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

Objective: Patients with advanced esophageal squamous cell carcinoma receive neoadjuvant chemotherapy or chemoradiotherapy to improve survival, but benefits are observed only in those with histologic response. Positron emission tomography with fludeoxyglucose F 18 ( INN fludeoxyglucose [ (18)F]) detects accumulation of glucose analog in viable cancer cells. This study investigated the usefulness of positron emission tomography with fludeoxyglucose F 18 in assessment of response of advanced esophageal squamous cell carcinoma to neoadjuvant treatment to establish new criteria to predict postoperative long-term survival. Methods: Fifty patients with locally advanced esophageal squamous cell carcinoma who received neoadjuvant therapy ( chemotherapy 35, chemoradiotherapy 15) underwent positron emission tomography with fludeoxyglucose F 18 before surgical resection in evaluation of posttreatment maximum standardized uptake value, residual tumor size ( maximum square area of longitudinal axis), histologic response, and postoperative survival. Results: After treatment, uptake was not noted in 21 patients ( posttreatment maximum standardized uptake value <2.5, negative) but was detected in 29 (>= 2.5, positive). Residual tumor size ranged from 0 to 54.0 mm(2) for negative results and 55.0 to 676.0 mm(2) for positive, clearly distinguishing histologic major response from nonresponse. The negative group demonstrated significantly higher 5-year cause-specific survival ( 67.7%) and lower hematogenous recurrence ( 4.8%) than the 36.5% and 37.0% values in the positive group, ( P <.0042 and P = .0083, respectively). Univariate Cox regression analyses identified posttreatment maximum standardized uptake value ( cutoff 2.5) as the only preoperative prognostic factor ( P = .0071). Conclusion: Posttreatment positron emission tomography with fludeoxyglucose F 18 reliably predicted histologic response and postoperative survival in advanced esophageal squamous cell carcinoma. This tool could potentially be used to tailor optimal treatment according to individual responses.