title: The value of post-neoadjuvant therapy PET-CT in the detection of interval metastases in esophageal carcinoma.
abstract: BACKGROUND
  PET-CT scanning is increasingly applied in the primary work-up of esophageal cancer patients. The additional value of a second PET-CT after completion of neoadjuvant therapy (NT) prior to surgery is presently unclear. Therefore, a consecutive series of esophageal cancer patients underwent PET-CT scanning after completion of NT for evaluation of metastatic disease that became manifest under NT.
  
  
  METHODS
  A consecutive series of patients planned for curative esophagectomy who underwent a PET-CT prior to and after NT were included in this study. Neoadjuvant therapy consisted of 5FU and cisplatinum combined with 50.4Gy radiotherapy. The first PET-CT was performed as part of the diagnostic work-up, the second PET-CT was performed after completion of NT and prior to surgery. Median interval between NT and second PETCT was 6 weeks. In case of metastatic disease on the post-neoadjuvant therapy PET-CT confirmed by a biopsy, patients were excluded from surgical resection.
  
  
  RESULTS
  Between November 2008 and July 2010 a total of 50 patients underwent first and second PET-CT scanning. 80% of patients was diagnosed with adenocarcinoma, 18% with squamous cell carcinoma. Confirmed metastatic disease on the second PET-CT was present in 4/50 patients (8%). These patients were excluded from resection. A false-positive diagnosis concerning a pulmonary lesion was present in 1 patient (2%); this infiltrate had disappeared on follow up imaging.
  
  
  CONCLUSIONS
  This study showed development of metastatic disease during NT detected by PET-CT in 8% of esophageal cancer patients, suggesting an additional value of a second PET-CT in order to prevent unnecessary surgical resections.
authors: Department of Surgery, Atrium Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.
authors: R L G M
authors: RL
authors: Blom
authors: W M J
authors: WM
authors: Schreurs
authors: H J
authors: HJ
authors: Belgers
authors: L E
authors: LE
authors: Oostenbrug
authors: R F A
authors: RF
authors: Vliegen
authors: M N
authors: MN
authors: Sosef
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000473:pathology; D002945:Cisplatin / Q000627:therapeutic use; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D020266:Radiotherapy, Conformal; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002945:Cisplatin