Predictive Value of Initial PET-SUVmax in Patients with Locally Advanced Esophageal and Gastroesophageal Junction Adenocarcinoma

Introduction: We have previously shown that in early clinical stage esophageal adenocarcinoma, a positron emission tomography standardized uptake values (PET SUV(max)) of <4.5 is associated with earlier pathologic stage and predicts better survival. In this study, we analyze the impact of the pretreatment PET SUV(max), in patients with locally advanced esophageal adenocarcinoma who undergo preoperative chemoradiotherapy. Methods: We performed a retrospective analysis, selecting patients with adenocarcinoma of the esophagus who had a pretreatment PET scan and who received chemoradiotherapy before esophagectomy. Data recorded included demographics, PET SUV(max), treatment details, pathologic details, and survival data. Comparison of categorical variables was done by chi(2) analysis, continuous variables by I test, survival analysis by the Kaplan-Meier method, and comparisons of survival using the log-rank test. Results: Between January 1996 and September 2007, 189 patients were appropriate for this analysis. The initial PET SUV(max) was <4.5 in 28 patients and >= 4.5 in 161 patients. The two groups were similar with regards to demographics and treatment details. Patients in the low SUV group were less likely to show evidence of treatment response after chemoradiotherapy, including a higher likelihood of residual nodal disease and a lower likelihood of a pathologic complete response and estimated treatment response. However, both groups had similar survival. Conclusions: Although the initial PET SUV(max) does not predict survival in patients with locally advanced esophageal adenocarcinoma who receive preoperative chemoradiotherapy, patients with a high initial SUV(max) respond better to preoperative therapy. These results can be used to better select esophageal cancer patients for combined modality treatment.