Response assessment to neoadjuvant chemoradiotherapy for esophageal cancer using PET/CT and DW-MRI

A. Borggreve; L. Goense; P. S. N. Van Rossum; S. E. Heethuis; R. Van Hillegersberg; J. J. W. Lagendijk; A. L. H. M. W. Van Lier; S. Mook; J. P. Ruurda; M. Van Vulpen; F. E. Voncken; B. M. P. Aleman; A. Bartels-Rutten; J. Ma; P. Fang; B. C. Musall; S. H. Lin; G. J. Meijer

doi:10.1016/S0167-8140(19)31218-6

Abstract

Material and Methods
In this prospective multicenter study, patients scheduled
to receive nCRT followed by esophagectomy for resectable
esophageal cancer underwent 18F-FDG PET/CT and DW-MRI
scanning prior to start of nCRT, during nCRT and 0-2 weeks
before esophagectomy. Response to nCRT was measured
using the tumor regression grading system based on
histopathological evaluation of the resection specimen
(TRG1-4). Relative changes in 18F-FDG PET/CT (ΔSUV and
ΔTLG) and DW-MRI (ΔADC) parameters were compared
between patients with a pCR (TRG1) and non-pCR (TRG2-
4) groups (Figure 1). Multivariable logistic regression
analysis with bootstrapped 95% confidence intervals and
corresponding concordance measurements were
calculated to evaluate the complementary value of 18FFDG
PET/CT and DW-MRI.
Results
A total of 69 patients with 203 18F-FDG PET/CT and 199
DW-MRI scans were eligible for analysis. A pCR was found
in 26.1% (18/69). Relative changes in 18F-FDG PET/CT
parameters after nCRT (ΔSUVmean,post [median, IQR] -63% (-
68%, -49%) for pCR versus -42% [-58%, -16%] for non-pCR,
p = 0.018 and ΔTLGpost [median, IQR] -86% [-93%, -81%] for
pCR versus -65% [-88%, -32%] for non-pCR, p = 0.036), as
well as changes in DW-MRI parameters during nCRT
(ΔADCduring [median, IQR] 28% [15%, 39%] for pCR versus 11%
[3.7%, 17%] for non-pCR, p = 0.006) were significantly
different between pathologic complete responders and
non-responders in esophageal cancer (Table 1). A cstatistic
of 0.74 for ΔSUVmean,post alone, of 0.77 for
ΔADCduring alone and of 0.81 for the combination of
ΔADCduring with ΔSUVmean,post was obtained in classifying
patients as pCR and non-pCR.
Conclusion
This prospective multicenter study demonstrates that
changes in 18F-FDG PET/CT parameters after nCRT
(ΔSUVmean,post and ΔTLGpost) and early treatment-induced
changes on DW-MRI during nCRT (ΔADCduring) discriminate
between pathologic complete responders from non-responders in esophageal cancer. Moreover, 18F-FDG
PET/CT and DW-MRI are of complementary value in the
assessment of histopathological response.

Original language	English
Pages (from-to)	S413-S414
Journal	Radiotherapy and Oncology
Volume	133
DOIs	https://doi.org/10.1016/S0167-8140(19)31218-6
Publication status	Published - Apr 2019

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Borggreve, A., Goense, L., Van Rossum, P. S. N., Heethuis, S. E., Van Hillegersberg, R., Lagendijk, J. J. W., Van Lier, A. L. H. M. W., Mook, S., Ruurda, J. P., Van Vulpen, M., Voncken, F. E., Aleman, B. M. P., Bartels-Rutten, A., Ma, J., Fang, P., Musall, B. C., Lin, S. H., & Meijer, G. J. (2019). Response assessment to neoadjuvant chemoradiotherapy for esophageal cancer using PET/CT and DW-MRI. Radiotherapy and Oncology, 133, S413-S414. https://doi.org/10.1016/S0167-8140(19)31218-6

@article{5c0ebfcd5ffa4d59aee5db05b6bc3df6,

title = "Response assessment to neoadjuvant chemoradiotherapy for esophageal cancer using PET/CT and DW-MRI",

abstract = "Material and MethodsIn this prospective multicenter study, patients scheduledto receive nCRT followed by esophagectomy for resectableesophageal cancer underwent 18F-FDG PET/CT and DW-MRIscanning prior to start of nCRT, during nCRT and 0-2 weeksbefore esophagectomy. Response to nCRT was measuredusing the tumor regression grading system based onhistopathological evaluation of the resection specimen(TRG1-4). Relative changes in 18F-FDG PET/CT (ΔSUV andΔTLG) and DW-MRI (ΔADC) parameters were comparedbetween patients with a pCR (TRG1) and non-pCR (TRG2-4) groups (Figure 1). Multivariable logistic regressionanalysis with bootstrapped 95% confidence intervals and corresponding concordance measurements werecalculated to evaluate the complementary value of 18FFDGPET/CT and DW-MRI.ResultsA total of 69 patients with 203 18F-FDG PET/CT and 199DW-MRI scans were eligible for analysis. A pCR was foundin 26.1% (18/69). Relative changes in 18F-FDG PET/CTparameters after nCRT (ΔSUVmean,post [median, IQR] -63% (-68%, -49%) for pCR versus -42% [-58%, -16%] for non-pCR,p = 0.018 and ΔTLGpost [median, IQR] -86% [-93%, -81%] forpCR versus -65% [-88%, -32%] for non-pCR, p = 0.036), aswell as changes in DW-MRI parameters during nCRT(ΔADCduring [median, IQR] 28% [15%, 39%] for pCR versus 11%[3.7%, 17%] for non-pCR, p = 0.006) were significantlydifferent between pathologic complete responders andnon-responders in esophageal cancer (Table 1). A cstatisticof 0.74 for ΔSUVmean,post alone, of 0.77 forΔADCduring alone and of 0.81 for the combination ofΔADCduring with ΔSUVmean,post was obtained in classifyingpatients as pCR and non-pCR.ConclusionThis prospective multicenter study demonstrates thatchanges in 18F-FDG PET/CT parameters after nCRT(ΔSUVmean,post and ΔTLGpost) and early treatment-inducedchanges on DW-MRI during nCRT (ΔADCduring) discriminatebetween pathologic complete responders from non-responders in esophageal cancer. Moreover, 18F-FDGPET/CT and DW-MRI are of complementary value in theassessment of histopathological response.",

author = "A. Borggreve and L. Goense and {Van Rossum}, {P. S. N.} and Heethuis, {S. E.} and {Van Hillegersberg}, R. and Lagendijk, {J. J. W.} and {Van Lier}, {A. L. H. M. W.} and S. Mook and Ruurda, {J. P.} and {Van Vulpen}, M. and Voncken, {F. E.} and Aleman, {B. M. P.} and A. Bartels-Rutten and J. Ma and P. Fang and Musall, {B. C.} and Lin, {S. H.} and Meijer, {G. J.}",

year = "2019",

month = apr,

doi = "10.1016/S0167-8140(19)31218-6",

language = "English",

volume = "133",

pages = "S413--S414",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

}

Borggreve, A, Goense, L, Van Rossum, PSN, Heethuis, SE, Van Hillegersberg, R , Lagendijk, JJW , Van Lier, ALHMW, Mook, S, Ruurda, JP, Van Vulpen, M, Voncken, FE, Aleman, BMP, Bartels-Rutten, A, Ma, J, Fang, P, Musall, BC, Lin, SH & Meijer, GJ 2019, 'Response assessment to neoadjuvant chemoradiotherapy for esophageal cancer using PET/CT and DW-MRI', Radiotherapy and Oncology, vol. 133, pp. S413-S414. https://doi.org/10.1016/S0167-8140(19)31218-6

TY - JOUR

T1 - Response assessment to neoadjuvant chemoradiotherapy for esophageal cancer using PET/CT and DW-MRI

AU - Borggreve, A.

AU - Goense, L.

AU - Van Rossum, P. S. N.

AU - Heethuis, S. E.

AU - Van Hillegersberg, R.

AU - Lagendijk, J. J. W.

AU - Van Lier, A. L. H. M. W.

AU - Mook, S.

AU - Ruurda, J. P.

AU - Van Vulpen, M.

AU - Voncken, F. E.

AU - Aleman, B. M. P.

AU - Bartels-Rutten, A.

AU - Ma, J.

AU - Fang, P.

AU - Musall, B. C.

AU - Lin, S. H.

AU - Meijer, G. J.

PY - 2019/4

Y1 - 2019/4

N2 - Material and MethodsIn this prospective multicenter study, patients scheduledto receive nCRT followed by esophagectomy for resectableesophageal cancer underwent 18F-FDG PET/CT and DW-MRIscanning prior to start of nCRT, during nCRT and 0-2 weeksbefore esophagectomy. Response to nCRT was measuredusing the tumor regression grading system based onhistopathological evaluation of the resection specimen(TRG1-4). Relative changes in 18F-FDG PET/CT (ΔSUV andΔTLG) and DW-MRI (ΔADC) parameters were comparedbetween patients with a pCR (TRG1) and non-pCR (TRG2-4) groups (Figure 1). Multivariable logistic regressionanalysis with bootstrapped 95% confidence intervals and corresponding concordance measurements werecalculated to evaluate the complementary value of 18FFDGPET/CT and DW-MRI.ResultsA total of 69 patients with 203 18F-FDG PET/CT and 199DW-MRI scans were eligible for analysis. A pCR was foundin 26.1% (18/69). Relative changes in 18F-FDG PET/CTparameters after nCRT (ΔSUVmean,post [median, IQR] -63% (-68%, -49%) for pCR versus -42% [-58%, -16%] for non-pCR,p = 0.018 and ΔTLGpost [median, IQR] -86% [-93%, -81%] forpCR versus -65% [-88%, -32%] for non-pCR, p = 0.036), aswell as changes in DW-MRI parameters during nCRT(ΔADCduring [median, IQR] 28% [15%, 39%] for pCR versus 11%[3.7%, 17%] for non-pCR, p = 0.006) were significantlydifferent between pathologic complete responders andnon-responders in esophageal cancer (Table 1). A cstatisticof 0.74 for ΔSUVmean,post alone, of 0.77 forΔADCduring alone and of 0.81 for the combination ofΔADCduring with ΔSUVmean,post was obtained in classifyingpatients as pCR and non-pCR.ConclusionThis prospective multicenter study demonstrates thatchanges in 18F-FDG PET/CT parameters after nCRT(ΔSUVmean,post and ΔTLGpost) and early treatment-inducedchanges on DW-MRI during nCRT (ΔADCduring) discriminatebetween pathologic complete responders from non-responders in esophageal cancer. Moreover, 18F-FDGPET/CT and DW-MRI are of complementary value in theassessment of histopathological response.

AB - Material and MethodsIn this prospective multicenter study, patients scheduledto receive nCRT followed by esophagectomy for resectableesophageal cancer underwent 18F-FDG PET/CT and DW-MRIscanning prior to start of nCRT, during nCRT and 0-2 weeksbefore esophagectomy. Response to nCRT was measuredusing the tumor regression grading system based onhistopathological evaluation of the resection specimen(TRG1-4). Relative changes in 18F-FDG PET/CT (ΔSUV andΔTLG) and DW-MRI (ΔADC) parameters were comparedbetween patients with a pCR (TRG1) and non-pCR (TRG2-4) groups (Figure 1). Multivariable logistic regressionanalysis with bootstrapped 95% confidence intervals and corresponding concordance measurements werecalculated to evaluate the complementary value of 18FFDGPET/CT and DW-MRI.ResultsA total of 69 patients with 203 18F-FDG PET/CT and 199DW-MRI scans were eligible for analysis. A pCR was foundin 26.1% (18/69). Relative changes in 18F-FDG PET/CTparameters after nCRT (ΔSUVmean,post [median, IQR] -63% (-68%, -49%) for pCR versus -42% [-58%, -16%] for non-pCR,p = 0.018 and ΔTLGpost [median, IQR] -86% [-93%, -81%] forpCR versus -65% [-88%, -32%] for non-pCR, p = 0.036), aswell as changes in DW-MRI parameters during nCRT(ΔADCduring [median, IQR] 28% [15%, 39%] for pCR versus 11%[3.7%, 17%] for non-pCR, p = 0.006) were significantlydifferent between pathologic complete responders andnon-responders in esophageal cancer (Table 1). A cstatisticof 0.74 for ΔSUVmean,post alone, of 0.77 forΔADCduring alone and of 0.81 for the combination ofΔADCduring with ΔSUVmean,post was obtained in classifyingpatients as pCR and non-pCR.ConclusionThis prospective multicenter study demonstrates thatchanges in 18F-FDG PET/CT parameters after nCRT(ΔSUVmean,post and ΔTLGpost) and early treatment-inducedchanges on DW-MRI during nCRT (ΔADCduring) discriminatebetween pathologic complete responders from non-responders in esophageal cancer. Moreover, 18F-FDGPET/CT and DW-MRI are of complementary value in theassessment of histopathological response.

U2 - 10.1016/S0167-8140(19)31218-6

DO - 10.1016/S0167-8140(19)31218-6

M3 - Meeting Abstract

SN - 0167-8140

VL - 133

SP - S413-S414

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

ER -

Response assessment to neoadjuvant chemoradiotherapy for esophageal cancer using PET/CT and DW-MRI

Abstract

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