Time Course of Tumor Metabolic Activity During Chemoradiotherapy of Esophageal Squamous Cell Carcinoma and Response to Treatment

DOI Web Site 15 Citations
  • Hinrich A. Wieder
    From the Departments of Nuclear Medicine, Surgery, Radiation Oncology, Pathology, Medicine III, and Diagnostic Radiology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
  • Björn L.D.M. Brücher
    From the Departments of Nuclear Medicine, Surgery, Radiation Oncology, Pathology, Medicine III, and Diagnostic Radiology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
  • Frank Zimmermann
    From the Departments of Nuclear Medicine, Surgery, Radiation Oncology, Pathology, Medicine III, and Diagnostic Radiology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
  • Karen Becker
    From the Departments of Nuclear Medicine, Surgery, Radiation Oncology, Pathology, Medicine III, and Diagnostic Radiology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
  • Florian Lordick
    From the Departments of Nuclear Medicine, Surgery, Radiation Oncology, Pathology, Medicine III, and Diagnostic Radiology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
  • Ambros Beer
    From the Departments of Nuclear Medicine, Surgery, Radiation Oncology, Pathology, Medicine III, and Diagnostic Radiology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
  • Markus Schwaiger
    From the Departments of Nuclear Medicine, Surgery, Radiation Oncology, Pathology, Medicine III, and Diagnostic Radiology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
  • Ulrich Fink
    From the Departments of Nuclear Medicine, Surgery, Radiation Oncology, Pathology, Medicine III, and Diagnostic Radiology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
  • Jörg Rüdiger Siewert
    From the Departments of Nuclear Medicine, Surgery, Radiation Oncology, Pathology, Medicine III, and Diagnostic Radiology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
  • Hubert J. Stein
    From the Departments of Nuclear Medicine, Surgery, Radiation Oncology, Pathology, Medicine III, and Diagnostic Radiology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
  • Wolfgang A. Weber
    From the Departments of Nuclear Medicine, Surgery, Radiation Oncology, Pathology, Medicine III, and Diagnostic Radiology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany

Abstract

<jats:sec><jats:title>Purpose</jats:title><jats:p>To evaluate the time course of therapy-induced changes in tumor glucose use during chemoradiotherapy of esophageal squamous cell carcinoma (ESCC) and to correlate the reduction of metabolic activity with histopathologic tumor response and patient survival.</jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p>Thirty-eight patients with histologically proven intrathoracic ESCC (cT3, cN0/+, cM0) scheduled to undergo a 4-week course of preoperative simultaneous chemoradiotherapy followed by esophagectomy were included. Patients underwent positron emission tomography with the glucose analog fluorodeoxyglucose (FDG-PET) before therapy (n = 38), after 2 weeks of initiation of therapy (n = 27), and preoperatively (3 to 4 weeks after chemoradiotherapy; n = 38). Tumor metabolic activity was quantitatively assessed by standardized uptake values (SUVs).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Mean tumor FDG uptake before therapy was 9.3 ± 2.8 SUV and decreased to 5.7 ± 1.9 SUV 14 days after initiation of chemoradiotherapy (−38% ± 18%; P < .0001). The preoperative scan showed an additional decrease of metabolic activity to 3.3 ± 1.1 SUV (P < .0001). In histopathologic responders (< 10% viable cells in the resected specimen), the decrease in SUV from baseline to day 14 was 44% ± 15%, whereas it was only 21% ± 14% in nonresponders (P = .0055). Metabolic changes at this time point were also correlated with patient survival (P = .011). In the preoperative scan, tumor metabolic activity had decreased by 70% ± 11% in histopathologic responders and 51% ± 21% in histopathologic nonresponders.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Changes in tumor metabolic activity after 14 days of preoperative chemoradiotherapy are significantly correlated with tumor response and patient survival. This suggests that FDG-PET might be used to identify nonresponders early during neoadjuvant chemoradiotherapy, allowing for early modifications of the treatment protocol.</jats:p></jats:sec>

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