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

doi:10.1016/j.jtcvs.2008.02.016

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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

Ichirou Higuchi, MD^a, Takushi Yasuda, MD^a^,_*, Masahiko Yano, MD^a, Yuichirou Doki, MD^a, Hiroshi Miyata, MD^a, Mitsuaki Tatsumi, MD^b, Hironori Fukunaga, MD^a, Shuji Takiguchi, MD^a, Yoshiyuki Fujiwara, MD^a, Jun Hatazawa, MD^b, Morito Monden, MD^a

^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 receiveneoadjuvant chemotherapy or chemoradiotherapy to improve survival,but benefits are observed only in those with histologic response.Positron emission tomography with fludeoxyglucose F 18 (INNfludeoxyglucose [¹⁸F]) detects accumulation of glucose analogin viable cancer cells. This study investigated the usefulnessof positron emission tomography with fludeoxyglucose F 18 inassessment of response of advanced esophageal squamous cellcarcinoma to neoadjuvant treatment to establish new criteriato predict postoperative long-term survival.

Methods: Fifty patients with locally advanced esophageal squamous cellcarcinoma who received neoadjuvant therapy (chemotherapy 35,chemoradiotherapy 15) underwent positron emission tomographywith fludeoxyglucose F 18 before surgical resection in evaluationof posttreatment maximum standardized uptake value, residualtumor size (maximum square area of longitudinal axis), histologicresponse, and postoperative survival.

Results: After treatment, uptake was not noted in 21 patients (posttreatmentmaximum standardized uptake value <2.5, negative) but wasdetected in 29 ( $≥$ 2.5, positive). Residual tumor size ranged from0 to 54.0 mm² for negative results and 55.0 to 676.0 mm² forpositive, clearly distinguishing histologic major response fromnonresponse. The negative group demonstrated significantly higher5-year cause-specific survival (67.7%) and lower hematogenousrecurrence (4.8%) than the 36.5% and 37.0% values in the positivegroup, (P < .0042 and P = .0083, respectively). UnivariateCox regression analyses identified posttreatment maximum standardizeduptake value (cutoff 2.5) as the only preoperative prognosticfactor (P = .0071).

Conclusion: Posttreatment positron emission tomography with fludeoxyglucoseF 18 reliably predicted histologic response and postoperativesurvival in advanced esophageal squamous cell carcinoma. Thistool could potentially be used to tailor optimal treatment accordingto individual responses.

Abbreviations and Acronyms FDG = fludeoxyglucose F 18; PET =positron emission tomography; SCC = squamous cell carcinoma;SUV_max = maximum standardized uptake value

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