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Nodal FDG-PET/CT uptake influences outcome and relapse location among esophageal cancer patients submitted to chemotherapy or radiochemotherapy

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Abstract

Purpose

Our aim was investigate whether lymph node uptake is associated with survival and regional relapses, and relapse patterns with respect to the radiotherapy fields in esophageal cancer (EC).

Materials and methods

The FDG-PET/CT image datasets of 56 patients were analyzed. All patients underwent definitive or neoadjuvant radio/chemotherapy (RCT). All patients suffering from persistent or recurrent local/regional-only disease after RCT were considered for salvage resection. Patients with adenocarcinoma without metastatic disease were considered for planned resection (usually within 3 months of treatment).

Results

Patients with PET-positive lymph nodes before treatment had a worse overall survival and a shorter disease-free survival than those without PET-positive nodes. They also had worse node and metastatic relapse-free survival. N2 patients had statistically significant poorer outcomes than N1–N0 patients and a better survival if the involved nodes were closer to the esophageal tumor. Involved node location by PET/CT also affected global, nodal and metastatic relapses. In addition, an increment of SUVmax value increased relative risk of death and increased relative risk of node and metastatic relapses. The first site of relapse was metastatic recurrence and, second, local recurrence. The most frequent were “in-field” loco/regional recurrence. We observed a relationship between patients classified-N1 and out-field nodal recurrence (p = 0.024), and between patients-N2 and in-field nodal recurrence. The number of PET-positive nodes was an independent significant prognostic predictor for relapse (p < 0.001).

Conclusion

Our study shows that only FDG-PET/CT can provide prognostic information in EC. Nodal PET/CT uptake influences outcome and relapse location among EC patients.

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Authors and Affiliations

  1. Radiation Oncology Department, Complejo Hospitalario Universitario de Albacete, Calle Hermanos Falcó, 30, 02008, Albacete, Spain

    E. Jimenez-Jimenez & S. Sabater

  2. Medical Physics Department, Clinica IMQ Zorrotzaurre, Bilbao, Spain

    P. Mateos

  3. Radiation Oncology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain

    I. Ortiz, N. Aymar, R. Roncero & J. Pardo

  4. Nuclear Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain

    M. Gimenez

Authors
  1. E. Jimenez-Jimenez
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  2. P. Mateos
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  3. I. Ortiz
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  4. N. Aymar
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  5. R. Roncero
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  6. M. Gimenez
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  7. J. Pardo
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  8. S. Sabater
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Correspondence to E. Jimenez-Jimenez.

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All authors declare that they have no conflict of interest.

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Retrospective study; treatment has not been modified.

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Retrospective study; treatment has not been modified.

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Jimenez-Jimenez, E., Mateos, P., Ortiz, I. et al. Nodal FDG-PET/CT uptake influences outcome and relapse location among esophageal cancer patients submitted to chemotherapy or radiochemotherapy. Clin Transl Oncol 21, 1159–1167 (2019). https://doi.org/10.1007/s12094-019-02038-6

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  • DOI: https://doi.org/10.1007/s12094-019-02038-6

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