Introduction: Preoperative or definitive chemoradiation is an accepted treatment for locally advanced esophageal squamous cell carcinoma (ESCC). The MUNICON study showed that positron‐emission tomography (PET) response following induction chemotherapy was predictive of outcomes in patients with gastroesophageal junction adenocarcinoma. We evaluated the predictive value of PET following induction chemotherapy in ESCC patients and assessed the impact of changing chemotherapy during radiation in PET nonresponders. Methods: We retrospectively reviewed all patients with locally advanced ESCC who received induction chemotherapy and chemoradiation; all patients had a PET before and after induction chemotherapy. Survival was calculated from date of repeat PET using Kaplan‐Meier analysis and compared between groups using the log‐rank test. Results: Of 111 patients, 70 (63%) were PET responders (defined as a 35% or more decrease in maximum standard uptake value) to induction chemotherapy. PET responders received the same chemotherapy during radiation. Of 41 PET nonresponders, 16 continued with the same chemotherapy and 25 were changed to alternative chemotherapy with radiation. Median progression‐free survival (70.1 months versus 7.1 months, p < 0.01) and overall survival (84.8 months versus 17.2 months, p < 0.01) were improved for PET responders versus nonresponders. Median progression‐free survival and overall survival for PET nonresponders who changed chemotherapy versus those who did not were 6.4 months versus 8.3 months (p = 0.556) and 14.1 versus 17.2 months (p = 0.81), respectively. Conclusions: PET after induction chemotherapy highly predicts for outcomes in ESCC patients who receive chemoradiation. However, our results suggest that PET nonresponders do not benefit from changing chemotherapy during radiation. Future trials should use PET nonresponse after induction chemotherapy to identify poor prognosis patients for novel therapies.

中文翻译：

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PET 扫描定向放化疗治疗食管鳞状细胞癌：改变 PET 无反应者的化疗方案没有任何益处

简介：术前或根治性放化疗是局部晚期食管鳞状细胞癌（ESCC）的公认治疗方法。MUNICON 研究表明，诱导化疗后的正电子发射断层扫描 (PET) 反应可以预测胃食管连接部腺癌患者的预后。我们评估了 ESCC 患者诱导化疗后 PET 的预测价值，并评估了放疗期间改变化疗对 PET 无反应者的影响。方法：我们回顾性分析所有接受诱导化疗和放化疗的局部晚期食管鳞癌患者。所有患者在诱导化疗前后均进行了 PET 检查。使用 Kaplan-Meier 分析从重复 PET 的日期计算存活率，并使用对数秩检验进行组间比较。结果：在 111 名患者中，70 名 (63%) 对诱导化疗有 PET 反应（定义为最大标准摄取值下降 35% 或更多）。PET 反应者在放疗期间接受了相同的化疗。在 41 名 PET 无反应者中，16 名继续接受相同的化疗，25 名改为替代化疗加放疗。PET 应答者与无应答者相比，中位无进展生存期（70.1 个月与 7.1 个月，p < 0.01）和总生存期（84.8 个月与 17.2 个月，p < 0.01）均有所改善。改变化疗的 PET 无反应者与未改变化疗者的中位无进展生存期和总生存期分别为 6.4 个月和 8.3 个月 (p = 0.556) 和 14.1 个月和 17.2 个月 (p = 0.81)。结论：诱导化疗后的 PET 可以高度预测接受放化疗的 ESCC 患者的预后。然而，我们的结果表明，PET 无反应者不会从放疗期间改变化疗中受益。未来的试验应使用诱导化疗后 PET 无反应来识别预后不良的患者，以进行新的治疗。