title: The integration of 18-fluoro-deoxy-glucose positron emission tomography and endoscopic ultrasound in the treatment-planning process for esophageal carcinoma.
abstract: OBJECTIVE
  Accurate delineation of the gross tumor volume (GTV) is important in radiation therapy treatment planning. We evaluated the impact of PET and endoscopic ultrasound (EUS) compared with CT simulation in the planning of radiation fields for patients with esophageal carcinoma.
  
  
  METHODS
  Twenty-five patients presenting with esophageal carcinoma for radiation therapy underwent PET scans in the treatment position after conventional CT simulation. Patients underwent PET/CT scanning after being injected with 10 to 20 mCi of [F-18]-2-deoxy-2-fluro-D-glucose. The length of the abnormality seen on the CT portion of the PET/CT scan vs. the PET scan alone was determined independently by 2 separate investigators. The length of the GTV and detection of regional adenopathy by PET was also correlated with EUS in 18 patients. Of the 18 patients who had EUS, 2 had T2 tumors and 16 had T3 tumors. Eighteen patients had adenocarcinoma and 7 had squamous cell carcinoma. Nine tumors were located at the gastroesophageal junction, 8 at the lower esophagus, 7 in the middle esophagus, and 1 in the cervical esophagus. The PET scans were reviewed to determine the length of the abnormality by use of a standard uptake value (SUV) of 2.5 to delineate the tumor extent.
  
  
  RESULTS
  The mean length of the cancer was 5.4 cm (95% CI 4.4-6.4 cm) as determined by PET scan, 6.77 cm (95% CI, 5.6-7.9 cm) as determined by CT scan, and 5.1 cm (95% CI, 4.0-6.1 cm) for the 22 patients who had endoscopy. The length of the tumors was significantly longer as measured by CT scans compared with PET scans (p = 0.0063). EUS detected significantly more patients with periesophageal and celiac lymphadenopathy compared to PET and CT. The SUV of the esophageal tumors was higher in patients with peri-esophageal lymphadenopathy identified on PET scans.
  
  
  CONCLUSIONS
  Endoscopic ultrasound and PET scans can add additional information to aid the radiation oncologist's ability to precisely identify the GTV in patients with esophageal carcinoma.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Andre
authors.initials: A
authors.lastname: Konski
authors.forename: Mohan
authors.initials: M
authors.lastname: Doss
authors.forename: Barton
authors.initials: B
authors.lastname: Milestone
authors.forename: Oleh
authors.initials: O
authors.lastname: Haluszka
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hanlon
authors.forename: Gary
authors.initials: G
authors.lastname: Freedman
authors.forename: Lee
authors.initials: L
authors.lastname: Adler
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000532:radiotherapy / Q000648:ultrastructure*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D004945:Esophagoscopy; D019788:Fluorodeoxyglucose F18; D006801:Humans; D049268:Positron-Emission Tomography; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D019788:Fluorodeoxyglucose F18