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High FDG uptake areas on pre-radiotherapy PET/CT identify preferential sites of local relapse after chemoradiotherapy for locally advanced oesophageal cancer

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Abstract

Purpose

The high failure rates in the radiotherapy (RT) target volume suggest that patients with locally advanced oesophageal cancer (LAOC) would benefit from increased total RT doses. High 2-deoxy-2-[18F]fluoro-D-glucose (FDG) uptake (hotspot) on pre-RT FDG positron emission tomography (PET)/CT has been reported to identify intra-tumour sites at increased risk of relapse after RT in non-small cell lung cancer and in rectal cancer. Our aim was to confirm these observations in patients with LAOC and to determine the optimal maximum standardized uptake value (SUVmax) threshold to delineate smaller RT target volumes that would facilitate RT dose escalation without impaired tolerance.

Methods

The study included 98 consecutive patients with LAOC treated by chemoradiotherapy (CRT). All patients underwent FDG PET/CT at initial staging and during systematic follow-up in a single institution. FDG PET/CT acquisitions were coregistered on the initial CT scan. Various subvolumes within the initial tumour (30, 40, 50, 60, 70, 80 and 90 % SUVmax thresholds) and in the subsequent local recurrence (LR, 40 and 90 % SUVmax thresholds) were pasted on the initial CT scan and compared[Dice, Jaccard, overlap fraction (OF), common volume/baseline volume, common volume/recurrent volume].

Results

Thirty-five patients had LR. The initial metabolic tumour volume was significantly higher in LR tumours than in the locally controlled tumours (mean 25.4 vs 14.2 cc; p = 0.002). The subvolumes delineated on initial PET/CT with a 30–60 % SUVmax threshold were in good agreement with the recurrent volume at 40 % SUVmax (OF = 0.60–0.80). The subvolumes delineated on initial PET/CT with a 30–60 % SUVmax threshold were in good to excellent agreement with the core volume (90 % SUVmax) of the relapse (common volume/recurrent volume and OF indices 0.61–0.89).

Conclusion

High FDG uptake on pretreatment PET/CT identifies tumour subvolumes that are at greater risk of recurrence after CRT in patients with LAOC. We propose a 60 % SUVmax threshold to delineate high FDG uptake areas on initial PET/CT as reduced target volumes for RT dose escalation.

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Acknowledgments

This study was supported by a grant from the “Ligue contre le cancer de Haute Normandie” and The North Ouest Canceropole (National Cancer Institute, INCa). We are grateful to Mr. Sebastien Vauclin from Dosisoft for his excellent collaboration

Conflicts of interest

None.

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Authors and Affiliations

  1. Nuclear Medicine Department, Henri Becquerel Cancer Center and Rouen University Hospital, Rouen, France

    Jérémie Calais, Lamyaa Nkhali, Sebastien Thureau, Charles Lemarignier, Romain Modzelewski, Isabelle Gardin & Pierre Vera

  2. QuantIF–LITIS (EA[Equipe d’Accueil] 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France

    Jérémie Calais, Bernard Dubray, Lamyaa Nkhali, Sebastien Thureau, Charles Lemarignier, Romain Modzelewski, Isabelle Gardin & Pierre Vera

  3. Department of Radiotherapy and Medical Physics, Centre Henri Becquerel and Rouen University Hospital, Rouen, France

    Bernard Dubray, Lamyaa Nkhali, Sebastien Thureau, Romain Modzelewski & Isabelle Gardin

  4. Department of Gastroenterology, Rouen University Hospital, Rouen, France

    Frederic Di Fiore & Pierre Michel

  5. Department of Oncology, Henri Becquerel Cancer Center, IRON, Rouen University Hospital, Rouen, France

    Frederic Di Fiore

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  1. Jérémie Calais
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Correspondence to Pierre Vera.

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Calais, J., Dubray, B., Nkhali, L. et al. High FDG uptake areas on pre-radiotherapy PET/CT identify preferential sites of local relapse after chemoradiotherapy for locally advanced oesophageal cancer. Eur J Nucl Med Mol Imaging 42, 858–867 (2015). https://doi.org/10.1007/s00259-015-3004-y

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