Purpose. The aims of the present study were 1) to assess the utility of PET/CT scan before and after neoadjuvant therapy and 2) to evaluate the therapeutic response in locally advanced esophageal cancer with comparing PET response criteria (PERCIST), to visual PET/CT analysis and to response evaluation criteria in solid tumours (RECIST 1.1).Materials and methods. 38 patients with locally advanced esophageal cancer receiving neoadjuvant chemoradiation therapy (NCRT) were prospectively enrolled. Chemo-radiation responses were evaluated by using FDG PET/CT and c.e.CT performed in a single-session, according to visual PET assessment, RECIST 1.1. and PERCIST 1.0. PET/c.e.CT was performed after at least 4-5 weeks from the end of NCRT. In accordance with PERCIST and RECIST, the response to therapy was categorized in four levels: CR (CMR)=1; PR (PMR)=2; SD (SMD)=3; PD (PMD)=4. For visual PET analysis, the readers identified three different categories on PET/CT scan on the basis of FDG-uptake [no evidence, residual (near or superior to surrounding tissue) and increase or new appearance]. Surgery or histopathology was used for the final definition of the response to therapy. Person chi-square was used to compare the proportion of four levels in RECIST/PERCIST and of three subsets in the visual PET analysis.Results. The body weight of patients resulted significantly lower after NCRT (75 vs. 71 kg, respectively before and after therapy; p=0.025). Semiquantitative PET data (such as SUVmax, SULpeak, metabolic tumour volume-MTV and tumour lesion glycolysis-TLG) were significantly higher before than after therapy (all p<0.05), independently from the final response. After NCRT, SUVmax of primary tumor, MTV and TLG resulted significantly lower in responder patients as the counterpart (all p<0.05). Moreover, the change in SUVmax and in TLG were significantly higher in responder than nonresponder patients. The difference of evaluation results between RECIST and PERCIST and between RECIST and visual PET analysis were not significant (p=0.863 and p=0.527, respectively). Conversely, a significant difference for the evaluation of response to NAC between the visual PET analysis and PERCIST was found (p=0.001). A complete and partial response to therapy was better discriminate by visual PET analysis and by PERCIST as compared to RECIST.Conclusions. The change in SUVmax and in TLG can be helpful to distinguish between responder and non-responder subjects. Both visual PET assessment and PERCIST are more sensitive than RECIST in detecting complete and partial remission of esophageal cancer after NAC.

PERCIST versus RECIST versus Visual PET assessment for the evaluation of response by PET/c.e.CT to chemoradiation neoadjuvant therapy in patients with locally advanced esophageal cancer

POMERRI, FABIO;
2015

Abstract

Purpose. The aims of the present study were 1) to assess the utility of PET/CT scan before and after neoadjuvant therapy and 2) to evaluate the therapeutic response in locally advanced esophageal cancer with comparing PET response criteria (PERCIST), to visual PET/CT analysis and to response evaluation criteria in solid tumours (RECIST 1.1).Materials and methods. 38 patients with locally advanced esophageal cancer receiving neoadjuvant chemoradiation therapy (NCRT) were prospectively enrolled. Chemo-radiation responses were evaluated by using FDG PET/CT and c.e.CT performed in a single-session, according to visual PET assessment, RECIST 1.1. and PERCIST 1.0. PET/c.e.CT was performed after at least 4-5 weeks from the end of NCRT. In accordance with PERCIST and RECIST, the response to therapy was categorized in four levels: CR (CMR)=1; PR (PMR)=2; SD (SMD)=3; PD (PMD)=4. For visual PET analysis, the readers identified three different categories on PET/CT scan on the basis of FDG-uptake [no evidence, residual (near or superior to surrounding tissue) and increase or new appearance]. Surgery or histopathology was used for the final definition of the response to therapy. Person chi-square was used to compare the proportion of four levels in RECIST/PERCIST and of three subsets in the visual PET analysis.Results. The body weight of patients resulted significantly lower after NCRT (75 vs. 71 kg, respectively before and after therapy; p=0.025). Semiquantitative PET data (such as SUVmax, SULpeak, metabolic tumour volume-MTV and tumour lesion glycolysis-TLG) were significantly higher before than after therapy (all p<0.05), independently from the final response. After NCRT, SUVmax of primary tumor, MTV and TLG resulted significantly lower in responder patients as the counterpart (all p<0.05). Moreover, the change in SUVmax and in TLG were significantly higher in responder than nonresponder patients. The difference of evaluation results between RECIST and PERCIST and between RECIST and visual PET analysis were not significant (p=0.863 and p=0.527, respectively). Conversely, a significant difference for the evaluation of response to NAC between the visual PET analysis and PERCIST was found (p=0.001). A complete and partial response to therapy was better discriminate by visual PET analysis and by PERCIST as compared to RECIST.Conclusions. The change in SUVmax and in TLG can be helpful to distinguish between responder and non-responder subjects. Both visual PET assessment and PERCIST are more sensitive than RECIST in detecting complete and partial remission of esophageal cancer after NAC.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/3167534
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