FDG-PET/CT evaluation of early metabolic response after neoadjuvant chemotherapy in patients with esophageal and GEJ cancer – a pilot study

Konference: 2010 35th Congress ESMO – účast ČR

Kategorie: Gastrointestinální nádory

Téma: Upper gastrointestinal tumors

Číslo abstraktu: 0811P

Autoři: Doc. MUDr. Milada Zemanová, Ph.D.; MUDr. Tomáš Haruštiak; MUDr. Pavel Fencl, CSc.; MUDr. Zdeňka Pechačová; MUDr. Gabriela Pazdrová; prof. MUDr. Luboš Petruželka, CSc.

Purpose: Aim of this pilot study is to demonstrate the possibility of early prediction of treatment response to neoadjuvant chemotherapy by measuring metabolic activity in 18-fluorodeoxyglucose-positron emission tomography/ computer tomografy (FDG-PET/CT) in patients with adenocarcinoma of the esophagus and gastroesophageal junction (GEJ).

Material and method: Patients with operable esophageal or GEJ cancer were treated with 3 cycles of neoadjuvant chemotherapy (CT) containing epirubicine and cisplatin plus 5-fluorouracil or capecitabine in standard schedule. FDG-PET/CT scan was done before treatment start and repeated after first cycle of CT and before surgery. Evaluation of metabolic response was performed according to PERCIST_1 criteria (PET Response Criteria in Solid Tumors, 2009) in parameters of SUV (Standardized Uptake Value) and TLG (Total Lesion Glycolysis). Correlation of FDG-PET metabolic response with perioperative staging (ypTNM) and with progression/recurrence rate was done. Study is ongoing, next step will be correlation of metabolic response with histopathologic regression and survival.

Results: 60 patients were enrolled, 56 men, 4 women, median age 58 years. Thirty nine of 51 (76%) of patients with completed neoadjuvant CT had surgery, 32 (63%) had radical resection, 19 (27%) of patients were inoperable. Twenty four of 60 (40%) of patients progressed with median follow-up of 308 days. FDG-PET/CT were evaluated in 33 patients, 21 of them are completed. Complete metabolic response (CMR) rate in parameters SUV/TLG after 1st cycle was 8%/27%, partial metabolic response (PMR) rate was 46%/35%, stable metabolic disease (SMD) was found in 42%/31% and progressive metabolic disease in 4%/4%. Significant positive correlations of TLG-CMR rate with ypN0 perioperative finding and TLG-SMD rate with progression/recurrence rate were found.

Conclusions: Preliminary results of our study confirm correlation of early metabolic response in FDG-PET/CT with treatment outcome particularly in the parameter of TLG.

Disclosure: All authors have declared no conflicts of interest.

Datum přednesení příspěvku: 9. 9. 2010