title: Has integrated 18F FDG PET/CT improved staging, reduced early recurrence or increased survival in oesophageal cancer?
abstract: BACKGROUND
  Survival in oesophageal cancer remains poor with high post-operative recurrence rates. PET/CT was introduced to the Three-Counties Cancer Network (3CCN) in 2006 to detect 'occult' metastatic disease not seen with conventional staging modalities. This study aims to determine whether the introduction of Integrated fluorodeoxyglucose (18F) Positron Emission Tomography (PET/CT) has changed the management, improved survival or reduced the rate of early post-operative recurrence in patients with operable oesophageal cancer.
  
  
  METHODS
  A retrospective review was undertaken of all patients diagnosed with oesophageal cancer in the 3CCN from 2005 to 2009. Early recurrence was defined as proven recurrence locally or at a distant site within one year of resection.
  
  
  RESULTS
  725 patients were identified. 200 (27.6%) patients underwent staging PET/CT. PET/CT altered treatment intent in 19 (9.5%) patients. 128 (17.7%) patients underwent oesophageal resection, 90 (70.3%) of which had a staging PET/CT. No significant difference was noted in post-operative mortality (4.4% Vs 5.3%, p = 0.8) or early recurrence where PET/CT was performed when adjusted for age, sex, stage or neo-adjuvant chemotherapy (p = 0.761, OR 1.136[95% CI 0.499-2.585]). PET/CT had no significant effect on survival (log-rank test; Chi-square 0.710, p = 0.4).
  
  
  CONCLUSIONS
  PET/CT has improved the accuracy of oesophageal cancer staging avoiding potentially unnecessary surgery. Ultimately however, its use has had no effect on early recurrence or survival rates. Inaccurate identification of occult metastatic disease prior to the introduction of staging PET/CT does not appear to be the primary cause of early recurrence in patients with oesophageal cancer.
authors.affiliation: Department of Upper GI Surgery, Worcestershire Royal Hospital, Worcester, United Kingdom. Electronic address: adwtorrance@doctors.org.uk.
authors.forename: Andrew D W
authors.initials: AD
authors.lastname: Torrance
authors.affiliation: Three Counties Upper GI Unit, Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucester, United Kingdom.
authors.forename: L Max
authors.initials: LM
authors.lastname: Almond
authors.affiliation: Three Counties Upper GI Unit, Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucester, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Fry
authors.affiliation: Department of Upper GI Surgery, Worcestershire Royal Hospital, Worcester, United Kingdom; Three Counties Upper GI Unit, Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucester, United Kingdom.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Wadley
authors.affiliation: Three Counties Upper GI Unit, Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucester, United Kingdom; Department of Radiology, Cheltenham Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom.
authors.forename: Iain D
authors.initials: ID
authors.lastname: Lyburn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000494:pharmacology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000494:pharmacology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed / Q000379:methods*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Oesophageal cancer; Positron-emission tomography; Recurrence; Staging; Survival