Preoperative Prediction of Pathologic Response to Neoadjuvant Chemoradiotherapy in Patients With Esophageal Cancer Using 18F-FDG PET/CT and DW-MRI: a prospective multicenter study
Publication date
2020-04-01
Authors
Borggreve, Alicia S
Goense, Lucas
van Rossum, P S N
Heethuis, Sophie E.
van Hillegersberg, Richard
Lagendijk, J J W
Lam, Marnix
van Lier, Astrid L H M W
Mook, S
Ruurda, J P
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Supervisors
Document Type
Article
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taverne
Abstract
PURPOSE: Accurate preoperative prediction of pathologic response to neoadjuvant chemoradiotherapy (nCRT) in patients with esophageal cancer could enable omission of esophagectomy in patients with a pathologic complete response (pCR). This study aimed to evaluate the individual and combined value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography ( 18F-FDG PET/CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) during and after nCRT to predict pathologic response in patients with esophageal cancer. METHODS AND MATERIALS: In this multicenter prospective study, patients scheduled to receive nCRT followed by esophagectomy for esophageal cancer underwent 18F-FDG PET/CT and DW-MRI scanning before the start of nCRT, during nCRT, and before esophagectomy. Response to nCRT was based on histopathologic evaluation of the resection specimen. Relative changes in 18F-FDG PET/CT and DW-MRI parameters were compared between patients with pCR and non-pCR groups. Multivariable ridge regression analyses with bootstrapped c-indices were performed to evaluate the individual and combined value of 18F-FDG PET/CT and DW-MRI. RESULTS: pCR was found in 26.1% of 69 patients. Relative changes in 18F-FDG PET/CT parameters after nCRT (Δ standardized uptake value [SUV] mean,postP = .016, and Δ total lesion glycolysis postP = .024), as well as changes in DW-MRI parameters during nCRT (Δ apparent diffusion coefficient [ADC] duringP = .008) were significantly different between pCR and non-pCR. A c-statistic of 0.84 was obtained for a model with ΔADC during, ΔSUV mean,post, and histology in classifying patients as pCR (versus 0.82 for ΔADC during and 0.79 for ΔSUV mean,post alone). CONCLUSIONS: Changes on 18F-FDG PET/CT after nCRT and early changes on DW-MRI during nCRT can help identify pCR to nCRT in esophageal cancer. Moreover, 18F-FDG PET/CT and DW-MRI might be of complementary value in the assessment of pCR.
Keywords
Taverne, Radiation, Oncology, Radiology Nuclear Medicine and imaging, Cancer Research, Journal Article
Citation
Borggreve, A S, Goense, L, van Rossum, P S N, Heethuis, S E, van Hillegersberg, R, Lagendijk, J J W, Lam, M G E H, van Lier, A L H M W, Mook, S, Ruurda, J P, van Vulpen, M, Voncken, F E M, Aleman, B M P, Bartels-Rutten, A, Ma, J, Fang, P, Musall, B C, Lin, S H & Meijer, G J 2020, 'Preoperative Prediction of Pathologic Response to Neoadjuvant Chemoradiotherapy in Patients With Esophageal Cancer Using 18 F-FDG PET/CT and DW-MRI : a prospective multicenter study', International Journal of Radiation Oncology Biology Physics, vol. 106, no. 5, pp. 998-1009. https://doi.org/10.1016/j.ijrobp.2019.12.038