Original article

European Journal of Nuclear Medicine and Molecular Imaging

, Volume 34, Issue 12, pp 1925-1932

First online:

Prediction of tumor response by FDG-PET: comparison of the accuracy of single and sequential studies in patients with adenocarcinomas of the esophagogastric junction

  • Hinrich A. WiederAffiliated withDepartment of Nuclear Medicine, Klinikum rechts der Isar, Technische Universitaet MuenchenDepartment of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen Email author 
  • , Katja OttAffiliated withDepartment of Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen
  • , Florian LordickAffiliated withDepartment of Surgery, Klinikum rechts der Isar, Technische Universitaet MuenchenDepartment of Medicine III, Klinikum rechts der Isar, Technische Universitaet Muenchen
  • , Karen BeckerAffiliated withDepartment of Medicine III, Klinikum rechts der Isar, Technische Universitaet MuenchenDepartment of Pathology, Klinikum rechts der Isar, Technische Universitaet Muenchen
  • , Alexander StahlAffiliated withDepartment of Nuclear Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen
  • , Ken HerrmannAffiliated withDepartment of Nuclear Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen
  • , Ulrich FinkAffiliated withDepartment of Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen
  • , Jörg Rüdiger SiewertAffiliated withDepartment of Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen
  • , Markus SchwaigerAffiliated withDepartment of Nuclear Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen
    • , Wolfgang A. WeberAffiliated withDepartment of Nuclear Medicine, Klinikum rechts der Isar, Technische Universitaet MuenchenDepartment of Nuclear Medicine, Universitaetsklinikum Freiburg, Albrecht-Ludwigs-Universitaet Freiburg

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Abstract

Purpose

Positron-emission-tomography with the glucose analog fluorodeoxyglucose (FDG-PET) has shown encouraging results for prediction of tumor response to chemotherapy. However, there is no consensus as to what time after initiation of therapy FDG-PET should be performed. To address this question we studied the time course of changes in tumor FDG-uptake in patients with locally advanced adenocarcinomas of the esophagogastric junction (AEG) treated with preoperative chemotherapy.

Methods

Twenty-four patients with AEG were included and underwent FDG-PET prior to therapy (PET1), 2 weeks after initiation of therapy (PET2), and preoperatively (PET3). Tumor metabolic activity was assessed by standardized uptake values (SUV) and correlated with histopathologic response and patient survival.

Results

Baseline tumor SUV was 8.3 ± 3.5 and decreased to 5.0 ± 1.8 at PET2 (p  <  0.0001). At PET3 there was further decrease to 3.5 ± 1.9 (p < 0.0001). The relative decrease of tumor FDG-uptake from PET1 to PET2 and from PET1 to PET3 were both significantly correlated with histopathologic response. Reduction of tumor SUV from PET1 to PET2 was significantly correlated with survival (p = 0.03) and there was a similar trend for changes from PET1 to PET3 (p = 0.09). In contrast, absolute SUVs did not demonstrate a significant correlation with histopathological response or patient survival at any of the studied time points.

Conclusion

In patients with AEG, relative changes in tumor FDG uptake are better predictors for treatment outcome than absolute SUVs. Metabolic changes within the first 2 weeks of therapy are at least as efficient for prediction of histopathologic response and patient survival as later changes.

Keywords

18F-FDG-PET Oncology Neoadjuvant chemotherapy Esophageal cancer Therapy response