Increased evidence for the prognostic value of FDG uptake on late-treatment PET in non-tumour-affected oesophagus in irradiated patients with oesophageal carcinoma
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18F-FDG uptake in irradiated non-tumour-affected oesophagus (NTO) on restaging PET is a potential surrogate for the measurement of radiation-induced inflammation. Radiation-induced inflammation itself has been shown to be of high prognostic relevance in patients undergoing preoperative radiochemotherapy (RCT) for locally advanced oesophageal cancer. We assessed the prognostic relevance of FDG uptake in the NTO in an independent cohort of patients treated with definitive RCT.
This retrospective evaluation included 72 patients with oesophageal squamous cell carcinoma treated with definitive RCT with curative intent. All patients underwent pretreatment and restaging FDG PET after receiving a radiation dose of 40–50 Gy. Standardized uptake values (SUVmax/SUVmean), metabolic tumour volume (MTV) and relative changes from pretreatment to restaging PET (∆SUVmax/∆SUVmean) were determined within the tumour and NTO. Univariate Cox regression with respect to overall survival (OS), local control (LC), distant metastases (DM) and treatment failure (TF) was performed. Independence of parameters was tested by multivariate Cox regression.
∆SUVmax NTO and MTV were prognostic factors for all investigated clinical endpoints (OS, LC, DM, TF). Inclusion of clinical and PET tumour parameters in multivariate analysis showed that ∆SUVmax NTO was an independent prognostic factor. Furthermore, multivariate analysis of ∆SUVmax NTO using previously published cut-off values from preoperatively treated patients revealed that ∆SUVmax NTO was independent prognostic factor for OS (HR = 1.88, p = 0.038), TF (HR = 2.11, p = 0.048) and DM (HR = 3.02, p = 0.047).
NTO-related tracer uptake during the course of treatment in patients with oesophageal carcinoma was shown to be of high prognostic relevance. Thus, metabolically activity of NTO measured in terms of ∆SUVmax NTO is a potential candidate for future treatment individualization (i.e. organ preservation).
KeywordsOesophageal cancer Definitive radiochemotherapy Restaging Response assessment Normal tissue Side effects Inflammation FDG PET
S.Z. provided ideas for the study. S.Z., Y.L. and F.H. performed the analysis and drafted the manuscript. F.H. designed the figures and calculated the underlying statistics. Y.L., C.L. and W.H. were responsible for treatment, imaging, collection of patient data and follow-up. C.F., P.G., S.Z. and Y.L. provided ideas, supervised the analysis and interpretation of the data and reviewed the manuscript. All authors read and approved the final manuscript.
This work was partly supported by the Major Projects of Fujian Natural Science Foundation (no. 2008-59-11), the Nature Science Foundation of China (no. 81101066), the Xiamen City Science and Technology Project guidance (3502Z20134004) and the Berliner Krebsgesellschaft (ZSF201720).
Compliance with ethical standards
Conflicts of interest
The study was approved by the Institutional Ethics Committees.
All patients provided signed written informed consent.
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