Use of volumetric analysis to predict pathologic response in esophageal cancer: a single-institution cohort study.

Background: Pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (CRT) is associated with improved survival in esophageal cancer. We used volumetric analysis of hypermetabolic esophageal tissue to assess if a decrease in volume following CRT was associated with pCR in esophageal cancer patients who underwent neoadjuvant therapy and esophagectomy. We aimed to determine if a decrease in the hypermetabolic esophageal volume could be a potential marker for better response to neoadjuvant CRT. Methods: Patients who received CRT followed by esophagectomy between 2013 and 2023 at a single institution were retrospectively reviewed. Patients were grouped by pathologic response grade. The hypermetabolic tumor volume, tumor size, and maximum standardized uptake value (mSUV) pre- and post-CRT were compared. Results: Of 309 patients, 69 had positron emission tomography scans available. Most patients were White (88.4%), but Black patients were more likely to have pCR on univariate analysis (50% Conclusions: Patients with pCR had a significantly larger decrease in tumor size and esophageal volume compared to other grade responders on univariate analysis, but on multivariable analysis only change in tumor size remained as an independent predictor of pCR. In this limited cohort, these findings encourage further investigation of volumetric analysis as a tool to predict pathologic response and indicate that it may potentially be a useful adjunct when counseling high-risk surgical patients deciding between resection and active surveillance.