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Journal of Clinical Oncology, Vol 21, Issue 3 (February), 2003: 428-432
© 2003 American Society for Clinical Oncology

Whole Body 18FDG-PET and the Response of Esophageal Cancer to Induction Therapy: Results of a Prospective Trial

Robert J. Downey, Tim Akhurst, David Ilson, Robert Ginsberg, Manjit S. Bains, Mithat Gonen, Heng Koong, Marc Gollub, Bruce D. Minsky, Maureen Zakowski, Alan Turnbull, Steven M. Larson, Valerie Rusch

From the Thoracic Service and Gastric and Mixed Tumor Service, Department of Surgery, Division of Nuclear Medicine and Division of GI Radiology, Department of Radiology, Division of Gastrointestinal Oncology, Department of Medicine, Department of Epidemiology and Biostatistics, Department of Radiation Oncology, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY; National Cancer Center, Singapore General Hospital, Singapore; and Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada.

Address reprint requests to Robert J Downey, MD, Division of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021; email: downeyr{at}mskcc.org.

Purpose: Whole-body 18F-fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) imaging before and after induction therapy was prospectively evaluated in patients with esophageal cancer to determine whether changes in PET images could measure response to therapy.

Patients and Methods: Between April 1997 and April 1999, 39 patients (34 men and five women; median age, 59 years; range, 36 to 76 years) with esophageal cancer were prospectively enrolled in a single-institution clinical trial of staging, including PET, induction therapy, restaging including PET, and esophagectomy. All patients undergoing esophagectomy after induction therapy (n = 17) were followed either to recurrence, to death, or through a disease-free interval of at least 24 months.

Results: PET after standard staging studies and before therapy imaged undetected sites of metastatic disease in six patients (15%). Restaging (including PET) after induction therapy did not identify any patients with disease progression or any patients with loco-regionally unresectable disease at exploration. The median decrease in the standardized uptake value (SUV) during induction therapy was 59%. After R0 esophagectomy, the 2-year disease-free and overall survival was 38% and 63%, respectively, among patients who had a less than 60% decrease in SUV, and 67% and 89%, respectively, among patients who had a greater than 60% decrease in SUV (P = .055 and P = .088, respectively).

Conclusion: Compared with conventional imaging, PET detects additional sites of metastatic disease at initial evaluation. After induction therapy, PET did not add to the estimation of loco-regional resectability and did not detect new distant metastases. However, changes in [18F]FDG PET may predict disease-free and overall survival after induction therapy and resection in patients with esophageal cancer. Further evaluation in larger trials is warranted.

Supported in part by National Cancer Institute grant no. 40166913.

Presented in part at the Thirty-seventh Annual Meeting of the American Society of Clinical Oncology, San Francisco, California, May 12–15, 2001.


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