title: 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.
abstract: OBJECTIVE
  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
  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.
authors.affiliation: Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA. ablackst@wfubmc.edu
authors.forename: A William
authors.initials: AW
authors.lastname: Blackstock
authors.forename: Michael R
authors.initials: MR
authors.lastname: Farmer
authors.forename: James
authors.initials: J
authors.lastname: Lovato
authors.forename: Girish
authors.initials: G
authors.lastname: Mishra
authors.forename: Susan A
authors.initials: SA
authors.lastname: Melin
authors.forename: Timothy
authors.initials: T
authors.lastname: Oaks
authors.forename: Mabea
authors.initials: M
authors.lastname: Aklilu
authors.forename: Paige B
authors.initials: PB
authors.lastname: Clark
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015996:Survival Rate; D014055:Tomography, Emission-Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18