title: Impact of PET-CT on primary staging and response control on multimodal treatment of esophageal cancer.
abstract: BACKGROUND
  The predictive value of positron emission tomography-computed tomography (PET-CT) in primary staging and response control in patients with esophageal carcinoma (EC) is under discussion. In the present study initial staging and metabolic response of PET-CT was correlated with tumor regression and survival in patients with multimodal treatment of EC.
  
  
  METHODS
  The authors conducted a retrospective analysis on a prospective database for 83 patients with EC (42 squamous cell, 39 adenocarcinoma, 2 anaplastic carcinoma) undergoing PET-CT for primary staging. Twenty-four of the patients underwent primary esophagectomy, 9 had palliative treatment, and 50 neoadjuvant radiochemotherapy (cisplatin, 5-fluorouracil; 50.4 Gy). The PET-CT study was repeated 6 weeks after induction of chemotherapy and compared with endoscopic ultrasound (EUS). For response control, the metabolic response (tumor standardized uptake value [SUV] reduction) was correlated with histopathologic (ypT0-4) and histomorphologic response (tumor regression) and survival.
  
  
  RESULTS
  At primary staging 81 of 83 EC (97.5%) showed an increased SUV uptake correlating with the EUS tumor stage. Suspicious lymph nodes were detected in 51 (61.4%) patients by PET-CT and 66 (79.5%) were detected by EUS. Fifteen patients had additional findings on PET-CT examination leading to a change in therapy in 9 patients (10.3%). Of 50 patients receiving a second PET-CT study, a SUV reduction >50% correlated with major histomorphologic response (tumor regression grade 4, <10% vital tumor cells) and histopathologic response (ypT0 ypN0). Furthermore, these patients showed a significantly increased survival (33.1 ± 3.5 months) compared to non-responders (21.7 ± 3.3 months; p = 0.02) and patients after primary surgery (29 ± 3.2 months; p = 0.05).
  
  
  CONCLUSIONS
  The present study shows that PET-CT is a valuable tool for primary staging and response control in multimodal treatment of patients with EC.
authors.affiliation: Department of General and Visceral Surgery, Muenster University Hospital, Waldeyerstr 1, 48149 Muenster, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Thurau
authors.forename: Daniel
authors.initials: D
authors.lastname: Palmes
authors.forename: Christiane
authors.initials: C
authors.lastname: Franzius
authors.forename: Evgeny
authors.initials: E
authors.lastname: Minin
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.forename: Kai Uwe
authors.initials: KU
authors.lastname: Juergens
authors.forename: Matthias
authors.initials: M
authors.lastname: Bruewer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods*; D010166:Palliative Care / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome