This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wieder, H. A. Articles by Weber, W. A. Search for Related Content PubMed PubMed Citation Articles by Wieder, H. A. Articles by Weber, W. A. Social Bookmarking                            What's this?

Time Course of Tumor Metabolic Activity During Chemoradiotherapy of Esophageal Squamous Cell Carcinoma and Response to Treatment

From the Departments of Nuclear Medicine, Surgery, Radiation Oncology, Pathology, Medicine III, and Diagnostic Radiology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany

Address reprint requests to Hinrich Wieder, MD, Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, D-81675 Munich, Germany; e-mail: h{at}wieder.de

PURPOSE: To evaluate the time course of therapy-induced changes in tumor glucose use during chemoradiotherapy of esophageal squamous cell carcinoma (ESCC) and to correlate the reduction of metabolic activity with histopathologic tumor response and patient survival.

PATIENTS AND METHODS: Thirty-eight patients with histologically proven intrathoracic ESCC (cT3, cN0/+, cM0) scheduled to undergo a 4-week course of preoperative simultaneous chemoradiotherapy followed by esophagectomy were included. Patients underwent positron emission tomography with the glucose analog fluorodeoxyglucose (FDG-PET) before therapy (n = 38), after 2 weeks of initiation of therapy (n = 27), and preoperatively (3 to 4 weeks after chemoradiotherapy; n = 38). Tumor metabolic activity was quantitatively assessed by standardized uptake values (SUVs).

RESULTS: Mean tumor FDG uptake before therapy was 9.3 ± 2.8 SUV and decreased to 5.7 ± 1.9 SUV 14 days after initiation of chemoradiotherapy (-38% ± 18%; P < .0001). The preoperative scan showed an additional decrease of metabolic activity to 3.3 ± 1.1 SUV (P < .0001). In histopathologic responders (< 10% viable cells in the resected specimen), the decrease in SUV from baseline to day 14 was 44% ± 15%, whereas it was only 21% ± 14% in nonresponders (P = .0055). Metabolic changes at this time point were also correlated with patient survival (P = .011). In the preoperative scan, tumor metabolic activity had decreased by 70% ± 11% in histopathologic responders and 51% ± 21% in histopathologic nonresponders.

CONCLUSION: Changes in tumor metabolic activity after 14 days of preoperative chemoradiotherapy are significantly correlated with tumor response and patient survival. This suggests that FDG-PET might be used to identify nonresponders early during neoadjuvant chemoradiotherapy, allowing for early modifications of the treatment protocol.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				P. Bystrom, A. Berglund, U. Garske, H. Jacobsson, A. Sundin, P. Nygren, J.-E. Frodin, and B. Glimelius Early prediction of response to first-line chemotherapy by sequential [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography in patients with advanced colorectal cancer Ann. Onc., June 1, 2009; 20(6): 1057 - 1061. [Abstract] [Full Text] [PDF]

				K. TAMURA, K. YOSHIKAWA, H. ISHIKAWA, M. HASEBE, H. TSUJI, T. YANAGI, K. SUZUKI, A. KUBO, and H. TSUJII Carbon-11-Methionine PET Imaging of Choroidal Melanoma and the Time Course after Carbon Ion Beam Radiotherapy Anticancer Res, May 1, 2009; 29(5): 1507 - 1514. [Abstract] [Full Text] [PDF]

				B. J. Krause, K. Herrmann, H. Wieder, and C. M. zum Buschenfelde 18F-FDG PET and 18F-FDG PET/CT for Assessing Response to Therapy in Esophageal Cancer J. Nucl. Med., May 1, 2009; 50(Suppl_1): 89S - 96S. [Abstract] [Full Text] [PDF]

				M. R. Benz, J. Czernin, M. S. Allen-Auerbach, W. D. Tap, S. M. Dry, D. Elashoff, K. Chow, V. Evilevitch, J. J. Eckardt, M. E. Phelps, et al. FDG-PET/CT Imaging Predicts Histopathologic Treatment Responses after the Initial Cycle of Neoadjuvant Chemotherapy in High-Grade Soft-Tissue Sarcomas Clin. Cancer Res., April 15, 2009; 15(8): 2856 - 2863. [Abstract] [Full Text] [PDF]

				M. Allen-Auerbach and W. A. Weber Measuring Response with FDG-PET: Methodological Aspects Oncologist, April 1, 2009; 14(4): 369 - 377. [Abstract] [Full Text] [PDF]

				T. J. Kim, H. Y. Kim, K. W. Lee, and M. S. Kim Multimodality Assessment of Esophageal Cancer: Preoperative Staging and Monitoring of Response to Therapy1 RadioGraphics, March 1, 2009; 29(2): 403 - 421. [Abstract] [Full Text] [PDF]

				J. Schwarz-Dose, M. Untch, R. Tiling, S. Sassen, S. Mahner, S. Kahlert, N. Harbeck, A. Lebeau, W. Brenner, M. Schwaiger, et al. Monitoring Primary Systemic Therapy of Large and Locally Advanced Breast Cancer by Using Sequential Positron Emission Tomography Imaging With [18F]Fluorodeoxyglucose J. Clin. Oncol., February 1, 2009; 27(4): 535 - 541. [Abstract] [Full Text] [PDF]

				S. Ben-Haim and P. Ell 18F-FDG PET and PET/CT in the Evaluation of Cancer Treatment Response J. Nucl. Med., January 1, 2009; 50(1): 88 - 99. [Abstract] [Full Text] [PDF]

				M. R. Benz, M. S. Allen-Auerbach, F. C. Eilber, H. J.J. Chen, S. Dry, M. E. Phelps, J. Czernin, and W. A. Weber Combined Assessment of Metabolic and Volumetric Changes for Assessment of Tumor Response in Patients with Soft-Tissue Sarcomas J. Nucl. Med., October 1, 2008; 49(10): 1579 - 1584. [Abstract] [Full Text] [PDF]

				I. Higuchi, T. Yasuda, M. Yano, Y. Doki, H. Miyata, M. Tatsumi, H. Fukunaga, S. Takiguchi, Y. Fujiwara, J. Hatazawa, et al. 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 J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 205 - 212. [Abstract] [Full Text] [PDF]

				V. Evilevitch, W. A. Weber, W. D. Tap, M. Allen-Auerbach, K. Chow, S. D. Nelson, F. R. Eilber, J. J. Eckardt, R. M. Elashoff, M. E. Phelps, et al. Reduction of Glucose Metabolic Activity Is More Accurate than Change in Size at Predicting Histopathologic Response to Neoadjuvant Therapy in High-Grade Soft-Tissue Sarcomas Clin. Cancer Res., February 1, 2008; 14(3): 715 - 720. [Abstract] [Full Text] [PDF]

				D. J. A. Margolis, J. M. Hoffman, R. J. Herfkens, R. B. Jeffrey, A. Quon, and S. S. Gambhir Molecular Imaging Techniques in Body Imaging Radiology, November 1, 2007; 245(2): 333 - 356. [Abstract] [Full Text] [PDF]

				J. F. Bruzzi, R. F. Munden, M. T. Truong, E. M. Marom, B. S. Sabloff, G. W. Gladish, R. B. Iyer, T.-S. Pan, H. A. Macapinlac, and J. J. Erasmus PET/CT of Esophageal Cancer: Its Role in Clinical Management RadioGraphics, November 1, 2007; 27(6): 1635 - 1652. [Abstract] [Full Text] [PDF]

				K. Herrmann, H. A. Wieder, A. K. Buck, M. Schoffel, B.-J. Krause, F. Fend, T. Schuster, C. Meyer zum Buschenfelde, H.-J. Wester, J. Duyster, et al. Early Response Assessment Using 3'-Deoxy-3'-[18F]Fluorothymidine-Positron Emission Tomography in High-Grade Non-Hodgkin's Lymphoma Clin. Cancer Res., June 15, 2007; 13(12): 3552 - 3558. [Abstract] [Full Text] [PDF]

				C. Nahmias, W. T. Hanna, L. M. Wahl, M. J. Long, K. F. Hubner, and D. W. Townsend Time Course of Early Response to Chemotherapy in Non-Small Cell Lung Cancer Patients with 18F-FDG PET/CT J. Nucl. Med., May 1, 2007; 48(5): 744 - 751. [Abstract] [Full Text] [PDF]

				L. Bedenne, P. Michel, O. Bouche, C. Milan, C. Mariette, T. Conroy, D. Pezet, B. Roullet, J.-F. Seitz, J.-P. Herr, et al. Chemoradiation Followed by Surgery Compared With Chemoradiation Alone in Squamous Cancer of the Esophagus: FFCD 9102 J. Clin. Oncol., April 1, 2007; 25(10): 1160 - 1168. [Abstract] [Full Text] [PDF]

				G. L. Cascini, A. Avallone, P. Delrio, C. Guida, F. Tatangelo, P. Marone, L. Aloj, F. De Martinis, P. Comella, V. Parisi, et al. 18F-FDG PET Is an Early Predictor of Pathologic Tumor Response to Preoperative Radiochemotherapy in Locally Advanced Rectal Cancer J. Nucl. Med., August 1, 2006; 47(8): 1241 - 1248. [Abstract] [Full Text] [PDF]

				S. Apisarnthanarax, M. M. Alauddin, F. Mourtada, H. Ariga, U. Raju, O. Mawlawi, D. Han, W. G. Bornmann, J. A. Ajani, L. Milas, et al. Early Detection of Chemoradioresponse in Esophageal Carcinoma by 3'-Deoxy-3'-3H-Fluorothymidine Using Preclinical Tumor Models Clin. Cancer Res., August 1, 2006; 12(15): 4590 - 4597. [Abstract] [Full Text] [PDF]

				K.-H. Lee, S.-H. Lee, D.-W. Kim, W. J. Kang, J.-K. Chung, S.-A. Im, T.-Y. Kim, Y. W. Kim, Y.-J. Bang, and D. S. Heo High fluorodeoxyglucose uptake on positron emission tomography in patients with advanced non-small cell lung cancer on platinum-based combination chemotherapy. Clin. Cancer Res., July 15, 2006; 12(14): 4232 - 4236. [Abstract] [Full Text] [PDF]

				W. A. Weber Positron Emission Tomography As an Imaging Biomarker J. Clin. Oncol., July 10, 2006; 24(20): 3282 - 3292. [Abstract] [Full Text] [PDF]

				R. Weissleder Molecular imaging in cancer. Science, May 26, 2006; 312(5777): 1168 - 1171. [Abstract] [Full Text] [PDF]

				A. J. Beer, H. A. Wieder, F. Lordick, K. Ott, M. Fischer, K. Becker, J. Stollfuss, and E. J. Rummeny Adenocarcinomas of Esophagogastric Junction: Multi-Detector Row CT to Evaluate Early Response to Neoadjuvant Chemotherapy Radiology, May 1, 2006; 239(2): 472 - 480. [Abstract] [Full Text] [PDF]

				N. Rizk, R. J. Downey, T. Akhurst, M. Gonen, M. S. Bains, S. Larson, and V. Rusch Preoperative 18[F]-Fluorodeoxyglucose Positron Emission Tomography Standardized Uptake Values Predict Survival After Esophageal Adenocarcinoma Resection Ann. Thorac. Surg., March 1, 2006; 81(3): 1076 - 1081. [Abstract] [Full Text] [PDF]

				C. Pottgen, S. Levegrun, D. Theegarten, S. Marnitz, S. Grehl, R. Pink, W. Eberhardt, G. Stamatis, T. Gauler, G. Antoch, et al. Value of 18F-Fluoro-2-Deoxy-D-Glucose-Positron Emission Tomography/Computed Tomography in Non-Small-Cell Lung Cancer for Prediction of Pathologic Response and Times to Relapse after Neoadjuvant Chemoradiotherapy Clin. Cancer Res., January 1, 2006; 12(1): 97 - 106. [Abstract] [Full Text] [PDF]

				W A Weber PET for response assessment in oncology: radiotherapy and chemotherapy Br. J. Radiol., November 1, 2005; Supplement_28(1): 42 - 49. [Abstract] [Full Text] [PDF]

				N. Avril, S. Sassen, B. Schmalfeldt, J. Naehrig, S. Rutke, W. A. Weber, M. Werner, H. Graeff, M. Schwaiger, and W. Kuhn Prediction of Response to Neoadjuvant Chemotherapy by Sequential F-18-Fluorodeoxyglucose Positron Emission Tomography in Patients With Advanced-Stage Ovarian Cancer J. Clin. Oncol., October 20, 2005; 23(30): 7445 - 7453. [Abstract] [Full Text] [PDF]

				J. Dose Schwarz, M. Bader, L. Jenicke, G. Hemminger, F. Janicke, and N. Avril Early Prediction of Response to Chemotherapy in Metastatic Breast Cancer Using Sequential 18F-FDG PET J. Nucl. Med., July 1, 2005; 46(7): 1144 - 1150. [Abstract] [Full Text] [PDF]

				W. A. Weber Use of PET for Monitoring Cancer Therapy and for Predicting Outcome J. Nucl. Med., June 1, 2005; 46(6): 983 - 995. [Abstract] [Full Text] [PDF]

				D. R. Aberle, C. Chiles, C. Gatsonis, B. J. Hillman, C. D. Johnson, B. L. McClennan, D. G. Mitchell, E. D. Pisano, M. D. Schnall, and A. G. Sorensen Imaging and Cancer: Research Strategy of the American College of Radiology Imaging Network Radiology, June 1, 2005; 235(3): 741 - 751. [Abstract] [Full Text] [PDF]

				G. J. Kelloff, J. M. Hoffman, B. Johnson, H. I. Scher, B. A. Siegel, E. Y. Cheng, B. D. Cheson, J. O'Shaughnessy, K. Z. Guyton, D. A. Mankoff, et al. Progress and Promise of FDG-PET Imaging for Cancer Patient Management and Oncologic Drug Development Clin. Cancer Res., April 15, 2005; 11(8): 2785 - 2808. [Abstract] [Full Text] [PDF]

				H. L. van Westreenen, D. C.P. Cobben, P. L. Jager, H. M. van Dullemen, J. Wesseling, P. H. Elsinga, and J. Th. Plukker Comparison of 18F-FLT PET and 18F-FDG PET in Esophageal Cancer J. Nucl. Med., March 1, 2005; 46(3): 400 - 404. [Abstract] [Full Text] [PDF]

				F. C. Detterbeck, J. F. Vansteenkiste, D. E. Morris, C. A. Dooms, A. H. Khandani, and M. A. Socinski Seeking a Home for a PET, Part 3: Emerging Applications of Positron Emission Tomography Imaging in the Management of Patients With Lung Cancer Chest, November 1, 2004; 126(5): 1656 - 1666. [Abstract] [Full Text] [PDF]