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- Title
Utility of positron emission–computed tomography for predicting pathological response in resectable oesophageal squamous cell carcinoma after neoadjuvant chemoradiation.
- Authors
Lee, Jiyun; Choi, Joon Young; Lim, Sung Won; Ahn, Myung-Ju; Park, Keunchil; Zo, Jae Il; Shim, Young Mog; Oh, Dongryul; Sun, Jong-Mu
- Abstract
OBJECTIVES Open in new tab Download slide Open in new tab Download slide 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.
- Subjects
SQUAMOUS cell carcinoma; RECEIVER operating characteristic curves; ABDOMINOPERINEAL resection; POSITRONS; CHEMORADIOTHERAPY; TOMOGRAPHY
- Publication
European Journal of Cardio-Thoracic Surgery, 2020, Vol 58, Issue 5, p1019
- ISSN
1010-7940
- Publication type
Article
- DOI
10.1093/ejcts/ezaa181