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Response rate and diagnostic accuracy of early PET-CT during neo-adjuvant therapies in oesophageal adenocarcinoma: a systematic review and meta-analysis
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  • Kieran Foley,
  • Jacqueline Jeffries,
  • Clare Hannon,
  • Bernadette Coles,
  • Kevin Bradley,
  • Elizabeth Smyth
Kieran Foley
Velindre Cancer Centre
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Jacqueline Jeffries
National Imaging Academy Wales (NIAW)
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Clare Hannon
Cambridge University Hospitals NHS Foundation Trust
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Bernadette Coles
Velindre Cancer Centre
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Kevin Bradley
Wales Diagnostic and Research Positron Emission Tomography Imaging Centre (PETIC)
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Elizabeth Smyth
Cambridge University Hospitals NHS Foundation Trust
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Abstract

Purpose Only 25% of oesophageal adenocarcinoma (OAC) patients have a pathological response to neo-adjuvant therapy (NAT) before oesophagectomy. Early response assessment using PET imaging may help guide management of these patients. We performed a systematic review and meta-analysis to synthesise the evidence detailing response rate and diagnostic accuracy of early PET-CT assessment. Methods We systematically searched several databases including MEDLINE and Embase. Studies with mixed cohorts of histology, tumour location, and a repeat PET-CT assessment after more than one cycle of NAT were excluded. Reference standard was pathological response, defined by Becker or Mandard classifications. Primary outcome was metabolic response rate after one cycle of NAT defined by a reduction in maximum standardised uptake value (SUVmax) of 35%. Secondary outcome was diagnostic accuracy of treatment response prediction, defined as the sensitivity and specificity of early PET-CT using this threshold. Quality of evidence was also assessed. Random-effects meta-analysis pooled response rates and diagnostic accuracy. This study was registered with PROSPERO (CRD42019147034). Results Overall, 1341 articles were screened, and six studies were eligible for analysis. These studies reported data for 518 patients (aged 27-78 years; 452 [87.3%] were male) between 2005-2020. Pooled sensitivity of early metabolic response to predict pathological response was 77.2% (95%CI 53.2%-100%). Significant heterogeneity existed between studies (I2=80.6% (95%CI 38.9%-93.8%), p=0.006). Pooled specificity was 75.0% (95%CI 68.2%-82.5%), however no significant heterogeneity between studies existed (I2=0.0% (95%CI 0.0%-67.4%), p=0.73). Conclusion High-quality evidence is lacking, and few studies met the inclusion criteria of this systematic review. The sensitivity of PET using a SUVmax reduction threshold of 35% was suboptimal and varied widely. However, specificity was consistent across studies with a pooled value of 75.0%, suggesting early PET assessment is a better predictor of treatment resistance than of pathological response. Further research is required to define optimal PET-guided treatment decisions in OAC.

Peer review status:Published

21 Oct 2020Submitted to International Journal of Clinical Practice
22 Oct 2020Submission Checks Completed
22 Oct 2020Assigned to Editor
23 Oct 2020Reviewer(s) Assigned
23 Nov 2020Review(s) Completed, Editorial Evaluation Pending
26 Nov 20201st Revision Received
27 Nov 2020Submission Checks Completed
27 Nov 2020Assigned to Editor
27 Nov 2020Reviewer(s) Assigned
02 Dec 2020Review(s) Completed, Editorial Evaluation Pending
03 Dec 2020Editorial Decision: Accept
10 Dec 2020Published in International Journal of Clinical Practice. 10.1111/ijcp.13906