Journal of Gastrointestinal Surgery

, Volume 13, Issue 5, pp 868–873

The Early Use of PET-CT Alters the Management of Patients with Esophageal Cancer

  • R. N. Williams
  • S. S. Ubhi
  • C. D. Sutton
  • A. L. Thomas
  • J. J. Entwisle
  • D. J. Bowrey
Original Article

Abstract

Introduction

The routine use of positron emission tomography–computed tomography (PET-CT) in the staging of patients with esophageal carcinoma remains contentious, with conflicting reports of its benefit. In our unit, PET-CT has been used routinely in the staging of all patients considered for radical therapy (surgery or chemoradiotherapy). Our aim was to determine the frequency with which PET-CT influenced decision making in the management of patients with carcinoma of the esophagus or gastroesophageal junction.

Methods

CT, PET-CT, and outcome information were collected on 38 patients considered for radical therapy. Patient proformas, with and without PET-CT findings, were constructed and each independently reviewed in a randomized and blinded fashion by five multidisciplinary team members (three surgeons, two oncologists) and a treatment strategy determined.

Results

PET-CT changed the staging for ten patients (26%). This translated into a change in management decision for seven patients (18%). The concordance between individual management plans and treatment intent was 79% for CT (150 of 190 decisions) and it was 92% for PET-CT (175 of 190 decisions). Full concordance between multidisciplinary team members was 66% with CT staging and 74% with the addition of PET-CT.

Conclusion

The use of PET-CT early in the staging algorithm for esophageal carcinoma altered the staging for a quarter of patients and the management for a fifth of patients, supporting its inclusion early in the staging algorithm.

Keywords

PET-CT Esophageal cancer Imaging Radionuclide scanning 

References

  1. 1.
    Antoch G, Saoudi N, Kuehl H, Dahmen G, Mueller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: Comparison with CT and PET. J Clin Oncol. 2004;22(21):4357–4368. doi:10.1200/JCO.2004.08.120.PubMedCrossRefGoogle Scholar
  2. 2.
    Freudenberg LS, Antoch G, Schutt P, Beyer T, Jentzen W, Muller SP, et al. FDG-PET/CT in re-staging of patients with lymphoma. Eur J Nucl Med Mol Imaging. 2004;31(3):325–329. doi:10.1007/s00259-003-1375-y.PubMedCrossRefGoogle Scholar
  3. 3.
    Schoder H, Yeung HW, Gonen M, Kraus D, Larson SM. Head and neck cancer: Clinical usefulness and accuracy of PET/CT image fusion. Radiology. 2004;231(1):65–72. doi:10.1148/radiol.2311030271.PubMedCrossRefGoogle Scholar
  4. 4.
    Lardinois D, Weder W, Hany TF, Kamel EM, Korom S, Seifert B, et al. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003;348(25):2500–2507. doi:10.1056/NEJMoa022136.PubMedCrossRefGoogle Scholar
  5. 5.
    Katsoulis IE, Wong WL, Mattheou AK, Damani N, Chambers J, Livingstone JI. Fluorine-18 fluorodeoxyglucose positron emission tomography in the preoperative staging of thoracic oesophageal and gastro-oesophageal junction cancer: a prospective study. Int J Surg. 2007;5(6):399–403. doi:10.1016/j.ijsu.2007.05.009.PubMedCrossRefGoogle Scholar
  6. 6.
    McDonough PB, Jones DR, Shen KR, Northup PG, Galysh RL, Hernandez A, et al. Does FDG-PET add information to EUS and CT in the initial management of esophageal cancer? A prospective single center study. Am J Gastroenterol. 2008;103(3):570–574. doi:10.1111/j.1572-0241.2007.01579.x.PubMedCrossRefGoogle Scholar
  7. 7.
    Yamada A, Oguchi K, Fukushima M, Imai Y, Kadoya M. Evaluation of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography in gastric carcinoma: relation to histological subtypes, depth of tumor invasion, and glucose transporter-1 expression. Ann Nucl Med. 2006;20(9):597–604. doi:10.1007/BF02984657.PubMedCrossRefGoogle Scholar
  8. 8.
    van Westreenen HL, Westerterp M, Sloof GW, Groen H, Bossuyt PM, Jager PL, et al. Limited additional value of positron emission tomography in staging oesophageal cancer. Br J Surg. 2007;94(12):1515–1520. doi:10.1002/bjs.5708.PubMedCrossRefGoogle Scholar
  9. 9.
    Bar-Shalom R, Guralnik L, Tsalic M, Leiderman M, Frenkel A, Gaitini D, et al. The additional value of PET/CT over PET in FDG imaging of oesophageal cancer. Eur J Nucl Med Mol Imaging. 2005;32(8):918–924. doi:10.1007/s00259-005-1795-y.PubMedCrossRefGoogle Scholar
  10. 10.
    Ishimori T, Patel PV, Wahl RL. Detection of unexpected additional primary malignancies with PET/CT. J Nucl Med. 2005;46(5):752–757.PubMedGoogle Scholar
  11. 11.
    Kamel EM, Thumshirn M, Truninger K, Schiesser M, Fried M, Padberg B, et al. Significance of incidental 18F-FDG accumulations in the gastrointestinal tract in PET/CT: correlation with endoscopic and histopathologic results. J Nucl Med. 2004;45(11):1804–1810.PubMedGoogle Scholar
  12. 12.
    Block MI, Patterson GA, Sundaresan RS, Bailey MS, Flanagan FL, Dehdashti F, et al. Improvement in staging of esophageal cancer with the addition of positron emission tomography. Ann Thorac Surg. 1997;64(3):770–776; discussion 776–777. doi:10.1016/S0003-4975(97)00619-X.PubMedCrossRefGoogle Scholar
  13. 13.
    Luketich JD, Schauer PR, Meltzer CC, Landreneau RJ, Urso GK, Townsend DW, et al. Role of positron emission tomography in staging esophageal cancer. Ann Thorac Surg. 1997;64(3):765–769. doi:10.1016/S0003-4975(97)00624-3.PubMedCrossRefGoogle Scholar
  14. 14.
    Kole AC, Plukker JT, Nieweg OE, Vaalburg W. Positron emission tomography for staging of oesophageal and gastroesophageal malignancy. Br J Cancer. 1998;78(4):521–527.PubMedGoogle Scholar
  15. 15.
    Rankin SC, Taylor H, Cook GJ, Mason R. Computed tomography and positron emission tomography in the pre-operative staging of oesophageal carcinoma. Clin Radiol. 1998;53(9):659–665. doi:10.1016/S0009-9260(98)80292-4.PubMedCrossRefGoogle Scholar
  16. 16.
    Luketich JD, Friedman DM, Weigel TL, Meehan MA, Keenan RJ, Townsend DW, et al. Evaluation of distant metastases in esophageal cancer: 100 consecutive positron emission tomography scans. Ann Thorac Surg. 1999;68(4):1133–1136; discussion 1136-7. doi:10.1016/S0003-4975(99)00974-1.PubMedCrossRefGoogle Scholar
  17. 17.
    Flamen P, Lerut A, Van Cutsem E, De Wever W, Peeters M, Stroobants S, et al. Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol. 2000;18(18):3202–3210.PubMedGoogle Scholar
  18. 18.
    Lerut T, Flamen P, Ectors N, Van Cutsem E, Peeters M, Hiele M, et al. Histopathologic validation of lymph node staging with FDG-PET scan in cancer of the esophagus and gastroesophageal junction: A prospective study based on primary surgery with extensive lymphadenectomy. Ann Surg. 2000;232(6):743–752. doi:10.1097/00000658-200012000-00003.PubMedCrossRefGoogle Scholar
  19. 19.
    Meltzer CC, Luketich JD, Friedman D, Charron M, Strollo D, Meehan M, et al. Whole-body FDG positron emission tomographic imaging for staging esophageal cancer comparison with computed tomography. Clin Nucl Med. 2000;25(11):882–887. doi:10.1097/00003072-200011000-00005.PubMedCrossRefGoogle Scholar
  20. 20.
    Wren SM, Stijns P, Srinivas S. Positron emission tomography in the initial staging of esophageal cancer. Arch Surg. 2002;137(9):1001–1006; discussion 1006–1007. doi:10.1001/archsurg.137.9.1001.PubMedCrossRefGoogle Scholar
  21. 21.
    Rasanen JV, Sihvo EI, Knuuti MJ, Minn HR, Luostarinen ME, Laippala P, et al. Prospective analysis of accuracy of positron emission tomography, computed tomography, and endoscopic ultrasonography in staging of adenocarcinoma of the esophagus and the esophagogastric junction. Ann Surg Oncol. 2003;10(8):954–960. doi:10.1245/ASO.2003.12.002.PubMedCrossRefGoogle Scholar
  22. 22.
    Heeren PA, Jager PL, Bongaerts F, van Dullemen H, Sluiter W, Plukker JT. Detection of distant metastases in esophageal cancer with (18)F-FDG PET. J Nucl Med. 2004;45(6):980–987.PubMedGoogle Scholar
  23. 23.
    Sihvo EI, Rasanen JV, Knuuti MJ, Minn HR, Luostarinen ME, Viljanen T, et al. Adenocarcinoma of the esophagus and the esophagogastric junction: Positron emission tomography improves staging and prediction of survival in distant but not in locoregional disease. J Gastrointest Surg. 2004;8(8):988–996. doi:10.1016/j.gassur.2004.09.040.PubMedCrossRefGoogle Scholar
  24. 24.
    Kato H, Miyazaki T, Nakajima M, Takita J, Kimura H, Faried A, et al. The incremental effect of positron emission tomography on diagnostic accuracy in the initial staging of esophageal carcinoma. Cancer. 2005;103(1):148–156. doi:10.1002/cncr.20724.PubMedCrossRefGoogle Scholar
  25. 25.
    Malik V, Keogan M, Gilham C, Duffy G, Ravi N, Reynolds JV. FDG-PET scanning in the management of cancer of the oesophagus and oesophagogastric junction: Early experience with 100 consecutive cases. Ir J Med Sci. 2006;175(4):48–54.PubMedCrossRefGoogle Scholar
  26. 26.
    Berrisford RG, Wong WL, Day D, Toy E, Napier M, Mitchell K, et al. The decision to operate: role of integrated computed tomography positron emission tomography in staging oesophageal and oesophagogastric junction cancer by the multidisciplinary team. Eur J Cardiothorac Surg. 2008;33(6):1112–1116. doi:10.1016/j.ejcts.2008.01.055.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • R. N. Williams
    • 1
  • S. S. Ubhi
    • 1
  • C. D. Sutton
    • 1
  • A. L. Thomas
    • 2
  • J. J. Entwisle
    • 3
  • D. J. Bowrey
    • 1
    • 4
  1. 1.Department of Surgery, Leicester Royal InfirmaryUniversity Hospital of Leicester NHS TrustLeicesterUK
  2. 2.Department of Oncology, Leicester Royal InfirmaryUniversity Hospital of Leicester NHS TrustLeicesterUK
  3. 3.Department of Radiology, Leicester Royal InfirmaryUniversity Hospital of Leicester NHS TrustLeicesterUK
  4. 4.Department of Surgery, Leicester Royal InfirmaryInfirmary SquareLeicesterUK

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