Predicting tumour response to chemoradiotherapy in oesophageal cancer by early interim 18F-FDG PET: where do we stand and where should we go?

摘要

Oesophageal cancer is a disease with a dismal prognosis and high mortality. There were an estimated 482,000 new cases and 407,000 patients died of the disease worldwide in 2008 [1]. Concurrent chemotherapy and radiotherapy is now considered the neoadjuvant treatment of choice in patients with operable oesophageal cancer, as has been demonstrated by the Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) trial [2]. However, not all patients benefit from this treatment. In the CROSS trial, as much as 39 % of patients had no histopathological tumour regression (tumour regression defined as <10 % viable tumour cells in the resected specimen). Yet, toxicity due to chemotherapy occurs in 11-90 % and there is also a risk of radiation-induced complications [2, 3]. In patients who respond insufficiently, inefficient chemoradiotherapy should be discontinued, and surgery should not be delayed.