JNM: PET/CT steers treatment for patients with esophageal cancer
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18F-FDG PET/CT imaging impacted staging in 40 percent of patients newly diagnosed with esophageal cancer and management in 34 percent of patients, according to a study published online May 11 in the Journal of Nuclear Medicine. PET/CT may help physicians direct patients to appropriate treatment, which could translate into survival improvements for patients with locally advanced disease.

Esophageal cancer presents a clinical management challenge as disease stage has major prognostic and treatment ramifications. Although accurate staging can help direct patients to the appropriate therapies, CT imaging, endoscopic ultrasound and PET are limited in their abilities to fully evaluate the extent of the disease.

Previous studies had suggested that PET/CT might improve accuracy in the assessment of locoregional lymph nodes and detection of distant metastatic disease. “Given the importance of disease stage to treatment choice, this superior accuracy is likely to have a high impact in management decisions,” Thomas W. Barber, MD, of the Centre for Cancer Imaging in Melbourne, Australia, and colleagues wrote.    

Barber and colleagues conducted a study to assess the incremental staging information, management impact and prognostic stratification of PET/CT compared with conventional imaging in a cohort of esophageal cancer patients.

The study included 139 patients referred for primary PET/CT staging of biopsy-proven esophageal cancer between July 2002 and June 2005. Patients underwent conventional staging, including CT and ultrasound, prior to PET/CT and compared the results and management plans.

Pre- and post-PET/CT staging was discordant in 40 percent of patients, according to Barber and colleagues, with 27 percent of patients upstaged and 14 percent downstaged. “PET/CT findings resulted in discordant stage grouping or a change in management in 54 percent of patients,” continued the researchers.

Both imaging protocols—conventional and PET/CT—provided prognostic stratification with separation of survival curves according to stage group, Barber et al wrote. The researchers observed a convergence of survival curves of patients with PET/CT Stage I-IIA and Stage IIB Stage III, which they attributed to more aggressive treatment of patients with stage IIB-III disease.

They also noted a five-year survival rate of 38 percent for patients with stage IIB-III disease, which is higher than the rates reported by previous researchers. Barber and colleagues suggested that the improvement is the result of more appropriate staging and subsequent treatment based on PET/CT results.

“PET/CT should be incorporated in routine clinical practice for the primary staging of patients with esophageal cancer,” the researchers concluded.