title: Detection of interval distant metastases: clinical utility of integrated CT-PET imaging in patients with esophageal carcinoma after neoadjuvant therapy.
abstract: BACKGROUND
  The objective of the study was to determine the utility of integrated computed tomography / positron emission tomography (CT-PET) imaging for detecting interval distant metastases and assessing therapeutic response in patients with locally advanced, potentially resectable esophageal carcinoma after neoadjuvant therapy.
  
  
  METHODS
  A retrospective study was performed of 88 patients with potentially resectable esophageal carcinoma who received neoadjuvant therapy before planned surgical resection. CT-PET before and after completion of neoadjuvant was used for evaluating therapeutic response; response criteria were based on qualitative and semiquantitative analyses.
  
  
  RESULTS
  Neoadjuvant therapy comprised chemoradiotherapy in 85 patients, with prior induction chemotherapy in 39 patients. Fifty-five patients proceeded to esophagectomy. Repeat CT-PET was performed after induction chemotherapy (n = 23) and after completing chemoradiotherapy (n = 85). CT-PET identified the interval appearance of metastatic disease in 7 (8%) patients. For assessment of locoregional therapeutic response, CT-PET was unable to predict pathological response to neoadjuvant therapy in the primary tumor or locoregional lymph nodes. CT-PET had sensitivity, specificity, and positive and negative predictive values of 57%, 46%, 39%, and 64%, respectively, for detection of residual macroscopic malignancy within the primary tumor; and sensitivity, specificity, and positive and negative predictive values of 0%, 90%, 0%, and 69% for detection of residual malignancy within resected lymph nodes.
  
  
  CONCLUSIONS
  CT-PET performed after neoadjuvant therapy in patients with potentially resectable esophageal carcinoma is important for detecting interval metastases that preclude surgical resection, but is of limited utility for assessing locoregional therapeutic response.
authors.affiliation: Division of Diagnostic Imaging, M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA. jbruzzi@mdanderson.org
authors.forename: John F
authors.initials: JF
authors.lastname: Bruzzi
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Mylene T
authors.initials: MT
authors.lastname: Truong
authors.forename: Reginald F
authors.initials: RF
authors.lastname: Munden
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: Homer A
authors.initials: HA
authors.lastname: Macapinlac
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Osama
authors.initials: O
authors.lastname: Mawlawi
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: Ritsuko R
authors.initials: RR
authors.lastname: Komaki
authors.forename: Norio
authors.initials: N
authors.lastname: Fukami
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Erasmus
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis / Q000175:diagnosis*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed