18F-FDG PET and 18F-FDG PET/CT for Assessing Response to Therapy in Esophageal Cancer
- 20 April 2009
- journal article
- review article
- Published by Society of Nuclear Medicine in Journal of Nuclear Medicine
- Vol. 50 (Suppl 1), 89S-96S
- https://doi.org/10.2967/jnumed.108.057232
Abstract
In patients with locally advanced esophageal cancer, preoperative chemotherapy or chemoradiotherapy has been shown to improve outcome with respect to survival. Patients who respond to induction therapy have a significantly improved survival, compared with patients who do not respond to the therapy. However, surrogate markers that predict response or prognosis-especially early in the course of therapy-are not available in clinical routine. In patients with esophageal cancer, PET with the glucose analog (18)F-FDG can be used for assessing response to therapy. Therapy response can be assessed with (18)F-FDG PET and (18)F-FDG PET/CT late, that is, after completion of therapy, and early in the course of therapy. In adenocarcinomas of the esophagogastric junction, (18)F-FDG has been established and validated in several studies as a surrogate marker that allows prediction of response and prognosis, whereas in other studies (18)F-FDG PET was not predictive of response and prognosis. The MUNICON study was an initial unicenter trial showing that a PET-guided treatment algorithm was feasible in patients with adenocarcinomas of the esophagogastric junction. The results of this study are important toward individualization of multimodal treatment. The use of (18)F-FDG PET and PET/CT for therapy monitoring in esophageal cancer is the subject of intense discussion, underlining the need for randomized multicenter studies. From a methodologic point of view, the most important issue in therapy monitoring using (18)F-FDG PET and PET/CT is the standardization of patient preparation, data acquisition and processing, and data interpretation, especially for prospective randomized multicenter studies. In conclusion, single-center studies investigating response assessment in patients with esophageal cancer have provided promising results. In the future, prospective randomized multicenter trials will have to be performed and research will address new imaging probes and innovative therapy regimens.This publication has 39 references indexed in Scilit:
- Recommendations on the Use of 18F-FDG PET in OncologyJournal of Nuclear Medicine, 2008
- Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysisThe Lancet Oncology, 2007
- Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal CancerThe New England Journal of Medicine, 2006
- Cancer Statistics, 2005CA: A Cancer Journal for Clinicians, 2005
- International variationOncogene, 2004
- Esophageal CancerThe New England Journal of Medicine, 2003
- Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trialThe Lancet, 2002
- Only pathologic complete response to neoadjuvant chemotherapy improves significantly the long term survival of patients with resectable esophageal squamous cell carcinomaCancer, 2001
- Chemoradiotherapy Followed by Surgery Compared with Surgery Alone in Squamous-Cell Cancer of the EsophagusThe New England Journal of Medicine, 1997
- Pre‐operative radiotherapy prolongs survival in operable esophageal carcinoma: A randomized, multicenter study of pre‐operative radiotherapy and chemotherapy. The second scandinavian trial in esophageal cancerWorld Journal of Surgery, 1992