Initial staging of esophageal cancer is of particular importance as it determines whether to opt for a curative treatment or palliative treatment for the patient. New findings have revealed that physicians employing positron emission tomography (PET)/computed tomography (CT) imaging can distinguish incremental staging data about the cancer, which can significantly impact management plans.

The study’s findings were published in the June 2012 issue of the Journal of Nuclear Medicine. “The superior accuracy of PET/CT compared to conventional staging investigations such as CT allows clinicians to more appropriately choose and more appropriately plan patient therapy. Our data also show that when PET/CT changes management, it does so correctly in almost all cases,” said Dr. Thomas Barber, from Center for Cancer Imaging, Peter MacCallum Cancer Center (East Melbourne, Victoria, Australia), and lead author of the study.

The study followed 139 patients with newly diagnosed esophageal cancer between July 2002 and June 2005. Each of the patients underwent conventional staging investigations of CT and/or endoscopic ultrasound, followed by PET/CT. When staging data from the conventional staging investigations differed from the PET/CT information, results were confirmed by pathologic/intraoperative findings or serial imaging and clinical follow-up. The impact on patient management plans was assessed by comparing pre-PET/CT plans with post-PET/CT plans. Survival rates of patients were also recorded after five years.

Results of the study demonstrated that information collected from imaging with PET/CT altered the stage group for 59 of the patients (40%) and the management plan for 47 of the patients (34%). Of the 47 patients who had a change in their management plan, imaging results were validated in 31 patients, and PET/CT correctly changed management in 26 (84%) of these. The five-year survival rate for patients with stage IIB-III disease was 38%, which is considerably higher than results previously reported (9%-34% in stage IIB and 6%-16% in stage III).

“These results demonstrate the power of metabolic imaging with FDG PET/CT when staging esophageal cancer,” Dr. Barber noted. “Our results demonstrate that this technique should be incorporated into routine clinical practice.”

Related Links:
Center for Cancer Imaging, Peter MacCallum Cancer Center