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

• Published in: International 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
• Language: English
• Published: United States 01.02.2006
• Subjects: CHEST; EVALUATION; FLUORINE 18; GLUCOSE; METASTASES; NEOPLASMS; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; RADIOLOGY AND NUCLEAR MEDICINE; THERAPY
• DOI: 10.1016/J.IJROBP.2005.0
• ISSN: 0360-3016

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.