Metabolic Imaging Predicts Response, Survival, and Recurrence in Adenocarcinomas of the Esophagogastric Junction
- 10 October 2006
- journal article
- research article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 24 (29), 4692-4698
- https://doi.org/10.1200/jco.2006.06.7801
Abstract
Purpose: A previous study suggested that measurement of therapy-induced changes in tumor glucose metabolism by positron emission tomography (PET) with the glucose analog [18F]fluorodeoxyglucose (FDG) allows to select patients most likely to benefit from preoperative chemotherapy in adenocarcinomas of the esophagogastric junction (AEG). The aim of this study was to prospectively validate these findings by using an a priori definition of metabolic response. Patients and Methods: Sixty-five patients with locally advanced AEGs were included. Tumor glucose utilization was quantitatively assessed by FDG-PET before chemotherapy and 14 days after initiation of therapy. Patients were classified as metabolic responders when the metabolic activity of the primary tumor had decreased by more than 35% at the time of the second PET. Results: Metabolic responders showed a high histopathologic response rate (44%) with a 3-year survival rate of 70%. In contrast, prognosis was poor for metabolic nonresponders with a histopathologic response rate of 5% (P = .001) and a 3-year survival rate of 35% (P = .01). A multivariate analysis (covariates: ypT-, ypN-category, histopathologic response) demonstrated that metabolic response was the only factor predicting recurrence (P = .018) in the subgroup of completely resected (R0) patients. Conclusion: This study prospectively demonstrates that changes in tumor metabolic activity during chemotherapy predict response, prognosis, and recurrence. These data provide the basis for clinical trials in which preoperative treatment is changed for patients without a metabolic response early in the course of therapy. PET-guided induction therapy may even be applicable to earlier tumor stages because surgery is only minimally delayed in nonresponding patients.Keywords
This publication has 24 references indexed in Scilit:
- Perioperative chemotherapy in operable gastric and lower oesophageal cancer: Final results of a randomised, controlled trial (the MAGIC trial, ISRCTN 93793971)Journal of Clinical Oncology, 2005
- Prediction of Response to Preoperative Chemotherapy in Gastric Carcinoma by Metabolic Imaging: Results of a Prospective TrialJournal of Clinical Oncology, 2003
- Preoperative chemotherapy for resectable thoracic esophageal cancerPublished by Wiley ,2003
- Neoadjuvant chemotherapy with cisplatin, 5-FU, and leucovorin (PLF) in locally advanced gastric cancer: a prospective phase II studyGastric Cancer, 2003
- Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trialThe Lancet, 2002
- Prediction of Response to Preoperative Chemotherapy in Adenocarcinomas of the Esophagogastric Junction by Metabolic ImagingJournal of Clinical Oncology, 2001
- Response to Neoadjuvant Chemotherapy Best Predicts Survival After Curative Resection of Gastric CancerAnnals of Surgery, 1999
- Chemotherapy Followed by Surgery Compared with Surgery Alone for Localized Esophageal CancerThe New England Journal of Medicine, 1998
- Classification of adenocarcinoma of the oesophagogastric junctionBritish Journal of Surgery, 1998
- Power and sample size calculations: A review and computer programControlled Clinical Trials, 1990