title: The early use of PET-CT alters the management of patients with esophageal cancer.
abstract: BACKGROUND
  The routine use of positron emission tomography-computed tomography (PET-CT) in the staging of patients with esophageal carcinoma remains contentious, with conflicting reports of its benefit. In our unit, PET-CT has been used routinely in the staging of all patients considered for radical therapy (surgery or chemoradiotherapy). Our aim was to determine the frequency with which PET-CT influenced decision making in the management of patients with carcinoma of the esophagus or gastroesophageal junction.
  
  
  METHODS
  CT, PET-CT, and outcome information were collected on 38 patients considered for radical therapy. Patient proformas, with and without PET-CT findings, were constructed and each independently reviewed in a randomized and blinded fashion by five multidisciplinary team members (three surgeons, two oncologists) and a treatment strategy determined.
  
  
  RESULTS
  PET-CT changed the staging for ten patients (26%). This translated into a change in management decision for seven patients (18%). The concordance between individual management plans and treatment intent was 79% for CT (150 of 190 decisions) and it was 92% for PET-CT (175 of 190 decisions). Full concordance between multidisciplinary team members was 66% with CT staging and 74% with the addition of PET-CT.
  
  
  CONCLUSIONS
  The use of PET-CT early in the staging algorithm for esophageal carcinoma altered the staging for a quarter of patients and the management for a fifth of patients, supporting its inclusion early in the staging algorithm.
authors.affiliation: Department of Surgery, Leicester Royal Infirmary, University Hospital of Leicester NHS Trust, Leicester, UK.
authors.forename: R N
authors.initials: RN
authors.lastname: Williams
authors.forename: S S
authors.initials: SS
authors.lastname: Ubhi
authors.forename: C D
authors.initials: CD
authors.lastname: Sutton
authors.forename: A L
authors.initials: AL
authors.lastname: Thomas
authors.forename: J J
authors.initials: JJ
authors.lastname: Entwisle
authors.forename: D J
authors.initials: DJ
authors.lastname: Bowrey
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D055088:Early Detection of Cancer; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D018579:Patient Selection; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed