Utility of positron emission-computed tomography for predicting pathological response in resectable oesophageal squamous cell carcinoma after neoadjuvant chemoradiation

Eur J Cardiothorac Surg. 2020 Nov 1;58(5):1019-1026. doi: 10.1093/ejcts/ezaa181.

Abstract

Objectives: For patients with locally advanced oesophageal cancer, improved complete pathological response after neoadjuvant chemoradiation (nCRT) and the detrimental effects on the quality of life related to oesophagectomy have led to the need for a reliable method to select patients who have achieved complete pathological response and do not need surgery. The reliability of 18F-fluorodeoxyglucose positron emission-computed tomography (PET-CT) for predicting the pathological response after nCRT was evaluated.

Methods: Patients with locally advanced oesophageal cancer who were treated with nCRT and oesophagectomy from July 2010 to February 2017 were analysed. On the post-nCRT PET-CT, a complete metabolic response was defined as all tumourous lesions demonstrating maximum standardized uptake value (SUVmax) ≤2.5. To minimize the effect of radiation-induced oesophagitis, complete metabolic response was also defined as no viable lesion distinguishable from the background with diffuse uptake. The sensitivity, specificity, positive predictive value and negative predictive value were analysed for SUVmax, [X]ΔSUVmax and %ΔSUVmax.

Results: A total of 158 patients with oesophageal squamous cell carcinoma were analysed. The rate of complete pathological response was 27.8%, and that of complete metabolic response was 7.6%. The sensitivity, specificity, positive predictive value and negative predictive value based on SUVmax ≤2.5 and visual normalization were 95%, 14%, 74% and 50%, respectively. Analysis for [X]ΔSUVmax and %ΔSUVmax using the optimal cut-off values determined by the receiver operating characteristic curves did not show an improved predictive efficacy.

Conclusions: PET-CT is not a reliable tool for predicting pathological response. Patients diagnosed with resectable oesophageal cancer who underwent neoadjuvant therapy should not be exempt from surgery based on PET-CT results.

Keywords: Negative predictive value; Neoadjuvant chemoradiation; Oesophageal cancer; Oesophageal carcinoma; Positron emission–computed tomography.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Chemoradiotherapy
  • Electrons
  • Esophageal Neoplasms* / diagnostic imaging
  • Esophageal Neoplasms* / therapy
  • Esophageal Squamous Cell Carcinoma* / diagnostic imaging
  • Esophageal Squamous Cell Carcinoma* / therapy
  • Fluorodeoxyglucose F18
  • Humans
  • Neoadjuvant Therapy
  • Positron Emission Tomography Computed Tomography
  • Positron-Emission Tomography
  • Quality of Life
  • Radiopharmaceuticals
  • Reproducibility of Results

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18