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Change in volume parameters induced by neoadjuvant chemotherapy provide accurate prediction of overall survival after resection in patients with oesophageal cancer

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess the prognostic value of volumetric parameters measured with CT and PET/CT in patients with neoadjuvant chemotherapy (NACT) and resection for oesophageal cancer (EC).

Methods

Patients with locally advanced EC, who were treated with NACT and resection, were retrospectively analysed. Data from CT volumetry and 18 F-FDG PET/CT (maximum standardized uptake [SUVmax], metabolic tumour volume [MTV], and total lesion glycolysis [TLG]) were recorded before and after NACT. The impact of volumetric parameter changes induced by NACT (MTVRATIO, TLGRATIO, etc.) on overall survival (OS) was assessed using a Cox proportional hazards model.

Results

Eighty-four patients were assessed using CT volumetry; of those, 50 also had PET/CT before and after NACT. Low post-treatment CT volume and thickness, MTV, TLG, and SUVmax were all associated with longer OS (p < 0.05), as were CTthicknessRATIO, MTVRATIO, TLGRATIO, and SUVmaxRATIO (p < 0.05). In the multivariate analysis, only MTVRATIO (Hazard ratio, HR 2.52 [95 % Confidence interval, CI 1.33–4.78], p = 0.005), TLGRATIO (HR 3.89 [95%CI 1.46–10.34], p = 0.006), and surgical margin status (p < 0.05), were independent predictors of OS.

Conclusions

MTVRATIO and TLGRATIO are independent prognostic factors for survival in patients after NACT and resection for EC.

Key points

• Change in PET parameters shows close correlation to survival in oesophageal cancer.

• Association with OS is independent of changes in SUVmax and CT volume.

• Metabolic parameters after NACT correlate with pathologic response and nodal status.

• Metabolic parameters may be better suited than SUVmax for response assessment.

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Abbreviations

AEG:

Adenocarcinoma of the gastro-oesophageal junction

CF:

Cisplatin and 5-fluorouracil

CI:

Confidence interval

DCF:

Docetaxel, cisplatin and 5-fluorouracil

EC:

Oesophageal cancer

EOX:

Epirubicin, oxaliplatin and Capecitabine

ESCC:

Squamous cell oesophageal cancer

FDG:

Fluoro-deoxyglucose

HR:

Hazard ratio

MTV:

Metabolic tumour volume

NACT:

Neoadjuvant chemotherapy

OS:

Overall survival

RCHT:

Radiochemotherapy

ROI:

Region of interest

SUVmax:

Maximal standardized uptake value

TLG:

Total lesion glycolysis

VOI:

Volume of interest

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Acknowledgments

The authors want to thank Mary McAllister for proofreading and correcting the manuscript. The scientific guarantor of this publication is Ahmed Ba-Ssalamah. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding.

One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Dietmar Tamandl, Barbara Fueger, Patrick Kinsperger, Alexander Haug & Ahmed Ba-Ssalamah

  2. Department of Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA

    Richard M. Gore

  3. Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria

    Matthias Paireder & Sebastian F. Schoppmann

  4. Department of Internal Medicine, Division of Medical Oncology, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria

    Michael Hejna

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  1. Dietmar Tamandl
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Corresponding author

Correspondence to Dietmar Tamandl.

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Fig. S1

Regression diagrams for the relation of CT tumour volume in comparison to metabolic tumour volumes at different SUV thresholds. a and b show pre-treatment values of MTV at 2.5 and MTV at 4.0 compared to CT volumetry. Likewise, c and d show post-treatment values of those respective parameters. R, Pearson regression coefficient (GIF 21 kb)

High resolution image (TIFF 3567 kb)

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Tamandl, D., Gore, R.M., Fueger, B. et al. Change in volume parameters induced by neoadjuvant chemotherapy provide accurate prediction of overall survival after resection in patients with oesophageal cancer. Eur Radiol 26, 311–321 (2016). https://doi.org/10.1007/s00330-015-3860-7

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  • DOI: https://doi.org/10.1007/s00330-015-3860-7

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