14026 Background: Response to chemoradiation for oesophageal carcinoma on PET scanning is associated with pathological response and survival. Recent trials suggest that neoadjuvant chemotherapy for oesophageal cancer improves disease free and overall survival. We have examined the relationship between PET and histopathological response in those who have undergone surgical resection following preoperative chemotherapy in Northern Ireland. Methods: We assessed 20 consecutive patients with resectable oesophageal cancer. Staging in all patients included an endoscopic ultrasound scan and PET scan before and after preoperative chemotherapy and a PET scan after pre-operative chemotherapy. PET response (≥50% decrease in SUVmax) and pathological response were assessed independently by a Nuclear Medicine specialist and two histopathologists. Evidence of histopathological response was assessed using the Mandard criteria and by determining the proportion of the total blocks of tumour with evidence of viable disease. Results: 20 have been treated, 15 males and 5 females with a median age of 68 (range 39–76). Clinical staging suggested stage III disease in 12 patients (60%), stage IIa in 6 (30%), stage IIb and IVa disease 1 in each group. 16 patients with adenocarcinoma received 3 cycles of ECF chemotherapy and 4 with squamous cell carcinoma received 2 cycles of Cisplatin/5FU chemotherapy. The median time to surgery from first chemotherapy was 101 days (range 84–165). Final pathological stage was less than predicted by pre-treatment staging in 9 patients (45%). PET response was seen in 10 patients (50%), of these, 9 had a Mandard score of ≤3. With median followup of 8 months (range 3–21 months), 18 patients (81.9%) are alive disease free, 3 (13.6%) have died from disease, 1 (4.5%) died postoperatively. Conclusions: In this small series evidence of response to pre-operative chemotherapy assessed by reduction in SUVmax on 18FDG PET scanning is associated with pathological response. We suggest that this association is worthy of further evaluation and prospective investigation. No significant financial relationships to disclose.
Patterns of recurrence in oesophageal cancer following oesophagectomy in the era of neoadjuvant chemotherapy