Diffusion-weighted MRI and 18F-FDG PET/CT in assessing the response to neoadjuvant chemoradiotherapy in locally advanced esophageal squamous cell carcinoma

Radiation Oncology

Chen-Peng Zhang¹  Xiu-Mei Ma²  Ling Rong²  Bin Hu²  Hai-Yan Chen²  Xin Xu²  Hua-Ying Xie²  Yong-Rui Bai²  Hua-Wei Wu³  Hai-Ping Lin⁴  Yu-Ming Wang⁴  Zhi-Yong Sun⁴  Qing Ye⁴ 

[1] Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China;Department of Radiation Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, 200127, Shanghai, China;Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China;Department of Thoracic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, 200127, Shanghai, China;

关键词: Esophageal squamous cell cancer;    Neoadjuvant chemoradiotherapy;    Pathological complete response;    F-FDG PET/CT;    DW-MRI;   

DOI  :  10.1186/s13014-021-01852-z

来源: Springer

【 摘 要 】

BackgroundNeoadjuvant chemoradiotherapy (nCRT) followed by surgery is a currently widely used strategy for locally advanced esophageal cancer (EC). However, the conventional imaging methods have certain deficiencies in the evaluation and prediction of the efficacy of nCRT. This study aimed to explore the value of functional imaging in predicting the response to neoadjuvant chemoradiotherapy (nCRT) in locally advanced esophageal squamous cell carcinoma (ESCC).MethodsFifty-four patients diagnosed with locally advanced ESCC from August 2017 to September 2019 and treated with nCRT were retrospectively analyzed. DW-MRI scanning was performed before nCRT, at 10–15 fractions of radiotherapy, and 4–6 weeks after the completion of nCRT. 18F-FDG PET/CT scans were performed before nCRT and 4–6 weeks after the completion of nCRT. These 18F-FDG PET/CT and DW-MRI parameters and relative changes were compared between patients with pathological complete response (pCR) and non-pCR.ResultsA total of 8 of 54 patients (14.8%) were evaluated as disease progression in the preoperative assessment. The remaining forty-six patients underwent operations, and the pathological assessments of the surgical resection specimens demonstrated pathological complete response (pCR) in 10 patients (21.7%) and complete response of primary tumor (pCR-T) in 16 patients (34.8%). The change of metabolic tumor volume (∆MTV) and change of total lesion glycolysis (∆TLG) were significantly different between patients with pCR and non-pCR. The SUVmax-Tpost, MTV-Tpost, and TLG-Tpost of esophageal tumors in 18F-FDG PET/CT scans after neoadjuvant chemoradiotherapy and the ∆ SUVmax-T and ∆MTV-T were significantly different between pCR-T versus non-pCR-T patients. The esophageal tumor apparent diffusion coefficient (ADC) increased after nCRT; the ADCduring, ADCpost and ∆ADCduring were significantly different between pCR-T and non-pCR-T groups. ROC analyses showed that the model that combined ADCduring with TLG-Tpost had the highest AUC (0.914) for pCR-T prediction, with 90.0% and 86.4% sensitivity and specificity, respectively.Conclusion18F-FDG PET/CT is useful for re-staging after nCRT and for surgical decision. Integrating parameters of 18F-FDG PET/CT and DW-MRI can identify pathological response of primary tumor to nCRT more accurately in ESCC.

【 授权许可】

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