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Use of 18F Fluorodeoxyglucose Positron Emission Tomography Computed Tomography in Assessing Response to Neoadjuvant Chemoradiation and Its Impact on Survival in Esophageal Squamous Cell Carcinoma

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Abstract

Background

To determine the accuracy of 18F-Fluorodeoxyglucose positron emission tomography computed tomography (FDG-PET CT) in predicting response to neoadjuvant chemoradiation (NACRT) in esophageal squamous cell cancer (SCC) and impact of such response on survival.

Methods

Retrospective analysis of patients with esophageal SCC (cT2-4N0-N+M0) who underwent PET CT before and 6 weeks after NACRT followed by surgery was carried out in this study. Metabolic response was assessed by change in standardized uptake value (ΔSUVmax) after NACRT and the pathological response was graded. A receiver operating characteristic curve (ROC) was used to identify the optimal cut off value of SUVmax to predict histopathological response. The impact of metabolic response and pathological response on survival was determined.

Results

Of the 73 patients analyzed, 27 had complete metabolic response, while 24 had pathological complete response (PCR). However, only 14 of the 27 complete metabolic responders actually had PCR. At 67% ΔSUVmax, the optimum balance between sensitivity (70.83%) and specificity (69.23%) was achieved and the correlation between metabolic response and pathological complete response achieved statistical significance (p = 0.0009). However, ΔSUVmax of 67% was found to have no significant association with survival (p = 0.51). PCR was the only significant determinant of improved survival (p = 0.04).

Conclusion

PCR which is a significant determinant of survival is not ideally predicted by ΔSUVmax on PET CT.

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Acknowledgments

The authors would like to thank Dr. Jiten Jaipuria, DNB, Consultant surgical oncology, Rajiv Gandhi cancer and research institute, Delhi, India, for his valuable inputs and statistical help.

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Authors and Affiliations

  1. Department of GI and HPB Oncosurgery, Rajiv Gandhi Cancer Institute and Research Centre, Sector -5, Rohini, Delhi, 110085, India

    Sayed Assif Iqbal, Shaifali Goel, Abhishek Aggarwal, Nikhil Gupta & Shivendra Singh

  2. Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, Sector -5, Rohini, Delhi, 110085, India

    Manoj Gupta

  3. Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, Sector -5, Rohini, Delhi, 110085, India

    Garima Durga

  4. Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector -5, Rohini, Delhi, 110085, India

    Vineet Talwar

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  1. Sayed Assif Iqbal
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  2. Shaifali Goel
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Contributions

Sayed Assif Iqbal: data acquisition, manuscript preparation, writing–original draft, manuscript review.

Shaifali Goel: data acquisition, data analysis and interpretation, manuscript review.

Abhishek Aggarwal: statistical analysis, quality control of data and algorithms, manuscript review.

Nikhil Gupta: data acquisition, supervision, manuscript review.

Manoj Gupta: data acquisition, data analysis and interpretation, manuscript review.

Garima Durga: data acquisition, quality control of data and algorithms, manuscript review.

Vineet Talwar: methodology, supervision, manuscript review.

Shivendra Singh: study concepts, study design, manuscript editing, manuscript review.

Corresponding author

Correspondence to Shivendra Singh.

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Iqbal, S.A., Goel, S., Aggarwal, A. et al. Use of 18F Fluorodeoxyglucose Positron Emission Tomography Computed Tomography in Assessing Response to Neoadjuvant Chemoradiation and Its Impact on Survival in Esophageal Squamous Cell Carcinoma. J Gastrointest Canc 52, 1073–1080 (2021). https://doi.org/10.1007/s12029-020-00543-4

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