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Ann Thorac Surg 2004;78:1152-1160
© 2004 The Society of Thoracic Surgeons

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Original article: general thoracic

Utility of PET, CT, and EUS to Identify Pathologic Responders in Esophageal Cancer

^a Departments of Thoracic and Cardiovascular Surgery, Houston, TX, USA
^b Radiology, Houston, TX, USA
^c Gastrointestinal Oncology, Houston, TX, USA
^d GI Medicine and Nutrition, Houston, TX, USA
^e Radiation Oncology, Houston, TX, USA
^f Nuclear Medicine, Houston, TX, USA
^g Pathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA

Accepted for publication April 12, 2004.

^* Address reprint requests to Dr Swisher, Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 445, Houston, TX 77030, USA
sswisher{at}mdanderson.org

Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.

BACKGROUND: This study evaluates the utility of positron emission tomography (PET), endoscopic ultrasonography (EUS), and computed tomographic (CT) scans to predict pathologic response and survival following preoperative chemoradiation (CRT) in esophageal cancer.

METHODS: One hundred three sequential patients with locoregionally advanced esophageal cancer, who were treated with CRT and esophageal resection between May 2001 and November 2003 at the University of Texas M.D. Anderson Cancer Center, were retrospectively reviewed. PET, EUS, and CT were performed before (pre) or after (post) CRT and before surgical resection. PET standardized uptake value (SUV) was defined as maximal uptake in primary tumor.

RESULTS: Most patients were male (91 [88%]) with adenocarcinoma (90 [87%]). Pretreatment clinical stages were: IIA (42 [41%]), IIB (5 [5%]), III (50 [49%]), and IVA (6 [6%]). At the time of surgery, 58 patients (56%) had a pathologic response to CRT (10% viable cells). Post-CRT measurements that correlated with pathologic response were: CT esophageal wall thickness (13.3 vs 15.3 mm, p = 0.04), EUS mass size (0.7 vs 1.7 cm, p = 0.01) and PET SUV (3.1 vs 5.8, p = 0.01). Post-CRT PET SUV equal to or greater than 4 had the highest accuracy for pathologic response (76%). Univariate and multivariate Cox regression analysis demonstrated that a post-CRT PET SUV equal to or greater than 4 was an independent predictor of survival (HR, 3.5, p = 0.04).

CONCLUSIONS: The FDG-PET SUV is the most accurate noninvasive test to predict long-term survival after preoperative CRT and before surgical resection. Post-CRT FDG-PET cannot, however, rule out residual microscopic disease so esophagectomy should remain a therapeutic option even if the post-CRT imaging modalities are normal.

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