Originally published as JCO Early Release 10.1200/JCO.2006.06.7801 on September 11 2006

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Metabolic Imaging Predicts Response, Survival, and Recurrence in Adenocarcinomas of the Esophagogastric Junction

Katja Ott, Wolfgang A. Weber, Florian Lordick, Karen Becker, Raymonde Busch, Ken Herrmann, Hinrich Wieder, Ulrich Fink, Markus Schwaiger, Jörg-Rüdiger Siewert

From the Departments of Surgery, Nuclear Medicine, Pathology, Internal Medicine III, Medical Statistic, Technische Universität München, Munich, Germany; and the Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA

Address reprint requests to Katja Ott, MD, Department of Surgery, Technische Universitaet Muenchen, Ismaningerstr 22, D-81675, Munich, Germany; e-mail: Katja.Ott{at}lrz.tum.de

PURPOSE: A previous study suggested that measurement of therapy-induced changes in tumor glucose metabolism by positron emission tomography (PET) with the glucose analog [¹⁸F]fluorodeoxyglucose (FDG) allows to select patients most likely to benefit from preoperative chemotherapy in adenocarcinomas of the esophagogastric junction (AEG). The aim of this study was to prospectively validate these findings by using an a priori definition of metabolic response.

PATIENTS AND METHODS: Sixty-five patients with locally advanced AEGs were included. Tumor glucose utilization was quantitatively assessed by FDG-PET before chemotherapy and 14 days after initiation of therapy. Patients were classified as metabolic responders when the metabolic activity of the primary tumor had decreased by more than 35% at the time of the second PET.

RESULTS: Metabolic responders showed a high histopathologic response rate (44%) with a 3-year survival rate of 70%. In contrast, prognosis was poor for metabolic nonresponders with a histopathologic response rate of 5% (P = .001) and a 3-year survival rate of 35% (P = .01). A multivariate analysis (covariates: ypT-, ypN-category, histopathologic response) demonstrated that metabolic response was the only factor predicting recurrence (P = .018) in the subgroup of completely resected (R0) patients.

CONCLUSION: This study prospectively demonstrates that changes in tumor metabolic activity during chemotherapy predict response, prognosis, and recurrence. These data provide the basis for clinical trials in which preoperative treatment is changed for patients without a metabolic response early in the course of therapy. PET-guided induction therapy may even be applicable to earlier tumor stages because surgery is only minimally delayed in nonresponding patients.

published online ahead of print at www.jco.org on September 11, 2006

K.O. and W.A.W. contributed equally to the article.

Terms in blue are defined in the glossary, found at the end of this article and online at www.jco.org.

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

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