The early use of PET-CT alters the management of patients with esophageal cancer.
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.
Williams
R N
RN
Department of Surgery, Leicester Royal Infirmary, University Hospital of Leicester NHS Trust, Leicester, UK.
Ubhi
S S
SS
Sutton
C D
CD
Thomas
A L
AL
Entwisle
J J
JJ
Bowrey
D J
DJ
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