Patients with localized esophageal adenocarcinoma (EAC) receive preoperative chemoradiation followed by surgery (trimodality [TM] therapy) or definitive chemoradiotherapy (bimodality [BM] therapy) based on comorbidities and tumor geography. However, we cannot individualize recommendations beyond these parameters. We hypothesized that iSUV could customize therapy.Methods
Data source was our prospective database of fully staged EAC patients (2002–2010). All patients had a cCR (post-chemoradiation negative biopsy and post-chemoradiation physiologic uptake on PET). iSUV cut-point was derived by recursive partitioning.Results
For 323 cCR patients, the median follow-up was 40.8 months. 206 (63.8%) patients had TM and 117 (36.2%) had BM therapy. Median OS of TM patients and BM patients were 94.8 months (95% CI; NA–NA) and 36.5 months (95% CI; 30.5–42.4; P < 0.001), respectively. Similar differences were observed in RFS (P < 0.001). The median iSUV was 9.4 (range, 0–58.0). Intriguingly, TM patients with iSUV of ≥6 had a better OS (94.8 months; 95% CI; 39.1–150.5) and RFS (94.8 months; 95% CI; 18.2–171.4) compared with BM patients with iSUV of ≥6 OS (31.4 months; 95% CI; 21.0–41.9; P < 0.001) and RFS (17.2 months; 95% CI; 14.5–19.8; P < 0.001). However, the prognosis of TM and BM cCR patients with iSUV <6 was similar (OS, P = 0.62 and RFS, P = 0.46). The pathological CR (pathCR) rate in TM patients was similar irrespective of iSUV of ≥6 (27.1%) versus iSUV <6 (28.6%; P = 0.85).Conclusion
Our unique data provide an insight into the fate of cCR EAC patients by iSUV. Patient with iSUV ≥6 dramatically benefit from surgery and TM therapy is encouraged. iSUV and pathCR do not correlate. iSUV can customize therapy of localized EAC patients.