77.8% reduction. This was as sensitive as the current PET Response Criteria in Solid Tumors (PERCIST) 30% reduction, but more specific with a higher negative predictive value (p<0.001). ΔSUVmax and Δlength independently predicted pTR, and composite avidity/spatial metrics outperformed avidity alone. Whilst both mTR and mNR were associated with pTR, in 82 patients with FDG-avid nodes before NAC we observed mNR in 10 (12.2%) not demonstrating mTR. <br/><br/> CONCLUSION<br/> Current definitions of metabolic response are suboptimal and too simplistic. Composite avidity/volume measures improve prediction. mNR may further improve response assessment, by specifically assessing metastatic tumor sub-populations, likely responsible for disease relapse, and should be urgently assessed when considering aborting therapy on the basis of mTR alone. |
| first_indexed | 2024-03-07T00:00:27Z |
| format | Journal article |
| id | oxford-uuid:75c0b8ec-7564-41be-a588-092e96e89593 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T00:00:27Z |
| publishDate | 2016 |
| publisher | Society of Nuclear Medicine |
| record_format | dspace |
| spelling | oxford-uuid:75c0b8ec-7564-41be-a588-092e96e895932022-03-26T20:11:24ZPredicting pathological response of esophageal cancer to neoadjuvant chemotherapy: the implications of metabolic nodal response for personalised therapyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:75c0b8ec-7564-41be-a588-092e96e89593Symplectic Elements at OxfordSociety of Nuclear Medicine2016Findlay, JBradley, KMun Wang, LFranklin, JTeoh, EGleeson, FMaynard, NGilies, RMiddleton, MINTRODUCTION<br/> Only a minority of esophageal cancers demonstrates a pathological tumor response (pTR) to neoadjuvant chemotherapy (NAC). 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is often used for restaging after NAC and to assess response. Increasingly, it is used during therapy to identify unresponsive tumors and predict pTR , using avidity of the primary tumor alone. However, definitions of such metabolic tumor response (mTR) vary. We aimed to comprehensively re-evaluate metabolic response assessment using accepted parameters, as well as novel concepts of metabolic nodal stage (mN) and nodal response (mNR). <br/><br/> PATIENTS AND METHODS<br/> This was a single-center retrospective UK cohort study. All patients with esophageal cancer staged before NAC with PET-CT and after with CT or PET-CT and undergoing resection from 2006-2014 were identified. pTR was defined as Mandard tumor regression grade 1-3; imaging parameters included metrics of tumor avidity (standardized uptake value [SUV]max/mean/peak), composites of avidity and volume (including metabolic tumor volume), nodal SUVmax, and our new concepts of mN stage and mNR. <br/><br/> RESULTS<br/> Eighty-two (27.2%) of 301 patients demonstrated pTR. No pre-NAC PET parameters predicted pTR. In 220 patients re-staged by PET-CT, The optimal tumor ΔSUVmax threshold was a 77.8% reduction. This was as sensitive as the current PET Response Criteria in Solid Tumors (PERCIST) 30% reduction, but more specific with a higher negative predictive value (p<0.001). ΔSUVmax and Δlength independently predicted pTR, and composite avidity/spatial metrics outperformed avidity alone. Whilst both mTR and mNR were associated with pTR, in 82 patients with FDG-avid nodes before NAC we observed mNR in 10 (12.2%) not demonstrating mTR. <br/><br/> CONCLUSION<br/> Current definitions of metabolic response are suboptimal and too simplistic. Composite avidity/volume measures improve prediction. mNR may further improve response assessment, by specifically assessing metastatic tumor sub-populations, likely responsible for disease relapse, and should be urgently assessed when considering aborting therapy on the basis of mTR alone. |
| spellingShingle | Findlay, J Bradley, K Mun Wang, L Franklin, J Teoh, E Gleeson, F Maynard, N Gilies, R Middleton, M Predicting pathological response of esophageal cancer to neoadjuvant chemotherapy: the implications of metabolic nodal response for personalised therapy |
| title | Predicting pathological response of esophageal cancer to neoadjuvant chemotherapy: the implications of metabolic nodal response for personalised therapy |
| title_full | Predicting pathological response of esophageal cancer to neoadjuvant chemotherapy: the implications of metabolic nodal response for personalised therapy |
| title_fullStr | Predicting pathological response of esophageal cancer to neoadjuvant chemotherapy: the implications of metabolic nodal response for personalised therapy |
| title_full_unstemmed | Predicting pathological response of esophageal cancer to neoadjuvant chemotherapy: the implications of metabolic nodal response for personalised therapy |
| title_short | Predicting pathological response of esophageal cancer to neoadjuvant chemotherapy: the implications of metabolic nodal response for personalised therapy |
| title_sort | predicting pathological response of esophageal cancer to neoadjuvant chemotherapy the implications of metabolic nodal response for personalised therapy |
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