Purpose: To evaluate the prognostic value of FDG-PET/CT after neo-adjuvant therapy in locally advanced oesophageal cancer (EC) patients. Methods and Materials: Among 108 EC patients who underwent FDG-PET/ CT after neo-adjuvant treatment, we selected 56 patients without evidence or suspicious for distant metastases. All patients were followed for a mean period of 13±9 months from nuclear imaging. PET/CT findings were correlated with patient management and long-term prognosis. Chi-square test was used for comparison of categorical variables and t-Student test for continuous data. Survival curves were computed using Kaplan Meier method. A p value of < 0.05 was considered statistically significant. Results: 15 patients had negative and 41 positive (27 vs. 73%) PET/CT after neo-adjuvant therapy. 6/15 patients underwent radical-intent surgery and 9/15 did not, whereas 31/41 performed surgery and 10/41 did not (p < 0.05). After a median time of 10 months, 28 patients were disease-free, 15 relapsed and 11 died. The event-free survival was significantly higher in patients with negative than with positive PET/CT after neo-adjuvant treatment (73 vs. 41%; log rank p < 0.05). Considering patients with positive PET/CT, in non-surgery subset only 1 patient was alive without evidence of disease while in surgery subset 17 patients were disease-free (10 vs. 55%, p < 0.001). Conclusion: PET/CT could stratify the recurrence risk of EC patients based on treatment efficacy. After 13 months from PET/CT, 89% of patients with negative PET/CT who did not undergo surgery resulted disease free. A positive PET/CT after neo-adjuvant therapy should be followed by surgery for improving the eventfree survival.
PET-guided prognosis: a promising role of metabolic imaging in oesophageal cancer
ALFIERI, RITA;CASTORO, CARLO;MUZZIO, PIER CARLO;POMERRI, FABIO
2012
Abstract
Purpose: To evaluate the prognostic value of FDG-PET/CT after neo-adjuvant therapy in locally advanced oesophageal cancer (EC) patients. Methods and Materials: Among 108 EC patients who underwent FDG-PET/ CT after neo-adjuvant treatment, we selected 56 patients without evidence or suspicious for distant metastases. All patients were followed for a mean period of 13±9 months from nuclear imaging. PET/CT findings were correlated with patient management and long-term prognosis. Chi-square test was used for comparison of categorical variables and t-Student test for continuous data. Survival curves were computed using Kaplan Meier method. A p value of < 0.05 was considered statistically significant. Results: 15 patients had negative and 41 positive (27 vs. 73%) PET/CT after neo-adjuvant therapy. 6/15 patients underwent radical-intent surgery and 9/15 did not, whereas 31/41 performed surgery and 10/41 did not (p < 0.05). After a median time of 10 months, 28 patients were disease-free, 15 relapsed and 11 died. The event-free survival was significantly higher in patients with negative than with positive PET/CT after neo-adjuvant treatment (73 vs. 41%; log rank p < 0.05). Considering patients with positive PET/CT, in non-surgery subset only 1 patient was alive without evidence of disease while in surgery subset 17 patients were disease-free (10 vs. 55%, p < 0.001). Conclusion: PET/CT could stratify the recurrence risk of EC patients based on treatment efficacy. After 13 months from PET/CT, 89% of patients with negative PET/CT who did not undergo surgery resulted disease free. A positive PET/CT after neo-adjuvant therapy should be followed by surgery for improving the eventfree survival.
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