Cancer Res Treat.  2013 Mar;45(1):22-30.

Response Evaluation after Neoadjuvant Chemoradiation by Positron Emission Tomography-Computed Tomography for Esophageal Squamous Cell Carcinoma

  • 1Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 2Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 4Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 5Department of Thoracic Surgery, Seoul National Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.


Parameters of positron emission tomography-computed tomography (PET-CT) were compared with the results of histopathologic examination in order to determine which can provide an objective indication of response after neoadjuvant chemoradiation for treatment of thoracic esophageal squamous cell carcinoma (SCC).
Between August 2003 and January 2010, data on 25 patients who underwent neoadjuvant chemoradiation and subsequent resection for treatment of esophageal SCC were retrospectively reviewed. Changes in maximum standardized uptake value (DeltaSUVmax), metabolic tumor volume (DeltaMTV), and total lesion glycolysis (DeltaTLG) were analyzed by comparison with the histopathologic findings.
Pathologic complete remission (CR) for the main tumor was achieved in 11 patients. Postradiation esophagitis was observed in 10 patients. DeltaSUVmax of the main tumor was significantly greater in the CR group than in the partial response (PR) group (p=0.039), while DeltaMTV and DeltaTLG of the main tumor were not (p=0.141 and p=0.349, respectively). The cut-off DeltaSUVmax value for CR was estimated as 72.1%, indicating significantly better accuracy than visual interpretation (p=0.045). Of the 48 involved lymph nodes, DeltaSUVmax and DeltaMTV of lymph nodes were significantly greater in the CR group than in the PR group (p=0.045 and p=0.014, respectively), while DeltaTLG was not (p=0.063). The cut-off value of DeltaSUVmax for prediction of CR in lymph nodes was calculated as 50.67%.
PET-CT could be used for prediction of response to neoadjuvant treatment in thoracic esophageal SCC. DeltaSUVmax may be a more significant predictor for CR after neoadjuvant chemoradiation than DeltaTLG and DeltaMTV.


Esophageal squamous cell carcinoma; Neoadjuvant therapy; Positron-emission tomography and computed tomography

MeSH Terms

Carcinoma, Squamous Cell
Esophageal Neoplasms
Lymph Nodes
Neoadjuvant Therapy
Positron-Emission Tomography and Computed Tomography
Retrospective Studies
Tumor Burden
Carcinoma, Squamous Cell
Esophageal Neoplasms


  • Fig. 1 ROC curve of ΔSUVmax. Area under ROC was calculated as 0.789 (95% confidence interval, 0.581 to 0.925) for prediction of complete remission. ROC, receiveroperating characteristic; ΔSUVmax, changes in maximum standardized uptake value.

  • Fig. 2 (A) Pretreatment fused positron emission tomography-computed tomography image shows a large hypermetabolic esophageal cancer (SUVmax=24.8). (B) Post-treatment image shows markedly decreased tumor uptake (SUVmax=4.4). Although there was residual hypermetabolic viable tumor by visual interpretation, reduction of SUVmax (ΔSUVmax) was 82.3%, by which complete remission could have been predicted according to the cut-off ΔSUVmax of 72%. Permanent pathologic examination revealed no remaining viable tumor. SUVmax, maximum standardized uptake value.

  • Fig. 3 (A) Pretreatment fused positron emission tomography-computed tomography image shows a large hypermetabolic esophageal cancer (SUVmax=26.6). (B) post-treatment image shows linearly increase uptake in the upper thoracic esophagus beyond the boundary of the primary tumor (SUVmax=7.1), which suggests active radiation esophagitis. Due to esophagitis, diagnosis of complete remission by visual interpretation is difficult, while reduction of SUVmax (ΔSUVmax) was 73.3%, which implies complete remission according to the cut-off ΔSUVmax of 72%. Permanent pathologic examination revealed no remaining viable tumor. SUVmax, maximum standardized uptake value.

  • Fig. 4 Kaplan-Meier survival curve for overall survival (A) and cumulative incidence of recurrence (B). Patients showing pathological CR appear to have better survival than those with PR, although statistical significance was not reached, respectively. CR, complete remission; PR+SD, partial response and stable disease.


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