Preoperative chemo-radiation-induced ulceration in patients with esophageal cancer: a confounding factor in tumor response assessment in integrated computed tomographic-positron emission tomographic imaging.

Abstract

HYPOTHESIS:

Positron emission tomography can be useful in predicting response of esophageal cancer after preoperative chemo-radiation therapy (CRT). We evaluated the use of integrated computed tomography (CT)-PET among patients with esophageal cancer being considered for resection after CRT.

METHODS:

Three reviewers blinded to clinical and pathologic staging retrospectively reviewed the CT-PET scans of patients with esophageal cancer after preoperative CRT who underwent esophagectomy. [F]-fluoro-2-deoxy-D-glucose uptake for residual malignancy was determined by visual analysis and semi-quantitatively when standardized uptake value (SUV) was > or =4.

RESULTS:

Forty-two patients underwent esophageal resection. Using visual analysis, CT-PET had a sensitivity of 47% and specificity of 58% in detecting residual malignancy. Using semi-quantitative analysis, 19 patients had a SUV > or =4 in the region of the primary esophageal tumor and were interpreted as having residual malignancy (sensitivity 43%, specificity 50%). Of these 19, six had complete pathologic response to CRT. These false-positive results, due to therapy-induced ulceration detected at endoscopy, limit the use of CT-PET alone in detecting residual malignancy. Similarly, sensitivity (25%) and specificity (73%) of endoscopy/biopsy in detecting residual malignancy were poor. However, the accuracy of CT-PET in detecting residual malignancy was improved when combined with endoscopic findings. In the absence of ulceration at endoscopy, 8 of 8 patients with SUV > or =4 after chemo-radiation had residual malignancy at surgery.

CONCLUSIONS:

CRT-induced ulceration results in false-positive results on CT-PET and precludes accurate detection of residual esophageal tumor. However, CT-PET in combination with endoscopy is useful in identifying patients with a high risk of residual tumor post-CRT.

• Authors: Jeremy J Erasmus, Reginald F Munden, Mylene T Truong, Jeremy J Ho, Wayne L Hofstetter, Homer A Macapinlac, Arlene M Correa, Tsung-Teh Wu, John F Bruzzi, Edith M Marom, Bradley S Sabloff, Jaffer A Ajani, Ritsuko Komaki, Zhongxing Liao, Jeffrey H Lee, Norio Fukami, Robert Bresalier, Stephen G Swisher
• Journal: Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer (J Thorac Oncol) Vol. 1 Issue 5 Pg. 478-86 (Jun 2006) ISSN: 1556-1380 [Electronic] United States
• PMID: 17409902 (Publication Type: Journal Article)

Chemical References

• Fluorodeoxyglucose F18

Topics

• Adult
• Aged
• Combined Modality Therapy (adverse effects)
• Esophageal Diseases (etiology)
• Esophageal Neoplasms (diagnostic imaging, pathology, therapy)
• Esophagectomy
• Esophagoscopy
• False Positive Reactions
• Female
• Fluorodeoxyglucose F18
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Neoplasm, Residual
• Positron-Emission Tomography
• Retrospective Studies
• Tomography, X-Ray Computed
• Ulcer (etiology)