Positron emission tomography/computed tomography and esophageal cancer in the clinical practice: How does it affect the prognosis?
OBJECTIVE
The aim of this study was to assess the diagnostic value of positron emission tomography/computed tomography (PET/CT) in staging of esophageal cancer and to evaluate the prognostic role of metabolic parameters before and after neo-adjuvant treatment.


METHODS
Mono-institutional retrospective study.


METHODS
We retrospectively evaluated 29 patients who underwent PET/CT at initial staging and after neo-adjuvant therapy. Metabolic parameters were calculated: mean, average, maximum standardized uptake value (SUVmax), and total lesion glycolysis (TLG). Diagnostic advantages of PET/CT over conventional imaging (CI) were determined. The relationships between baseline and after-therapy SUVmax and TLG, change in SUV and TLG (reported as ∆) for the primary tumor and prognosis were assessed.


METHODS
Non-parametric statistic (e.g. Wilcoxon test and chi-square test).


RESULTS
Twenty-nine patients were eligible for the initial staging. Thirteen patients were incorrectly staged based on CI; PET/CT was able to identify distant lymph nodes in seven patients (59%) and distant metastases in four (31%). The median SUVmax before and after neoadjuvant therapy was 10.38 and 3.53 (P = 0.0005), respectively. Only few semi-quantitative parameters obtained by PET/CT after neoadjuvant therapy seemed to have a prognostic value. TLG and ∆TLG were significantly different between disease-free and died patients (0.49 versus 15.51 and 100% versus 94%, respectively; all P = <0.05).


CONCLUSIONS
PET/CT is confirmed as being able to detect distant metastases and to avoid unnecessary surgery. Although not routinely reported, post-neoadjuvant TLG and ∆TLG might be considered as useful prognostic parameters and should be further evaluated prospectively.
Radiotherapy and Nuclear Medicine Unit, Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy. cervino@ioveneto.it
Anna R
AR
Cervino
Laura
L
Evangelista
Rita
R
Alfieri
Carlo
C
Castoro
Vanna Chiarion
VC
Sileni
Fabio
F
Pomerri
Luigi
L
Corti
Pier C
PC
Muzzio
D000328:Adult; D000368:Aged; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed