PROGNOSTIC VALUE OF TOTAL LESION GLYOLOLYSIS AND METABOLIC TUMOR VOLUME IN PATIENTS WITH ESOPHAGEAL CARCINOMA IN THE SETTING OF NEOADJUVANT THERAPY

Introduction: Neoadjuvant therapy with chemotherapy and radiotherapy followed by esophagectomy (trimodal therapy) is the treatment of choice for most potentially curative esophageal cancers. The prognosis of this neoplasm can be estimated by measuring uptake by positron emission computed tomography (PET), such as MTV (metabolic tumor volume) and TLG (total lesion glycolysis), which reflect metabolic volume and tumor activity, respectively. To date, there are few studies evaluating the prognostic value of MTV and TLG for patients with esophageal carcinoma undergoing trimodal therapy. Objective: To investigate the prognostic value of MTV and TLG in patients with esophageal carcinoma undergoing trimodal therapy. Method: A retrospective cohort study was performed with 115 patients with esophageal carcinoma who underwent neoadjuvant therapy with platinum and taxol regimen chemoradiotherapy. Logistic regressions evaluated the relationship of MTV and TGL in esophageal carcinoma, both calculated in the primary tumor (T_MTV and T_TLG) and in the lymph nodes (N_MTV and N_TLG), with the outcomes complete pathological response (pCR), overall survival (OS) and disease free survival (DFS). Results: We included 115 patients who underwent neoadjuvant platinum and taxol-based chemoradiotherapy, followed by esophagectomy. The average follow-up was 32 months (SD ± 22). The average age was 60 years (SD ± 8), with a predominance of males (75%). Surgical access was by transthoracic approach (videothoracoscopy) in 75% of cases, and trashiatal approach in 25%, with cervical anastomosis in all cases. The two neoadjuvant chemotherapy regimens adopted were carboplatin and paclitaxol (75%), and cisplatin and paclitaxol (25%). The neoadjuvant radiation dose was 41.4 cGy (80%), 45 cGy (10%), and 50.4 (10%). The average T_MTV was 30.5 (SD ± 49); Mean T_TLG was 203 (SD ± 299); Mean NMTV was 1.35 (SD ± 4.8); the mean N_TLG was 9.3 (SD ± 25). In both univariate and multivariate analysis, T_MTV, T_TLG, N_MTV and N_TLG were associated with higher SG and SLD (p <0.05). There was no statistically significant difference for the variables studied for the pCR outcome. Conclusions: MTV and TGL of both primary and lymph node tumors are important prognostic variables in esophageal carcinoma undergoing trimodal therapy.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019