Customization of treatment for patients with esophageal adenocarcinoma (EAC) who achieve clinical complete response (cCR) after chemoradiation using initial standardized uptake value (iSUV) of 18f-fluorodeoxyglucose PET.

4069 Background: Patients with localized esophageal adenocarcinoma (EAC) receive preoperative chemoradiation followed by surgery (trimodality [TM] therapy) or definitive chemoradiotherapy (bimodality [BM] therapy) based on comorbidities and tumor geography. However, we cannot individualize recommendations beyond these parameters. We hypothesized that iSUV could customize therapy. Methods: Data source was our prospective database of fully staged EAC patients (2002-2010). All patients had a cCR (post-chemoradiation negative biopsy and post-chemoradiation physiologic uptake on PET). iSUV cut-point was derived by recursive partitioning. Results: For 323 cCR patients, the median follow-up was 40.8 months. 206 (63.8%) patients had TM and 117 (36.2%) had BM therapy. Median OS of TM patients and BM patients were 94.8 months (95 % CI; NA-NA) and 36.5 months (95% CI; 30.5-42.4; p<0.001), respectively. Similar differences were observed in RFS (p<0.001). The median iSUV was 9.4 (range, 0-58.0). Intriguingly, TM patie...