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Original Articles: General Thoracic

Assessment of Treatment Response and Recurrence in Esophageal Carcinoma Based on Tumor Length and Standardized Uptake Value on Positron Emission Tomography–Computed Tomography

^a Division of Abdominal and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
^b Division of Nuclear Medicine, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
^c Department of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

Accepted for publication May 6, 2008.

^_* Address correspondence to Dr Roedl, Department of Radiology, Fruit St 55, Boston, MA 02114 (Email: johannes.roedl{at}gmail.com).

Background: Previous studies demonstrated that a decrease of the standardized uptake value between pretreatment and posttreatment positron emission tomography (PET) scans can predict histopathologic treatment response in patients with esophageal cancer.

Methods: Forty-seven patients who underwent PET–computed tomography (CT) scans before (scan 1) and after (scan 2) neoadjuvant chemoradiotherapy and during the follow-up period after surgery (scan 3) were included in this study. It was evaluated whether decrease of metabolic tumor length between scan 1 and scan 2 can predict histopathologic response to treatment. Moreover, the value of PET-CT was compared with PET in the assessment of tumor recurrence based on a visual analysis of scan 3. Reference standards for treatment response and recurrence were histopathology results.

Results: The reduction of tumor length between before and after chemoradiotherapy scans (between scan 1 and scan 2) was a better predictor of histopathologic response and of time to recurrence than the decrease in standardized uptake value. The most accurate differentiation was achieved when using a cut-off value of 33% reduction of the initial tumor length. Using this threshold to define metabolic response, the sensitivity was 91% (19 of 21) and the specificity was 92% (24 of 26) for predicting histopathologic treatment response. Based on a visual analysis, PET-CT was more accurate than PET in the differentiation of tumor recurrence from posttreatment tissue changes. Integrated PET-CT achieved a sensitivity of 91% (48 of 53) and a specificity of 81% (30 of 37) in identifying sites of tumor recurrence, compared with 83% (44 of 53) and 65% (24 of 37) with PET.

Conclusions: Decrease of tumor length was shown to be a better predictor of treatment response and disease-free survival than decrease of standardized uptake value. Furthermore, PET-CT is more accurate in the evaluation of recurrence than PET.

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Donald E. Low
Ann. Thorac. Surg. 2008 86: 1138. [Extract] [Full Text] [PDF]

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				D. E. Low Invited commentary. Ann. Thorac. Surg., October 1, 2008; 86(4): 1138 - 1138. [Full Text] [PDF]