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PET SUVmax as a Predictor of Pathologic Complete Response to Neoadjuvant Chemoradiation Therapy in Patients With Carcinoma of the Esophagus
S350
International Journal of Radiation Oncology Biology Physics
alive and 54% had recurrent disease. The median age was 63 years (range 3891) and median Karnofsky Performance Status was 90% (range 60-100%). Histology of primary tumor was 74% adenocarcinoma, 23% squamous cell carcinoma, and 3% other. Median weight loss pre-RT was 7% and post-RT was 4.7%. 43% of patients had pretreatment feeding tubes which were used for an average of 2.1 weeks (SD Z 2.8). For patients with pre-CRT feedings tubes, median survival was significantly lower than for those not requiring feeding tubes (12 vs 21 months, p Z 0.017). 75% of patients had nutritional consultation, with a median of 2 nutrition notes during RT (range 0-11). Patients with four or more nutritional notes had significantly lower median survival (16 vs 31 months, p Z 0.016). Patients with feedings tubes were statistically more likely to have a greater number of nutritional notes (p Z 0.019). While pre-CRT albumin <3.4 was predictive of lower survival (p Z 0.018), post-CRTalbumin and pre- and post- CRT serum total protein did not significantly impact survival. Percent weight loss before RT was associated with lower survival (p Z 0.011) while percent weight loss during CRT was not. Survival was significantly higher with pre-CRT regular or soft diet versus diet restriction of liquid or NPO (p Z 0.001). Conclusions: Poor survival is predicted by factors suggesting inadequate nutritional status prior to RT, including weight loss, albumin level, and liquid or NPO diet. Even with feeding tube placement and frequent nutritional support, survival remains low, suggesting the need for even more aggressive supportive strategies in this patient population. Author Disclosure: A. Choflet: A. Employee; Johns Hopkins Hospital. S. Alcorn: A. Employee; Johns Hopkins Hospital. R. Hales: A. Employee; Johns Hopkins Hospital.
Author Disclosure: T. Nonaka: None. Y. Nakayama: None. N. Mizoguchi: None. M. Shiomi: None.
2337 Radiation Therapy for Squamous Cell Carcinoma of the Cervical Esophagus T. Nonaka, Y. Nakayama, N. Mizoguchi, and M. Shiomi; Kanagawa Cancer Center, Yokohama, Japan Purpose/Objective(s): Cancer of the cervical esophagus is a rare disease among all malignancy of the esophagus. This study was designed to evaluate the efficacy of radiation therapy (RT) for squamous cell carcinoma (SCC) of cervical esophagus. Materials/Methods: From 2008 to 2013, 23 patients with SCC of the cervical esophagus who were treated with RT were retrospectively analyzed. Of the 23, six patients who had distant metastasis at diagnosis were excluded from this analysis. Thus, 17 patients who received RT with or without concurrent chemotherapy were enrolled into this study. The median age was 70 years (range: 47-80 years), and 13 were male and four were female. The distribution of the clinical stage according to TNM staging system (6th edition, 2002) was as follows: stage I in three patients, stage II in five patients, and stage III in nine patients. All 17 patients received external beam RT (EBRT). The initial RT field up to 40 Gy encompassed the mid and lower neck area, which included level III-IV LN region of the neck, and the upper mediastinal area of which the lower margin was the carina of the bronchus. Then, the dose with 20-30 Gy was added to the primary tumor and the metastatic nodes, and the median dose to the tumors was 66 Gy. Two cycles of systemic chemotherapy with platinum-based regimen were administered concurrently with RT to 11 patients (65%). Results: The median follow-up period of the 13 survivors was 20 months. The 2-year overall survival rate (OS), and the loco-regional control rate (LC) were 71% and 50%, respectively. The progression of the disease was found in eight patients (47%). The seven of the eight patients developed loco-regional recurrence including one with both of the distant and the loco-regional recurrence, and the remaining one patient met multiple metastases to the lung without loco-regional recurrence. These clinical outcomes of the patients with stage I were favorable compared with other patients with advanced stage, however, the difference was not statistical. No patients developed severe toxicity related to the treatment. Conclusions: Our results demonstrated that clinical outcomes of the patients with SCC of the cervical esophagus treated with definitive RT were favorable, and suggested that the better loco-regional control could improve the prognosis of the patients with this disease.
2338 A Multi-institutional Study Evaluating the Reliability of the Spinal Instability Neoplastic Score (SINS) Among Radiation Oncologists for Spinal Metastases A. Sahgal,1 R. Schouten,2 A. Versteeg,3 S. Boriani,4 P. Pal Varga,5 L. Rhines,6 N. Kawahara,7 D. Fourney,8 L. Weir,9 J. Reynolds,10 M. Fehlings,11 Z. Gokaslan,12 and C. Fisher9; 1Sunnybrook Health Sciences Center, Toronto, ON, Canada, 2Christchurch Hospital, Christchurch, New Zealand, 3University Medical Center Utrecht, Utrecht, Netherlands, 4Rizzoli Institute, Bologna, Italy, 5National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary, 6MD Anderson Cancer Center, Houston, TX, 7Kanazawa Medical University, Kahoku-gun, Japan, 8University of Saskatchewan, Saskatoon, SK, Canada, 9University of British Columbia, Vancouver, BC, Canada, 10Oxford University Hospital NHS Trust, Oxford, United Kingdom, 11University of Toronto, Toronto, ON, Canada, 12Johns Hopkins University, Baltimore, MD Purpose/Objective(s): The Spinal Instability Neoplastic Score (SINS) is a newly developed assessment tool that incorporates both radiologic and clinical factors in the evaluation of mechanical instability secondary to spinal metastases. This study aims to define the inter- and intra-observer reliability and validity of SINS among radiation oncologists. Materials/Methods: Thirty-three radiation oncologists, across ten international sites, reviewed both the imaging and clinical history for 30 spinal metastases cases. For each case, the total SINS (0-18 points), three clinical categories (stable: 0-6 points, potentially unstable: 7-12 points, and unstable: 13-18 points), and a binary scale (‘stable’: 0-6 points and ‘current or possible instability’; surgical consultation recommended: 7-18 points) were recorded. Evaluation was repeated 6-8 weeks later. Inter-observer agreement and intra-observer reproducibility were calculated by means of the kappa statistic and translated into levels of agreement (slight, fair, moderate, substantial, and excellent). Validity was determined by comparing the ratings against a spinal surgeon’s consensus standard. Results: Substantial (k Z 0.76) inter-observer reliability was observed when using the SINS binary scale. Analysis of the separate SINS components showed excellent level of inter-observer agreement for location (k Z 0.94) and pain (k Z 0.88) and moderate agreement for bone lesion quality (k Z 0.55), spinal alignment (k Z 0.42), vertebral body collapse (k Z 0.57), and posterolateral involvement of the spinal elements (k Z 0.43). Excellent (k Z 0.80) intra-observer reliability when using the SINS binary scale was also observed. Analysis of the separate SINS components showed similar levels of intra-observer agreement as compared to the interobserver results. Validity of the binary scale was also excellent (k Z 0.85) compared with the gold standard. None of the unstable cases were rated as stable by the radiation oncologists ensuring all were appropriately recommended for surgical consultation. Conclusions: Among radiation oncologists, SINS is a highly reliable, reproducible and valid assessment tool which should help in determining the patient most appropriate for surgical referral. Author Disclosure: A. Sahgal: None. R. Schouten: None. A. Versteeg: None. S. Boriani: None. P. Pal Varga: None. L. Rhines: None. N. Kawahara: None. D. Fourney: None. L. Weir: None. J. Reynolds: None. M. Fehlings: None. Z. Gokaslan: None. C. Fisher: E. Research Grant; AO Spine.
2339 PET SUVmax as a Predictor of Pathologic Complete Response to Neoadjuvant Chemoradiation Therapy in Patients With Carcinoma of the Esophagus M. Zaki,1 T. Shaikh,2 M. Dominello,1 E.J. McSpadden,1 M. Yu,2 S. Cohen,2 W. Scott,2 A. Shields,1 P. Philip,1 M. Choi,1 J.E. Meyer,2 and A.A. Konski1; 1Wayne State University School of Medicine, Detroit, MI, 2Fox Chase Cancer Center, Philadelphia, PA
Volume 90 Number 1S Supplement 2014 Purpose/Objective(s): Previous studies have depicted a correlation between 18FDG PET maximum standardized uptake value (SUVmax) and pathologic complete response (pCR) in patients treated with preoperative chemoradiation therapy (CRT) for esophageal cancer. However, it is unclear whether or not this correlation differs based on tumor histology. Our objective is to determine how SUVmax before and after neoadjuvant CRT for esophageal carcinoma relates to the rate of pCR at surgical resection, and to examine whether or not the relationship varies based on histology. Materials/Methods: After IRB approval, patients at two NCI-designated cancer centers from 2000-2013 who were treated with neoadjuvant CRT followed by surgical resection for esophageal cancer were identified. Medical records were reviewed to gather clinical, radiographic, and pathologic data. PET scans were performed prior to and 3-6 weeks after the completion of preoperative CRT. SUVmax was measured at each scan, and the percent decrease in SUVmax was calculated. A least squares regression analysis was performed to investigate an association between pCR and important clinical factors. Results: One hundred and thirty-two patients were identified. Median age was 62 (36-80), 79% male and 21% female. Adenocarcinoma was identified in 83% and squamous cell carcinoma in 16%; one patient had a neuroendocrine tumor. One hundred and four (79%) patients had a PET scan both prior to and after the completion of preoperative CRT. Thirty percent of patients achieved a pCR, 20% had residual microscopic disease, and 50% had gross residual disease. The pCR rates for adenocarcinoma and squamous cell carcinoma were 28% and 36% respectively. The percent decrease in SUVmax was significantly associated with pCR (p Z 0.04). The median pre- and post-treatment SUVmax were 9.5 (2.3 - 44.4) and 4.1 (0 - 24.4) respectively, and did not differ significantly based on histology. The mean reduction in SUVmax was 60%. For patients achieving a pCR, the mean reduction was 69% compared to 56% for patients with residual disease. When controlling for histology, SUVmax remained associated with pCR (p Z 0.04). The median post-treatment SUVmax was 4.1. Patients who had a post-treatment SUV of 4.1 or less were more likely to have a pCR (p Z 0.02). Conclusions: In this cohort of patients, we confirm that SUV response after neoadjuvant CRT is significantly associated with pCR. Additionally, this association holds true when controlling for histologic type. These data should be considered as new approaches are modeled based on responseadapted therapy. Author Disclosure: M. Zaki: None. T. Shaikh: None. M. Dominello: None. E.J. McSpadden: None. M. Yu: None. S. Cohen: None. W. Scott: None. A. Shields: None. P. Philip: None. M. Choi: None. J.E. Meyer: None. A.A. Konski: None.
2340 The Important Prognostic Value of Pretreatment Stage in Patients Achieving Pathologic Complete Response After Neoadjuvant Therapy of Esophageal Cancer J. Yang,1 Z. Xiao,1 L. Tan,1 z. Zhou,1 Q. Feng,1 L. Wang,1 H. Zhang,1 d. Chen,1 J. Liang,1 Z. Hui,1 W. Yin,1 and J. He2; 1Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC), Beijing, China, 2Department of Thoracic Surgical Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC), Beijing, China Purpose/Objective(s): To evaluate the relation between pretreatment stage and pathologic response as well as prognosis after neoadjuvant treatment in esophageal squamous cell cancer (ESCC). Materials/Methods: A total of 296 ESCC patients treated by neoadjuvant radiation therapy in our hospital between 1980 and 2007 were retrospectively reviewed. The prescription doses were 36w50Gy (median,40Gy), 2Gy/F each daily, 5F/Week. Radiation therapy was delivered with anteroposterior opposing fields for most patients. Radiation treatment area encompassed primary tumor and relevant lymph node regions. All patients
Poster Viewing Abstracts S351 received esophagectomy and two-field lymphadenectomy 4 weeks after radiation therapy. Tumor regression grades (TRG) of the specimens were categorized as TRG-1, TRG-2 and TRG-3 referring to Claire L. Donohoe’s proposal in Annals of Surgery of 2013. The sixth edition of UICC TNM classification was used for pretreatment staging of diseases. Only patients with both complete response (TRG-1) and pathologically negative lymph node were defined as pathological complete response (pCR), or no pCR otherwise. Kaplan-Meier method, log rank test were used for survival analysis. Results: The follow-up period ranged from 6.3 to 10 years. The study population consisted of 232 males and 64 females with median age of 55(22w78) years; There were 10, 51, 209 and 26 lesions located at cervical, upper, moderate, and lower thoracic esophagus respectively with median length of 6.0(2w12)cm. Of 296 patients, 78(26.4%) achieved pCR, of which 27(22.9%) pCR in 118(39.9%) patients with resectable disease (RD, cT2-3N0-1M0), and 51(28.7%) pCR in 178(60.1%) patients with non-resectable disease (NRD, cT4N0-1M0). Neither the difference of pCR rate (22.9 vs 28.7%, P Z 0.270) nor lymph node metastases rate (25.4% vs 33.1%, p Z 0.156) between RD and NRD was statistically significant, while NRD had higher number of metastatic lymph nodes (p Z 0.014). The patients with RD had better 5-year OS (40.7% vs 21.6%, P Z 0.004) in the whole study population. In addition, the patients achieving pCR had significant longer 5-year OS in both RD (66.5% vs 34.5%, HR Z 0.573, 95% CI Z 0.368w0.894, P Z 0.014) and NRD (34.1% vs 16.5%, HR Z 0.582, 95% CI Z 0.407w0.832, P Z 0.003). When stratified by pCR status, patients with RD gained better 5-year OS (66.7% vs 38.7%, P Z 0.024) in 78 pCR patients. Similarly, in 218 no pCR patients, the earlier pretreatment stage, the longer 5-year OS (33.0% vs 14.7%, P Z 0.015). What’s more, Higher TRG (P Z 0.000) had significant inverse influence on OS in no pCR patients. Conclusions: Our study indicates pretreatment stage is not associated with pCR after neoadjuvant treatment in ESCC, in other words, the radiosensitivity did not change along with disease stage. However, pretreatment stage is still predictive to the prognosis of ESCC after neoadjuvant treatment, regardless of whether pCR is achieved. Author Disclosure: J. Yang: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). E. Research Grant; Z121107001012004. Z. Xiao: A. Employee; of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). E. Research Grant; Z121107001012004. I. Travel Expenses; Z121107001012004. L. Tan: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). Z. Zhou: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC),. Q. Feng: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). L. Wang: None. H. Zhang: A. Employee; 1Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). D. Chen: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC),. J. Liang: A. Employee; of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). Z. Hui: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). W. Yin: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College(PUMC). J. He: A. Employee; Department of Thoracic Surgical Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC).
International Journal of Radiation Oncology Biology Physics
alive and 54% had recurrent disease. The median age was 63 years (range 3891) and median Karnofsky Performance Status was 90% (range 60-100%). Histology of primary tumor was 74% adenocarcinoma, 23% squamous cell carcinoma, and 3% other. Median weight loss pre-RT was 7% and post-RT was 4.7%. 43% of patients had pretreatment feeding tubes which were used for an average of 2.1 weeks (SD Z 2.8). For patients with pre-CRT feedings tubes, median survival was significantly lower than for those not requiring feeding tubes (12 vs 21 months, p Z 0.017). 75% of patients had nutritional consultation, with a median of 2 nutrition notes during RT (range 0-11). Patients with four or more nutritional notes had significantly lower median survival (16 vs 31 months, p Z 0.016). Patients with feedings tubes were statistically more likely to have a greater number of nutritional notes (p Z 0.019). While pre-CRT albumin <3.4 was predictive of lower survival (p Z 0.018), post-CRTalbumin and pre- and post- CRT serum total protein did not significantly impact survival. Percent weight loss before RT was associated with lower survival (p Z 0.011) while percent weight loss during CRT was not. Survival was significantly higher with pre-CRT regular or soft diet versus diet restriction of liquid or NPO (p Z 0.001). Conclusions: Poor survival is predicted by factors suggesting inadequate nutritional status prior to RT, including weight loss, albumin level, and liquid or NPO diet. Even with feeding tube placement and frequent nutritional support, survival remains low, suggesting the need for even more aggressive supportive strategies in this patient population. Author Disclosure: A. Choflet: A. Employee; Johns Hopkins Hospital. S. Alcorn: A. Employee; Johns Hopkins Hospital. R. Hales: A. Employee; Johns Hopkins Hospital.
Author Disclosure: T. Nonaka: None. Y. Nakayama: None. N. Mizoguchi: None. M. Shiomi: None.
2337 Radiation Therapy for Squamous Cell Carcinoma of the Cervical Esophagus T. Nonaka, Y. Nakayama, N. Mizoguchi, and M. Shiomi; Kanagawa Cancer Center, Yokohama, Japan Purpose/Objective(s): Cancer of the cervical esophagus is a rare disease among all malignancy of the esophagus. This study was designed to evaluate the efficacy of radiation therapy (RT) for squamous cell carcinoma (SCC) of cervical esophagus. Materials/Methods: From 2008 to 2013, 23 patients with SCC of the cervical esophagus who were treated with RT were retrospectively analyzed. Of the 23, six patients who had distant metastasis at diagnosis were excluded from this analysis. Thus, 17 patients who received RT with or without concurrent chemotherapy were enrolled into this study. The median age was 70 years (range: 47-80 years), and 13 were male and four were female. The distribution of the clinical stage according to TNM staging system (6th edition, 2002) was as follows: stage I in three patients, stage II in five patients, and stage III in nine patients. All 17 patients received external beam RT (EBRT). The initial RT field up to 40 Gy encompassed the mid and lower neck area, which included level III-IV LN region of the neck, and the upper mediastinal area of which the lower margin was the carina of the bronchus. Then, the dose with 20-30 Gy was added to the primary tumor and the metastatic nodes, and the median dose to the tumors was 66 Gy. Two cycles of systemic chemotherapy with platinum-based regimen were administered concurrently with RT to 11 patients (65%). Results: The median follow-up period of the 13 survivors was 20 months. The 2-year overall survival rate (OS), and the loco-regional control rate (LC) were 71% and 50%, respectively. The progression of the disease was found in eight patients (47%). The seven of the eight patients developed loco-regional recurrence including one with both of the distant and the loco-regional recurrence, and the remaining one patient met multiple metastases to the lung without loco-regional recurrence. These clinical outcomes of the patients with stage I were favorable compared with other patients with advanced stage, however, the difference was not statistical. No patients developed severe toxicity related to the treatment. Conclusions: Our results demonstrated that clinical outcomes of the patients with SCC of the cervical esophagus treated with definitive RT were favorable, and suggested that the better loco-regional control could improve the prognosis of the patients with this disease.
2338 A Multi-institutional Study Evaluating the Reliability of the Spinal Instability Neoplastic Score (SINS) Among Radiation Oncologists for Spinal Metastases A. Sahgal,1 R. Schouten,2 A. Versteeg,3 S. Boriani,4 P. Pal Varga,5 L. Rhines,6 N. Kawahara,7 D. Fourney,8 L. Weir,9 J. Reynolds,10 M. Fehlings,11 Z. Gokaslan,12 and C. Fisher9; 1Sunnybrook Health Sciences Center, Toronto, ON, Canada, 2Christchurch Hospital, Christchurch, New Zealand, 3University Medical Center Utrecht, Utrecht, Netherlands, 4Rizzoli Institute, Bologna, Italy, 5National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary, 6MD Anderson Cancer Center, Houston, TX, 7Kanazawa Medical University, Kahoku-gun, Japan, 8University of Saskatchewan, Saskatoon, SK, Canada, 9University of British Columbia, Vancouver, BC, Canada, 10Oxford University Hospital NHS Trust, Oxford, United Kingdom, 11University of Toronto, Toronto, ON, Canada, 12Johns Hopkins University, Baltimore, MD Purpose/Objective(s): The Spinal Instability Neoplastic Score (SINS) is a newly developed assessment tool that incorporates both radiologic and clinical factors in the evaluation of mechanical instability secondary to spinal metastases. This study aims to define the inter- and intra-observer reliability and validity of SINS among radiation oncologists. Materials/Methods: Thirty-three radiation oncologists, across ten international sites, reviewed both the imaging and clinical history for 30 spinal metastases cases. For each case, the total SINS (0-18 points), three clinical categories (stable: 0-6 points, potentially unstable: 7-12 points, and unstable: 13-18 points), and a binary scale (‘stable’: 0-6 points and ‘current or possible instability’; surgical consultation recommended: 7-18 points) were recorded. Evaluation was repeated 6-8 weeks later. Inter-observer agreement and intra-observer reproducibility were calculated by means of the kappa statistic and translated into levels of agreement (slight, fair, moderate, substantial, and excellent). Validity was determined by comparing the ratings against a spinal surgeon’s consensus standard. Results: Substantial (k Z 0.76) inter-observer reliability was observed when using the SINS binary scale. Analysis of the separate SINS components showed excellent level of inter-observer agreement for location (k Z 0.94) and pain (k Z 0.88) and moderate agreement for bone lesion quality (k Z 0.55), spinal alignment (k Z 0.42), vertebral body collapse (k Z 0.57), and posterolateral involvement of the spinal elements (k Z 0.43). Excellent (k Z 0.80) intra-observer reliability when using the SINS binary scale was also observed. Analysis of the separate SINS components showed similar levels of intra-observer agreement as compared to the interobserver results. Validity of the binary scale was also excellent (k Z 0.85) compared with the gold standard. None of the unstable cases were rated as stable by the radiation oncologists ensuring all were appropriately recommended for surgical consultation. Conclusions: Among radiation oncologists, SINS is a highly reliable, reproducible and valid assessment tool which should help in determining the patient most appropriate for surgical referral. Author Disclosure: A. Sahgal: None. R. Schouten: None. A. Versteeg: None. S. Boriani: None. P. Pal Varga: None. L. Rhines: None. N. Kawahara: None. D. Fourney: None. L. Weir: None. J. Reynolds: None. M. Fehlings: None. Z. Gokaslan: None. C. Fisher: E. Research Grant; AO Spine.
2339 PET SUVmax as a Predictor of Pathologic Complete Response to Neoadjuvant Chemoradiation Therapy in Patients With Carcinoma of the Esophagus M. Zaki,1 T. Shaikh,2 M. Dominello,1 E.J. McSpadden,1 M. Yu,2 S. Cohen,2 W. Scott,2 A. Shields,1 P. Philip,1 M. Choi,1 J.E. Meyer,2 and A.A. Konski1; 1Wayne State University School of Medicine, Detroit, MI, 2Fox Chase Cancer Center, Philadelphia, PA
Volume 90 Number 1S Supplement 2014 Purpose/Objective(s): Previous studies have depicted a correlation between 18FDG PET maximum standardized uptake value (SUVmax) and pathologic complete response (pCR) in patients treated with preoperative chemoradiation therapy (CRT) for esophageal cancer. However, it is unclear whether or not this correlation differs based on tumor histology. Our objective is to determine how SUVmax before and after neoadjuvant CRT for esophageal carcinoma relates to the rate of pCR at surgical resection, and to examine whether or not the relationship varies based on histology. Materials/Methods: After IRB approval, patients at two NCI-designated cancer centers from 2000-2013 who were treated with neoadjuvant CRT followed by surgical resection for esophageal cancer were identified. Medical records were reviewed to gather clinical, radiographic, and pathologic data. PET scans were performed prior to and 3-6 weeks after the completion of preoperative CRT. SUVmax was measured at each scan, and the percent decrease in SUVmax was calculated. A least squares regression analysis was performed to investigate an association between pCR and important clinical factors. Results: One hundred and thirty-two patients were identified. Median age was 62 (36-80), 79% male and 21% female. Adenocarcinoma was identified in 83% and squamous cell carcinoma in 16%; one patient had a neuroendocrine tumor. One hundred and four (79%) patients had a PET scan both prior to and after the completion of preoperative CRT. Thirty percent of patients achieved a pCR, 20% had residual microscopic disease, and 50% had gross residual disease. The pCR rates for adenocarcinoma and squamous cell carcinoma were 28% and 36% respectively. The percent decrease in SUVmax was significantly associated with pCR (p Z 0.04). The median pre- and post-treatment SUVmax were 9.5 (2.3 - 44.4) and 4.1 (0 - 24.4) respectively, and did not differ significantly based on histology. The mean reduction in SUVmax was 60%. For patients achieving a pCR, the mean reduction was 69% compared to 56% for patients with residual disease. When controlling for histology, SUVmax remained associated with pCR (p Z 0.04). The median post-treatment SUVmax was 4.1. Patients who had a post-treatment SUV of 4.1 or less were more likely to have a pCR (p Z 0.02). Conclusions: In this cohort of patients, we confirm that SUV response after neoadjuvant CRT is significantly associated with pCR. Additionally, this association holds true when controlling for histologic type. These data should be considered as new approaches are modeled based on responseadapted therapy. Author Disclosure: M. Zaki: None. T. Shaikh: None. M. Dominello: None. E.J. McSpadden: None. M. Yu: None. S. Cohen: None. W. Scott: None. A. Shields: None. P. Philip: None. M. Choi: None. J.E. Meyer: None. A.A. Konski: None.
2340 The Important Prognostic Value of Pretreatment Stage in Patients Achieving Pathologic Complete Response After Neoadjuvant Therapy of Esophageal Cancer J. Yang,1 Z. Xiao,1 L. Tan,1 z. Zhou,1 Q. Feng,1 L. Wang,1 H. Zhang,1 d. Chen,1 J. Liang,1 Z. Hui,1 W. Yin,1 and J. He2; 1Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC), Beijing, China, 2Department of Thoracic Surgical Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC), Beijing, China Purpose/Objective(s): To evaluate the relation between pretreatment stage and pathologic response as well as prognosis after neoadjuvant treatment in esophageal squamous cell cancer (ESCC). Materials/Methods: A total of 296 ESCC patients treated by neoadjuvant radiation therapy in our hospital between 1980 and 2007 were retrospectively reviewed. The prescription doses were 36w50Gy (median,40Gy), 2Gy/F each daily, 5F/Week. Radiation therapy was delivered with anteroposterior opposing fields for most patients. Radiation treatment area encompassed primary tumor and relevant lymph node regions. All patients
Poster Viewing Abstracts S351 received esophagectomy and two-field lymphadenectomy 4 weeks after radiation therapy. Tumor regression grades (TRG) of the specimens were categorized as TRG-1, TRG-2 and TRG-3 referring to Claire L. Donohoe’s proposal in Annals of Surgery of 2013. The sixth edition of UICC TNM classification was used for pretreatment staging of diseases. Only patients with both complete response (TRG-1) and pathologically negative lymph node were defined as pathological complete response (pCR), or no pCR otherwise. Kaplan-Meier method, log rank test were used for survival analysis. Results: The follow-up period ranged from 6.3 to 10 years. The study population consisted of 232 males and 64 females with median age of 55(22w78) years; There were 10, 51, 209 and 26 lesions located at cervical, upper, moderate, and lower thoracic esophagus respectively with median length of 6.0(2w12)cm. Of 296 patients, 78(26.4%) achieved pCR, of which 27(22.9%) pCR in 118(39.9%) patients with resectable disease (RD, cT2-3N0-1M0), and 51(28.7%) pCR in 178(60.1%) patients with non-resectable disease (NRD, cT4N0-1M0). Neither the difference of pCR rate (22.9 vs 28.7%, P Z 0.270) nor lymph node metastases rate (25.4% vs 33.1%, p Z 0.156) between RD and NRD was statistically significant, while NRD had higher number of metastatic lymph nodes (p Z 0.014). The patients with RD had better 5-year OS (40.7% vs 21.6%, P Z 0.004) in the whole study population. In addition, the patients achieving pCR had significant longer 5-year OS in both RD (66.5% vs 34.5%, HR Z 0.573, 95% CI Z 0.368w0.894, P Z 0.014) and NRD (34.1% vs 16.5%, HR Z 0.582, 95% CI Z 0.407w0.832, P Z 0.003). When stratified by pCR status, patients with RD gained better 5-year OS (66.7% vs 38.7%, P Z 0.024) in 78 pCR patients. Similarly, in 218 no pCR patients, the earlier pretreatment stage, the longer 5-year OS (33.0% vs 14.7%, P Z 0.015). What’s more, Higher TRG (P Z 0.000) had significant inverse influence on OS in no pCR patients. Conclusions: Our study indicates pretreatment stage is not associated with pCR after neoadjuvant treatment in ESCC, in other words, the radiosensitivity did not change along with disease stage. However, pretreatment stage is still predictive to the prognosis of ESCC after neoadjuvant treatment, regardless of whether pCR is achieved. Author Disclosure: J. Yang: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). E. Research Grant; Z121107001012004. Z. Xiao: A. Employee; of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). E. Research Grant; Z121107001012004. I. Travel Expenses; Z121107001012004. L. Tan: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). Z. Zhou: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC),. Q. Feng: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). L. Wang: None. H. Zhang: A. Employee; 1Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). D. Chen: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC),. J. Liang: A. Employee; of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). Z. Hui: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC). W. Yin: A. Employee; Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College(PUMC). J. He: A. Employee; Department of Thoracic Surgical Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CAMS), Peking Union Medical College (PUMC).