Are Patients with Esophageal Cancer Who Become PET Negative after Neoadjuvant Chemoradiation Free of Cancer?

• Published in: Journal of the American College of Surgeons Vol. 206; no. 5; pp. 879 - 886
• Main Authors: McLoughlin, James M., MD, Melis, Marcovalerio, MD, Siegel, Erin M., PhD, Dean, E. Michelle, PAC, Weber, Jill M., MS, Chern, Jeannie, BS, Elliott, Melanie, BS, Kelley, Scott T., MD, FACS, Karl, Richard C., MD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2008
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents - administration & dosage; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Female; Humans; Male; Middle Aged; Neoadjuvant Therapy; Positron-Emission Tomography; Predictive Value of Tests; Radiotherapy; Remission Induction; Surgery
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2007.12.027

Background Esophageal cancer continues to increase in incidence. Many patients are presenting with stage II or greater disease and proceeding to neoadjuvant chemoradiation therapy before resection. Approximately 30% of patients will achieve a complete response and might not benefit from proceeding to resection. This study will examine the ability of PET to predict patients with a complete pathologic response. Study Design A query of our IRB-approved esophageal database revealed 81 patients who underwent a pre- and postchemoradiation PET scan and then proceeded to esophageal resection. Statistical analysis was performed to determine the ability of PET to predict a complete pathologic response. Results When comparing posttherapy PET with final pathology, it was determined that PET could not consistently differentiate a complete pathologic response from patients who still had persistent disease. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 61.8%, 43.8%, 70%, 35%, and 56%, respectively, for patients with a complete PET response after neoadjuvant therapy. Conclusions A complete PET response after neoadjuvant chemoradiation is not substantially predictive of a complete pathologic response. Patients should still be referred for resection unless distant metastases are identified.