A prospective evaluation of the impact of 18-F-fluoro-deoxy-D-glucose positron emission tomography staging on survival for patients with locally advanced esophageal cancer

Purpose: To determine the impact of 18-F-fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) in the staging and prognosis of patients with locally advanced esophageal cancer (LAEC). Methods and Materials: Between January 2000 and October 2004, all patients with LAEC evaluated in the Depart...

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Published inInternational journal of radiation oncology, biology, physics Vol. 64; no. 2
Main Authors Blackstock, A. William, Farmer, Michael R., Lovato, James, Mishra, Girish, Melin, Susan A., Oaks, Timothy, Aklilu, Mabea, Clark, Paige B., Levine, Edward A.
Format Journal Article
LanguageEnglish
Published United States 01.02.2006
Subjects
CHEST
EVALUATION
FLUORINE 18
GLUCOSE
METASTASES
NEOPLASMS
PATIENTS
POSITRON COMPUTED TOMOGRAPHY
RADIOLOGY AND NUCLEAR MEDICINE
THERAPY
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Summary:Purpose: To determine the impact of 18-F-fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) in the staging and prognosis of patients with locally advanced esophageal cancer (LAEC). Methods and Materials: Between January 2000 and October 2004, all patients with LAEC evaluated in the Department of Radiation Oncology were considered for enrollment into a Phase II trial of preoperative chemoradiation. Entry required a staging whole-body FDG-PET scan. Results: One hundred ten consecutive patients were evaluated; 38 were ineligible for reasons including treatment elsewhere, prior malignancy, or refusal of treatment. After conventional staging (clinical examination, endoscopic ultrasound, and chest/abdominal computerized tomography), 33 patients were ineligible because of metastatic disease or poor performance status. Of the remaining 39 patients, 23 were confirmed to have LAEC after FDG-PET staging and were treated in the Phase II trial (Cohort I). Sixteen patients, however, had FDG-PET findings consistent with occult metastatic disease and were deemed ineligible for the trial but were treated with curative intent (Cohort II). The 2-year survival rate for the 23 patients in Cohort I was 64%, compared with 17% (p = 0.003) for patients in Cohort II (FDG-PET positive). Conclusions: More than one-third of patients determined to have LAEC with conventional staging were upstaged with the use of FDG-PET. Despite comparable therapy, upstaging with FDG-PET predicts poor 2-year survival.
ISSN:0360-3016
1879-355X
DOI:10.1016/J.IJROBP.2005.0