The Early Use of PET-CT Alters the Management of Patients with Esophageal Cancer
- First Online:
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.
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.
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.
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.
KeywordsPET-CT Esophageal cancer Imaging Radionuclide scanning
- 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
- 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.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.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
- 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
- 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
- 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
- 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
- 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