Role of surgical resection in complete responders on FDG-PET after chemoradiotherapy for locally advanced esophageal squamous cell carcinoma

To determine the role of surgery in complete responders on FDG-PET after CRT and the prognostic significance of metabolic response in locally advanced esophageal squamous cell carcinoma.We retrospectively reviewed 154 patients with locally advanced esophageal cancer with increased uptake on FDG-PET. Eighty-one patients received definitive CRT and 73 received trimodality therapy. We defined metabolic complete remission (PET-CR) when FDG uptake of the primary tumor and lymph nodes were decreased and was indistinguishable from surrounding normal tissue. Oncologic outcomes were compared between trimodality group, definitive CRT group, and PET-CR subgroup of definitive CRT.Thirty-one (38.3%) of the definitive CRT patients and 39 (53.4%) of the trimodality therapy patients achieved PET-CR after CRT. The 2-year OS of the trimodality group was higher than that of the definitive CRT group, but equivalent to that of the PET-CR subgroup of definitive CRT. The 2-year LRFS and DFS of the trimodality group were higher than that of the PET-CR subgroup or the entire of definitive CRT group.The addition of surgery showed higher DFS and LRFS rates than those of the PET-CR subgroup of definitive CRT. Despite achieving PET-CR, surgery still seems to improve local tumor control.