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The Feasibility of 18F-Fluorothymidine PET for Prediction of Tumor Response after Induction Chemotherapy Followed by Chemoradiotherapy with S-1/Oxaliplatin in Patients with Resectable Esophageal Cancer

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Abstract

Purpose

The aim of this study was to determine whether 18F-fluorothymidine (FLT) PET is feasible for the early prediction of tumor response to induction chemotherapy followed by concurrent chemoradiotherapy in patients with esophageal cancer.

Methods

This study was prospectively performed as a collateral study of “randomized phase II study of preoperative concurrent chemoradiotherapy with or without induction chemotherapy with S-1/oxaliplatin in patients with resectable esophageal cancer”. 18F-FLT positron emission tomography (PET) images were obtained before and after two cycles of induction chemotherapy, and the percent change of maximum standardized uptake value (SUVmax) was calculated. All patients underwent esophagography, gastrofiberoscopy, endoscopic ultrasonography (EUS), computed tomography (CT) and 18F-fluorodeoxyglucose (FDG) PET at baseline and 3–4 weeks after completion of concurrent chemoradiotherapy. Final tumor response was determined by both clinical and pathologic tumor responses after surgery.

Results

The 13 patients for induction chemotherapy group were enrolled until interim analysis. In a primary tumor visual analysis, the tumor detection rates of baseline 18F-FLT and 18F-FDG PET were 85% and 100%, respectively. The tumor uptakes on 18F-FLT PET were lower than those of 18F-FDG PET. Among nine patients who completed second 18F-FLT PET, eight patients were responders and one patient was a non-responder in the assessment of final tumor response. The percent change of SUVmax in responders ranged from 41.2% to 79.2% (median 57.1%), whereas it was 10.2% in one non-responder.

Conclusion

The percent change of tumor uptake in 18F-FLT PET after induction chemotherapy might be feasible for early prediction of tumor response after induction chemotherapy and concurrent chemoradiotherapy in patients with esophageal cancer.

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Acknowledgements

This work was supported by Real-time Molecular Imaging Program from National Research Foundation (NRF), through its real-time molecular imaging research program (no. 2010–002040).

Conflicts of Interest

None.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, South Korea

    Seol Hoon Park, Jin-Sook Ryu & Seung-Jun Oh

  2. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, South Korea

    Hoon-Yong Jung, Gin Hyug Lee, Ho Jun Song & Sung-Bae Kim

  3. Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, South Korea

    Seung-Il Park & Yong Hee Kim

  4. Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, South Korea

    Jong Hoon Kim

  5. Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, South Korea

    Ho-Young Song

  6. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, South Korea

    Kyoung Ja Cho

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  1. Seol Hoon Park
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Correspondence to Jin-Sook Ryu.

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Park, S.H., Ryu, JS., Oh, SJ. et al. The Feasibility of 18F-Fluorothymidine PET for Prediction of Tumor Response after Induction Chemotherapy Followed by Chemoradiotherapy with S-1/Oxaliplatin in Patients with Resectable Esophageal Cancer. Nucl Med Mol Imaging 46, 57–64 (2012). https://doi.org/10.1007/s13139-011-0118-4

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  • DOI: https://doi.org/10.1007/s13139-011-0118-4

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