Combined tumor plus nontumor interim FDG-PET parameters are prognostic for response to chemoradiation in squamous cell esophageal cancer

Sebastian Zschaeck; Yimin Li; Rebecca Bütof; Chen Lili; Wu Hua; Esther C G Troost; Marcus Beck; Holger Amthauer; David Kaul; Jörg Kotzerke; Alexander D J Baur; Pirus Ghadjar; Michael Baumann; Mechthild Krause; Frank Hofheinz

doi:10.1002/ijc.32897

Combined tumor plus nontumor interim FDG-PET parameters are prognostic for response to chemoradiation in squamous cell esophageal cancer

Int J Cancer. 2020 Sep 1;147(5):1427-1436. doi: 10.1002/ijc.32897. Epub 2020 Feb 19.

Authors

Sebastian Zschaeck^{1

2

3

4

5}, Yimin Li⁶, Rebecca Bütof^{3

4

7}, Chen Lili⁶, Wu Hua⁸, Esther C G Troost^{3

4

5

7

9}, Marcus Beck¹, Holger Amthauer¹⁰, David Kaul¹, Jörg Kotzerke^{4

5

11}, Alexander D J Baur¹², Pirus Ghadjar¹, Michael Baumann^{3

4

5

7

9

13}, Mechthild Krause^{3

4

5

7

9}, Frank Hofheinz¹⁴

Affiliations

¹ Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
² Berlin Institute of Health (BIH), Berlin, Germany.
³ Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
⁴ OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.
⁵ German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK) partner site Dresden, Dresden, Germany.
⁶ Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China.
⁷ National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany.
⁸ Department of Nuclear Medicine, The Xiamen First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China.
⁹ Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology OncoRay, Dresden, Germany.
¹⁰ Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
¹¹ Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
¹² Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Radiologie, Berlin, Germany.
¹³ German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹⁴ Helmholtz-Zentrum Dresden-Rossendorf, PET Center, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany.

PMID: 32010957
DOI: 10.1002/ijc.32897

Abstract

We have investigated the prognostic value of two novel interim ¹⁸ F-fluorodeoxyglucose positron emission tomography (FDG-PET) parameters in patients undergoing chemoradiation (CRT) for esophageal squamous cell carcinoma (ESCC): one tumor parameter (maximal standardized uptake ratio rSUR) and one normal tissue parameter (change of FDG uptake within irradiated nontumor-affected esophagus ∆SUV_NTO ). PET data of 134 European and Chinese patients were analyzed. Parameter establishment was based on 36 patients undergoing preoperative CRT plus surgery, validation was performed in 98 patients receiving definitive CRT. Patients received PET imaging prior and during fourth week of CRT. Clinical parameters, baseline PET parameters, and interim PET parameters (rSUR and ∆SUV_NTO ) were analyzed and compared to event-free survival (EFS), overall survival (OS), loco-regional control (LRC) and freedom from distant metastases (FFDM). Combining rSUR and ∆SUV_NTO revealed a strong prognostic impact on EFS, OS, LRC and FFDM in patients undergoing preoperative CRT. In the definitive CRT cohort, univariate analysis with respect to EFS revealed several staging plus both previously established interim PET parameters as significant prognostic factors. Multivariate analyses revealed only rSUR and ∆SUV_NTO as independent prognostic factors (p = 0.003, p = 0.008). Combination of these parameters with the cutoff established in preoperative CRT revealed excellent discrimination of patients with a long or short EFS (73% vs. 17% at 2 years, respectively) and significantly discriminated all other endpoints (OS, p < 0.001; LRC, p < 0.001; FFDM, p = 0.02), even in subgroups. Combined use of interim FDG-PET derived parameters ∆SUV_NTO and rSUR seems to have predictive potential, allowing to select responders for definitive CRT and omission of surgery.

Keywords: chemoradiation; esophageal cancer; interim PET; normal tissue FDG uptake; personalized treatment; standardized uptake ratio.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Chemoradiotherapy
Esophageal Neoplasms / diagnostic imaging*
Esophageal Neoplasms / therapy
Esophageal Squamous Cell Carcinoma / diagnostic imaging*
Esophageal Squamous Cell Carcinoma / therapy
Female
Fluorodeoxyglucose F18 / metabolism
Fluorodeoxyglucose F18 / therapeutic use*
Follow-Up Studies
Humans
Male
Middle Aged
Positron-Emission Tomography*
Prognosis
Progression-Free Survival
Radiopharmaceuticals / metabolism
Radiopharmaceuticals / therapeutic use*
Retrospective Studies
Survival Rate

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18