18F-fluorodeoxyglucose positron emission computed tomography for monitoring tumor response in esophageal carcinoma treated with concurrent chemoradiotherapy

Peiliang Zhang; Zengyun Li; Dongqing Wang; Fuling Ma; Ran Zhang; Wanhua Liang; Mingping Sun; Zheng Fu; Xiaorong Sun

doi:10.3892/ol.2017.7528

¹⁸F-fluorodeoxyglucose positron emission computed tomography for monitoring tumor response in esophageal carcinoma treated with concurrent chemoradiotherapy

Oncol Lett. 2018 Feb;15(2):1845-1852. doi: 10.3892/ol.2017.7528. Epub 2017 Dec 5.

Authors

Peiliang Zhang¹, Zengyun Li², Dongqing Wang³, Fuling Ma¹, Ran Zhang¹, Wanhua Liang¹, Mingping Sun³, Zheng Fu⁴, Xiaorong Sun⁴

Affiliations

¹ Department of Radiation Oncology, Linyi Central Hospital, Yishui, Linyi, Shandong 276400, P.R. China.
² Department of Oncology, Laiwu Municipal Hospital of Traditional Chinese Medicine, Laiwu, Shandong 271100, P.R. China.
³ Department of Radiation Oncology, Shandong Tumor Hospital, Jinan, Shandong 250117, P.R. China.
⁴ Department of Nuclear Medicine, Shandong Tumor Hospital, Jinan, Shandong 250117, P.R. China.

Abstract

The aim of the present study was to explore the value of ^18F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) in monitoring the early tumor response of esophageal squamous cell carcinoma (ESCC) treated with concurrent chemoradiotherapy (CRT). A total of 48 patients with pathologically proven ESCC were retrospectively analyzed. All patients underwent two serial ¹⁸F-FDG PET scans at baseline (pre-CRT) and 40 Gy/4 weeks of starting radiation therapy (inter-CRT). All patients received intensity-modulated radiotherapy (with a total radiation dose of 59.6 Gy) concurrently with cisplatin-based chemotherapy. The maximum standardized uptake value (SUV_max) and metabolic tumor volume (MTV) were measured using ¹⁸F-FDG PET. The percentage changes (Δ) in SUV_max and MTV between two serial scans were calculated and were revealed to be associated with the objective tumor response (oTR), according to the Response Evaluation Criteria in Solid Tumors 1.1. Among the 48 patients, 20.8% achieved a complete response, 68.8% exhibited a partial response and the oTR rate was 89.6%. On the pre-CRT PET scans, the mean SUV_max and MTV were 14.1±5.8 and 58.2±25.4 cm³, respectively. Following 40 Gy irradiation over 4 weeks, the mean SUV_max and MTV significantly decreased to 4.3±3.5 and 19.0±12.1 cm³, respectively (P<0.001). A significantly higher ΔSUV_max and ΔMTV was observed in the responders compared with that in the non-responders [0.71±0.16 vs. 0.51±0.26 (P=0.015); and 0.64±0.13 vs. 0.42±0.09 (P=0.001), respectively]. Univariate analysis revealed that ΔSUV_max and ΔMTV were significantly associated with oTR (P=0.010 and P=0.001, respectively). ΔMTV was used as a predictor and a cut-off value of 54% discriminated responders from non-responders with a sensitivity of 69.8% and a specificity of 100% (P=0.001). The area under the receiver operating characteristic curve was 0.837 (95% confidence interval, 0.702-0.928). The results of the present study indicated that interim ¹⁸F-FDG PET scans may provide early prognostic value for determining oTR in patients with ESCC undergoing treatment with CRT.

Keywords: chemoradiotherapy; esophageal squamous cell carcinoma; positron emission computed tomography; response.