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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 F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (F-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 F-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 F-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 F-FDG PET/CT and DW-MRI.
Results: pCR was found in 26.1% of 69 patients. Relative changes in F-FDG PET/CT parameters after nCRT (Δ standardized uptake value [SUV]P = .016, and Δ total lesion glycolysis P = .024), as well as changes in DW-MRI parameters during nCRT (Δ apparent diffusion coefficient [ADC]P = .008) were significantly different between pCR and non-pCR. A c-statistic of 0.84 was obtained for a model with ΔADC, ΔSUV, and histology in classifying patients as pCR (versus 0.82 for ΔADC and 0.79 for ΔSUV alone).
Conclusions: Changes on F-FDG PET/CT after nCRT and early changes on DW-MRI during nCRT can help identify pCR to nCRT in esophageal cancer. Moreover, F-FDG PET/CT and DW-MRI might be of complementary value in the assessment of pCR.
Download full-text PDF |
Source |
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103753 | PMC |
http://dx.doi.org/10.1016/j.ijrobp.2019.12.038 | DOI Listing |
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