Abstract 1437P
Background
Peri-operative chemotherapy is the established standard of care (SOC) for patients with operable adenocarcinoma (AC) of the oesophago-gastric junction (OGJ) and stomach. FLOT (fluroruracil, leucovorin, oxaliplatin and docetaxel) has been shown to be superior to ECX / ECF and has been widely adopted as SOC (standard of care) in this setting. However, despite multimodality treatment, a large proportion of patients will relapse. The aim of this study was to assess the utility of FDG – PET in predicting early relapse and to assess the outcome in this early relapse group.
Methods
A total of 40 patients with OGJ and gastric AC who underwent FLOT neoadjuvant (NAC) chemotherapy and curative surgery between June 2016 and November 2019 were eligible. Median age was 61 and 85% of patients were male. 37 patients had baseline and post-NAC PET scans. The maximum standardised uptake value (SUVmax ) at baseline (pre-SUVmax) and post-NAC (post-SUVmax) and the SUVmax % reduction after NAC were analysed to identify any correlation with early relapse. Of the relapsed cohort, the subsequent treatment was reviewed to identify the benefit of palliative chemotherapy in this group.
Results
The recurrence rate was 25% (10 patients) and mean recurrence free survival was 4.8 months (range 0-12 months). Mean pre-SUVmax in relapsed and non-relapsed groups were 9.60 ± 3.35 and 11.1 ± 7.44, respectively (P=0.57). Mean post -SUVmax in relapsed and non-relapsed groups were 6.07 ± 2.26 and 4.83 ± 1.64, respectively (P=0.082). The % reduction of mean SUVmax in relapsed and non-relapsed groups were 54.4% + 42.4% and 60.2% + 29.9%, respectively (P=0.64). Overall, there was no significant difference in the SUVmax values and % reduction between the relapsed and non-relapsed groups. Early relapse was seen in all patients who relapsed and 4 of the relapsed patients were deemed unfit for further treatment. The remaining 6 patients had first line palliative treatment and 50% of these patients were fit to proceed to second line chemotherapy.
Conclusions
Although this study is limited by the small number of patients and relatively short follow up, it shows that the prognostic value of tumour SUVmax values and % reduction for predicting early relapse may be limited in this patient population. A significant proportion of early relapsed patients appear to be fit for further chemotherapy. More work is needed to establish the benefit of palliative chemotherapy in these patients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Pavetha Seeva.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.