title: Impact of Endoscopic Ultrasonography on18F-FDG-PET/CT Upfront Towards Patient Specific Esophageal Cancer Treatment.
abstract: BACKGROUND
  In patients with potentially resectable esophageal cancer (EC), the value of endoscopic ultrasonography (EUS) after fluorine-18 labeled fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) is questionable. Retrospectively, we assessed the impact of EUS after PET/CT on the given treatment in EC patients.
  
  
  METHODS
  During the period 2009-2015, 318 EC patients were staged as T1-4aN0-3M0 with hybrid18F-FDG-PET/CT or18F-FDG-PET with CT and EUS if applicable in a nonspecific order. We determined the impact of EUS on the given treatment in 279 patients who also were staged with EUS. EUS had clinical consequences if it changed curability, extent of radiation fields or lymph node resection (AJCC stations 2-5), and when the performed fine-needle aspiration (FNA) provided conclusive information of suspicious lymph node.
  
  
  RESULTS
  EUS had an impact in 80 (28.7%) patients; it changed the radiation field in 63 (22.6%), curability in 5 (1.8%), lymphadenectomy in 48 (17.2%), and FNA was additional in 21 (7.5%). In patients treated with nCRT (n = 194), EUS influenced treatment in 53 (27.3%) patients; in 38 (19.6%) the radiation field changed, in 3 (1.5%) the curability, in 35 (18.0%) the lymphadenectomy, and in 17 (8.8%) FNA was additional. EUS influenced both the extent of radiation field and nodal resection in 31 (16.0%) nCRT patients.
  
  
  CONCLUSIONS
  EUS had an impact on the given treatment in approximately 29%. In most patients, the magnitude of EUS found expression in the extent of radiotherapy target volume delineation to upper/high mediastinal lymph nodes.
authors.affiliation: Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: J B
authors.initials: JB
authors.lastname: Hulshoff
authors.affiliation: Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: V E M
authors.initials: VEM
authors.lastname: Mul
authors.affiliation: Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: H E M
authors.initials: HEM
authors.lastname: de Boer
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Noordzij
authors.affiliation: Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Korteweg
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: van Dullemen
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: W B
authors.initials: WB
authors.lastname: Nagengast
authors.affiliation: Radiotherapeutic Institution Friesland, Leeuwarden, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Oppedijk
authors.affiliation: Postgraduate School of Medicine, Groningen, The Netherlands.|Surgery Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: J P E N
authors.initials: JPEN
authors.lastname: Pierie
authors.affiliation: Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. j.t.m.plukker@umcg.nl.
authors.forename: John Th M
authors.initials: JTM
authors.lastname: Plukker
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D044963:Biopsy, Fine-Needle; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D019160:Endosonography / Q000379:methods*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D019788:Fluorodeoxyglucose F18