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J Thorac Cardiovasc Surg 2008;136:205-212
© 2008 The American Association for Thoracic Surgery

General Thoracic Surgery

Lack of fludeoxyglucose F 18 uptake in posttreatment positron emission tomography as a significant predictor of survival after subsequent surgery in multimodality treatment for patients with locally advanced esophageal squamous cell carcinoma

^a Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
^b Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan

Received for publication June 19, 2007; revisions received January 25, 2008; accepted for publication February 15, 2008.

^_* Address for reprints: Takushi Yasuda, MD, Department of Surgery, School of Medicine, Kinki University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan. (Email: tyasuda{at}surg.med.kindai.ac.jp).

Objective: Patients with advanced esophageal squamous cell carcinoma receive neoadjuvant chemotherapy or chemoradiotherapy to improve survival, but benefits are observed only in those with histologic response. Positron emission tomography with fludeoxyglucose F 18 (INN fludeoxyglucose [¹⁸F]) detects accumulation of glucose analog in viable cancer cells. This study investigated the usefulness of positron emission tomography with fludeoxyglucose F 18 in assessment of response of advanced esophageal squamous cell carcinoma to neoadjuvant treatment to establish new criteria to predict postoperative long-term survival.

Methods: Fifty patients with locally advanced esophageal squamous cell carcinoma who received neoadjuvant therapy (chemotherapy 35, chemoradiotherapy 15) underwent positron emission tomography with fludeoxyglucose F 18 before surgical resection in evaluation of posttreatment maximum standardized uptake value, residual tumor size (maximum square area of longitudinal axis), histologic response, and postoperative survival.

Results: After treatment, uptake was not noted in 21 patients (posttreatment maximum standardized uptake value <2.5, negative) but was detected in 29 (2.5, positive). Residual tumor size ranged from 0 to 54.0 mm² for negative results and 55.0 to 676.0 mm² for positive, clearly distinguishing histologic major response from nonresponse. The negative group demonstrated significantly higher 5-year cause-specific survival (67.7%) and lower hematogenous recurrence (4.8%) than the 36.5% and 37.0% values in the positive group, (P < .0042 and P = .0083, respectively). Univariate Cox regression analyses identified posttreatment maximum standardized uptake value (cutoff 2.5) as the only preoperative prognostic factor (P = .0071).

Conclusion: Posttreatment positron emission tomography with fludeoxyglucose F 18 reliably predicted histologic response and postoperative survival in advanced esophageal squamous cell carcinoma. This tool could potentially be used to tailor optimal treatment according to individual responses.

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