Kazuhiro Kitajima1, Hayato Kaida2, Koya Nakatani3, Mana Ishibashi4, Takahiro Morita5, Masatoyo Nakajo6, Yukihisa Tamaki7, Ryogo Minamimoto8. 1. Department of Radiology, Division of Nuclear Medicine and PET Center, Hyogo College of Medicine, Nishinomiya. 2. Department of Radiology, Kinki University Faculty of Medicine, Osaka. 3. Department of Diagnostic Radiology, Kurashiki Central Hospital, Kurashiki, Okayama. 4. Department of Pathophysiological and Therapeutic Sciences, Division of Radiology, Tottori University, Yonago. 5. Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo. 6. Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima. 7. Department of Radiation Oncology, Shimane University Faculty of Medicine, Shimane. 8. Department of Radiology, Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Abstract
OBJECTIVES: The aim of the study was to evaluate PET response criteria in solid tumors (PERCIST) to indicate therapeutic response to definitive chemoradiotherapy, as well as prediction of recurrence and death in patients with esophageal cancer. METHODS: Before and after recieving definitive chemoradiotherapy, 181 patients with esophageal cancer underwent fluorodeoxyglucose-PET/computed tomography (FDG-PET/CT). PERCIST, reduction rates of tumor uptake and volume of whole lesions, tumor node metastasis (TNM) staging regarding progression-free survival (PFS), and overall survival (OS) were analyzed using log-rank and Cox methods. RESULTS: Complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), and progressive metabolic disease (PMD) shown by PERCIST were seen in 42 (23.2%), 113 (62.4%), 14 (7.7%), and 12 (6.6%) patients, respectively. Progression developed in 137 (75.7%) patients and 101 (56.1%) patients died (median follow-up 16.9, range 3.2-124.9 months). Those who achieved CMR showed significantly longer PFS and OS as compared with patients who did not (PMR, SMD, and PMD) (both P < 0.0001). In univariate analysis, initial clinical T status (P = 0.0048), N status (P = 0.011), and TNM stage (P = 0.0006), PERCIST (P < 0.0001), and reduction rate of peak lean body mass standardized uptake value (P < 0.0001), of metabolic tumor volume (P < 0.0001), and of total lesion glycolysis (TLG) (P < 0.0001) were associated with significantly increased OS. Multivariate analysis confirmed PERCIST [hazard ratio (HR): 13.15, 95% confidence interval (CI), 4.54-55.8; P < 0.0001], and TLG reduction rate (HR: 2.21, 95% CI, 1.04-4.68; P = 0.040) as independent OS predictors. CONCLUSION: PERCIST is useful for evaluating therapeutic response to definitive chemoradiotherapy, and predicting progression and death in patients with esophageal cancer.
OBJECTIVES: The aim of the study was to evaluate PET response criteria in solid tumors (PERCIST) to indicate therapeutic response to definitive chemoradiotherapy, as well as prediction of recurrence and death in patients with esophageal cancer. METHODS: Before and after recieving definitive chemoradiotherapy, 181 patients with esophageal cancer underwent fluorodeoxyglucose-PET/computed tomography (FDG-PET/CT). PERCIST, reduction rates of tumor uptake and volume of whole lesions, tumor node metastasis (TNM) staging regarding progression-free survival (PFS), and overall survival (OS) were analyzed using log-rank and Cox methods. RESULTS: Complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), and progressive metabolic disease (PMD) shown by PERCIST were seen in 42 (23.2%), 113 (62.4%), 14 (7.7%), and 12 (6.6%) patients, respectively. Progression developed in 137 (75.7%) patients and 101 (56.1%) patientsdied (median follow-up 16.9, range 3.2-124.9 months). Those who achieved CMR showed significantly longer PFS and OS as compared with patients who did not (PMR, SMD, and PMD) (both P < 0.0001). In univariate analysis, initial clinical T status (P = 0.0048), N status (P = 0.011), and TNM stage (P = 0.0006), PERCIST (P < 0.0001), and reduction rate of peak lean body mass standardized uptake value (P < 0.0001), of metabolic tumor volume (P < 0.0001), and of total lesion glycolysis (TLG) (P < 0.0001) were associated with significantly increased OS. Multivariate analysis confirmed PERCIST [hazard ratio (HR): 13.15, 95% confidence interval (CI), 4.54-55.8; P < 0.0001], and TLG reduction rate (HR: 2.21, 95% CI, 1.04-4.68; P = 0.040) as independent OS predictors. CONCLUSION:PERCIST is useful for evaluating therapeutic response to definitive chemoradiotherapy, and predicting progression and death in patients with esophageal cancer.