Impact of Primary Staging with Fibroblast Activation Protein Specific Enzyme Inhibitor (FAPI)-PET/CT on Radio-Oncologic Treatment Planning of Patients with Esophageal Cancer,Molecular Imaging and Biology

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Impact of Primary Staging with Fibroblast Activation Protein Specific Enzyme Inhibitor (FAPI)-PET/CT on Radio-Oncologic Treatment Planning of Patients with Esophageal Cancer
Molecular Imaging and Biology ( IF 3.1 ) Pub Date : 2020-10-15 , DOI: 10.1007/s11307-020-01548-y
J Ristau _{1,

2,

3,

4} , F L Giesel _{4,

5,

6} , M F Haefner _{1,

2,

3,

4} , F Staudinger ₅ , T Lindner ₅ , A Merkel ₅ , J Schlittenhardt ₅ , C Kratochwil _{5,

6} , P L Choyke ₇ , K Herfarth _{1,

2,

3,

4,

8} , J Debus _{1,

2,

3,

4,

8,

9} , U Haberkorn _{4,

5,

6,

10} , S A Koerber _{1,

2,

3,

4}

Affiliation

Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg University Hospital, Heidelberg, Germany.
National Center for Tumor diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany.
German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg University Hospital, Heidelberg, Germany.
Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany.
Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany.
Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.

Purpose

Quinoline-based ligands targeting cancer-associated fibroblasts have emerged as promising radiopharmaceuticals in different tumor entities. The aim of this retrospective study was to explore the potential of FAPI-PET/CT in the initial staging of esophageal cancer patients and its usefulness in radiotherapy planning as a first clinical analysis.

Methods

Seven patients with treatment-naive esophageal cancer underwent FAPI-PET/CT. Tracer uptake was quantified by standardized uptake values (SUV)max and (SUV)mean. Six patients received definitive and one neoadjuvant (chemo)radiation therapy. Endo-esophageal clipping, the gold standard to define tumor margins not delineable per CT, was performed in three patients.

Results

Primary tumors demonstrated high FAPI uptake with a median SUVmax of 17.2. Excellent tumor-to-background ratios resulted in accurate target volume delineation and were found in perfect match with clipping. Detection of regional lymph node metastases facilitated the use of simultaneous integrated boost radiotherapy plans for these patients.

Conclusion

FAPI-PET/CT may be beneficial for the management of esophageal cancer particularly in planning radiotherapy, but further research is necessary to increase patient number and statistical reliability.

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