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Published in: Abdominal Radiology 2/2008

01-03-2008

Role of PET/PET CT in the staging and restaging of thoracic oesophageal cancer and gastro-oesophageal cancer: a literature review

Authors: Wai Lup Wong, R. Jane Chambers

Published in: Abdominal Radiology | Issue 2/2008

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Abstract

Background

Current evidence for the use of FDG PET/PET-CT in staging thoracic oesophageal and GOJ cancer is reviewed.

Methods

PubMed, Medline, Embase (1988–November 2006) and the Cochrane database identifed studies in which FDG PET and PET CT were used for the assessment of thoracic and GOJ cancer.

Results

Conventional assessment remains the mainstay for evaluating the primary site. EUS is used for assessing the primary site, but when EUS is incomplete or not tolerated FDG PET CT is invaluable. The major of advantage of FDG PET CT lies in the ability to detect metastatic disease beyond the celiac axis. There is growing evidence to show that FDG PET CT is useful for assessment of treatment response. FDG PET CT will also detect other occult primary cancers.

Conclusions

The contribution of FDG PET CT to the investigation of patients with primary thoracic oesophageal and GOJ cancer has resulted in improved staging, so providing the ability to optimise treatment.
Literature
2.
go back to reference Muller JM, Erasmi H, Stelzner M, Zieran U, Pichlman H (1990) Surgical therapy of oesophageal cancer Br J Surg 77:845–857PubMedCrossRef Muller JM, Erasmi H, Stelzner M, Zieran U, Pichlman H (1990) Surgical therapy of oesophageal cancer Br J Surg 77:845–857PubMedCrossRef
3.
go back to reference Geh JI, Crellin AM, Glynn Jones R (2001) Pre-operative (neo-adjuvant) chemotherapy in oesophageal cancer Br J Surg 88:338–356PubMedCrossRef Geh JI, Crellin AM, Glynn Jones R (2001) Pre-operative (neo-adjuvant) chemotherapy in oesophageal cancer Br J Surg 88:338–356PubMedCrossRef
4.
go back to reference Blazeby JM, Sanford E, Falk SJ, Alderson D, Donovan JL (2005) Health related quality of life during neoadjuvant treatment and surgery for localised oesophageal carcinoma Cancer 103:1791–1799PubMedCrossRef Blazeby JM, Sanford E, Falk SJ, Alderson D, Donovan JL (2005) Health related quality of life during neoadjuvant treatment and surgery for localised oesophageal carcinoma Cancer 103:1791–1799PubMedCrossRef
5.
go back to reference Rice TW (2000) Clinical staging of oesophageal cancer CT EUS and PET, Chest Surgery Clin N Am 10:471–485 Rice TW (2000) Clinical staging of oesophageal cancer CT EUS and PET, Chest Surgery Clin N Am 10:471–485
6.
go back to reference Czernin J, Phelps ME (2002) Positron emission tomography scanning: current and future applications Ann Rev Med 53:89–112PubMedCrossRef Czernin J, Phelps ME (2002) Positron emission tomography scanning: current and future applications Ann Rev Med 53:89–112PubMedCrossRef
7.
go back to reference A framework for the development of PET services in England. Department of Health document October 2005 gateway number 5265 A framework for the development of PET services in England. Department of Health document October 2005 gateway number 5265
8.
go back to reference Block MI, et al. (1997) Improvement in staging of esophageal cancer with the addition of Positron Emission Tomography, Ann Thorac Surg 64:770–777PubMedCrossRef Block MI, et al. (1997) Improvement in staging of esophageal cancer with the addition of Positron Emission Tomography, Ann Thorac Surg 64:770–777PubMedCrossRef
9.
go back to reference Flamen P, et al. (2000) Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma J Clin Oncol 18:3202–3210PubMed Flamen P, et al. (2000) Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma J Clin Oncol 18:3202–3210PubMed
10.
go back to reference Kato, et al. (2002) Comparison between positron emission tomography and computed tomography in the use of the assessment of esophageal carcinoma Cancer 4:921–928 Kato, et al. (2002) Comparison between positron emission tomography and computed tomography in the use of the assessment of esophageal carcinoma Cancer 4:921–928
11.
go back to reference Kim , et al. (2001) Evaluation of lymph node metastases in squamous cell carcinoma of the esophagus with positron emission tomography Ann Thorac Surg 71:290–294 Kim , et al. (2001) Evaluation of lymph node metastases in squamous cell carcinoma of the esophagus with positron emission tomography Ann Thorac Surg 71:290–294
12.
go back to reference Kole AC, et al. (1988) Positron emission tomography for staging of oesophageal and gastroesophageal malignancy Br J Cancer 78: 521–527 Kole AC, et al. (1988) Positron emission tomography for staging of oesophageal and gastroesophageal malignancy Br J Cancer 78: 521–527
13.
go back to reference Rankin SC, et al. (1988) Computed tomography and positron emission tomography in the pre-operative staging of oesophageal carcinoma Clin Radiol 53: 659–665CrossRef Rankin SC, et al. (1988) Computed tomography and positron emission tomography in the pre-operative staging of oesophageal carcinoma Clin Radiol 53: 659–665CrossRef
14.
go back to reference McTeer D, et al. (1999) Evaluation of 18 F-FDG positron emission tomography gastric and oesophageal carcinoma BJR 72:525–529 McTeer D, et al. (1999) Evaluation of 18 F-FDG positron emission tomography gastric and oesophageal carcinoma BJR 72:525–529
15.
go back to reference Neto C, Zhuang H, Ghesani N, Alavi A (2001) Detection of Barretts oeophagus superimposed by oesophageal cancer by FDG positron emission tomography Clin Nucl Med 26:1060PubMedCrossRef Neto C, Zhuang H, Ghesani N, Alavi A (2001) Detection of Barretts oeophagus superimposed by oesophageal cancer by FDG positron emission tomography Clin Nucl Med 26:1060PubMedCrossRef
16.
go back to reference Bakheet S, Amin T, Alia A-G, Kuzo R, Powe J (1999) f-18 FDG uptake in benign oesophageal cancer Clin Nucl Med 24:995PubMedCrossRef Bakheet S, Amin T, Alia A-G, Kuzo R, Powe J (1999) f-18 FDG uptake in benign oesophageal cancer Clin Nucl Med 24:995PubMedCrossRef
17.
go back to reference Flanagan FL, et al. (1997) Staging of esophageal cancer with 18 F-fluorodeoxyglucose positron emission tomography AJR 168:417–424PubMed Flanagan FL, et al. (1997) Staging of esophageal cancer with 18 F-fluorodeoxyglucose positron emission tomography AJR 168:417–424PubMed
18.
go back to reference Heeren , et al. (2004) Detection of distant metastases in esophageal cancer with 18 F-FDG PET JNM 45:980–987 Heeren , et al. (2004) Detection of distant metastases in esophageal cancer with 18 F-FDG PET JNM 45:980–987
19.
go back to reference Lerut T, et al. (2000) Histopathologic validation of lymph node staging with FDG-PET scan in cancer of the esophagus and gastroesophageal junction: a prospective study based on primary surgery with extensive lymphadenectomy Ann Surg 232:743–752PubMedCrossRef Lerut T, et al. (2000) Histopathologic validation of lymph node staging with FDG-PET scan in cancer of the esophagus and gastroesophageal junction: a prospective study based on primary surgery with extensive lymphadenectomy Ann Surg 232:743–752PubMedCrossRef
20.
go back to reference Meltzer CC, et al. (2000) Whole-body FDG positron emission tomographic imaging for staging esophageal cancer: comparison with computed tomography Clin Nucl Med 25:882–887PubMedCrossRef Meltzer CC, et al. (2000) Whole-body FDG positron emission tomographic imaging for staging esophageal cancer: comparison with computed tomography Clin Nucl Med 25:882–887PubMedCrossRef
21.
go back to reference Lowe VJ, Booya F, Fletcher JG, et al. (2006) Comparision of PET, CT and EUS in the initial staging of patients with oesophageal cancer Mol Imaging Biol 7:422–430CrossRef Lowe VJ, Booya F, Fletcher JG, et al. (2006) Comparision of PET, CT and EUS in the initial staging of patients with oesophageal cancer Mol Imaging Biol 7:422–430CrossRef
22.
go back to reference Luketich JD, et al. (1999) Evaluation of distant metastases in esophageal cancer: 100 consecutive positron emission tomography scans Ann Thorac Surg 68:1133–1137PubMedCrossRef Luketich JD, et al. (1999) Evaluation of distant metastases in esophageal cancer: 100 consecutive positron emission tomography scans Ann Thorac Surg 68:1133–1137PubMedCrossRef
23.
go back to reference Duong CP, et al. (2006) Significant clinical impact and prognostic stratification provided by FDG PET in the staging of oesophageal cancer Eur J Nucl Med Mol Imaging 33:759–769PubMedCrossRef Duong CP, et al. (2006) Significant clinical impact and prognostic stratification provided by FDG PET in the staging of oesophageal cancer Eur J Nucl Med Mol Imaging 33:759–769PubMedCrossRef
24.
go back to reference Blackstock AW, et al. (2006) A prospective evaluation of the impact of FDG PET staging on survival for patients with locally advanced oesophageal cancer Int J Radiat Oncol Biol Phys 64:455–460PubMed Blackstock AW, et al. (2006) A prospective evaluation of the impact of FDG PET staging on survival for patients with locally advanced oesophageal cancer Int J Radiat Oncol Biol Phys 64:455–460PubMed
25.
go back to reference Hong D, et al. (2005) Value of baseline PET for predicting overall survival in patient with non-metastatic oesophageal or gastro-oesophageal junction cancer Cancer 104:1602–1606 Hong D, et al. (2005) Value of baseline PET for predicting overall survival in patient with non-metastatic oesophageal or gastro-oesophageal junction cancer Cancer 104:1602–1606
26.
go back to reference Fukunaga T, et al. (1988) Evaluation of esophageal cancers using fluorine-18-fluorodeoxyglucose PET J Nucl Med 39:1002–1007 Fukunaga T, et al. (1988) Evaluation of esophageal cancers using fluorine-18-fluorodeoxyglucose PET J Nucl Med 39:1002–1007
27.
go back to reference Cerfolio RJ, Bryant AS (2006) Maximum standardized uptake values on positron emission tomography of oesophageal cancer predicts stage, tumour biology and survival Ann Thorac Surg 82:391–395PubMedCrossRef Cerfolio RJ, Bryant AS (2006) Maximum standardized uptake values on positron emission tomography of oesophageal cancer predicts stage, tumour biology and survival Ann Thorac Surg 82:391–395PubMedCrossRef
28.
go back to reference Rizk N, et al. (2006) Preoperative FDG PET SUV predict survival after oesophageal adenocarcinoma resection Ann Thorac Surg 81:1076–1082PubMedCrossRef Rizk N, et al. (2006) Preoperative FDG PET SUV predict survival after oesophageal adenocarcinoma resection Ann Thorac Surg 81:1076–1082PubMedCrossRef
29.
go back to reference Westreenen M, et al. (2005) Esophageal cancer: CT, endoscopic US and FDG PET for assessment of response to neoadjuvant therapy- systematic review Radiology 236:841–851PubMedCrossRef Westreenen M, et al. (2005) Esophageal cancer: CT, endoscopic US and FDG PET for assessment of response to neoadjuvant therapy- systematic review Radiology 236:841–851PubMedCrossRef
30.
go back to reference Downey RJ, et al. (2003) Whole body 18-FDG PET and the response of oesophageal cancer to induction therapy: results of a prospective study J Clin Oncol 21:428–432PubMedCrossRef Downey RJ, et al. (2003) Whole body 18-FDG PET and the response of oesophageal cancer to induction therapy: results of a prospective study J Clin Oncol 21:428–432PubMedCrossRef
31.
go back to reference Flamen P, et al. (2002) PET for assessment of the response to induction radiochemotherapy in locally advanced oesophageal cancer Ann Oncol 13:361–368 Flamen P, et al. (2002) PET for assessment of the response to induction radiochemotherapy in locally advanced oesophageal cancer Ann Oncol 13:361–368
32.
go back to reference Weber et al. (2001) Prediction of response to pre-operative chemotherapy in adenocarcinomas of the esophageal junction by metabolic imaging J Clin Oncol 19:3058–3065 Weber et al. (2001) Prediction of response to pre-operative chemotherapy in adenocarcinomas of the esophageal junction by metabolic imaging J Clin Oncol 19:3058–3065
33.
go back to reference Brucher BJDM, et al. (2001) Neoadjuvant therapy of oesophageal squamous cell carcinoma: response evaluation by PET Ann Surg 233:300–309PubMedCrossRef Brucher BJDM, et al. (2001) Neoadjuvant therapy of oesophageal squamous cell carcinoma: response evaluation by PET Ann Surg 233:300–309PubMedCrossRef
34.
go back to reference Couper GW, et al. (1998) Detection of response to chemotherapy using PET in patients with oesophageal and gastric cancer Br J Surg 85:1403–1406PubMedCrossRef Couper GW, et al. (1998) Detection of response to chemotherapy using PET in patients with oesophageal and gastric cancer Br J Surg 85:1403–1406PubMedCrossRef
35.
go back to reference Cefolio RJ, Bryant AS, Ohja B, Bartolucci AA, Eloubeidi MA (2005) The accuracy of EUS with FNA, integrated PET CT and CT in restaging patients with oesophageal cancer after neo-adjuvant chemotherapy J Thorac Cadiovas Surg 129:1232–1241CrossRef Cefolio RJ, Bryant AS, Ohja B, Bartolucci AA, Eloubeidi MA (2005) The accuracy of EUS with FNA, integrated PET CT and CT in restaging patients with oesophageal cancer after neo-adjuvant chemotherapy J Thorac Cadiovas Surg 129:1232–1241CrossRef
36.
go back to reference Melcher L, Wong WL, Sanghera B, et al. (2004) Sequential FDG-PET scanning in the assessment of response to neoadjuvant chemotherapy in operable esophageal cancer. J Clin Oncol 22,14S:4056 Melcher L, Wong WL, Sanghera B, et al. (2004) Sequential FDG-PET scanning in the assessment of response to neoadjuvant chemotherapy in operable esophageal cancer. J Clin Oncol 22,14S:4056
37.
go back to reference Melcher L, Sanghera B, Wong WL, et al (2006) The relationship between FDG PET values histological response and survival in patients undergoing neoadjuvant chemotherapy for potentially operable oesophageal cancer. J Clin Oncol 24:18S Melcher L, Sanghera B, Wong WL, et al (2006) The relationship between FDG PET values histological response and survival in patients undergoing neoadjuvant chemotherapy for potentially operable oesophageal cancer. J Clin Oncol 24:18S
38.
go back to reference Korst RJ, Kansler AL, Port JL, Lee PC, Kerem Y, Altorki NK (2006) Downstaging of T or N predicts long term survival after pre-operative chemotherapy and radical resection for oesophageal cancer Ann Thorac Surg 82:480–485PubMedCrossRef Korst RJ, Kansler AL, Port JL, Lee PC, Kerem Y, Altorki NK (2006) Downstaging of T or N predicts long term survival after pre-operative chemotherapy and radical resection for oesophageal cancer Ann Thorac Surg 82:480–485PubMedCrossRef
39.
go back to reference Duong CP, et al. (2006) FDG PET status following chemoradiation provides high management impact and powerful prognostic stratification in oesophageal cancer Eur J Nucl Med Mol Imaging 33:770–778PubMedCrossRef Duong CP, et al. (2006) FDG PET status following chemoradiation provides high management impact and powerful prognostic stratification in oesophageal cancer Eur J Nucl Med Mol Imaging 33:770–778PubMedCrossRef
40.
go back to reference Levine EA, et al. (2006) Predictive value of FDG PET in the identification of responders to chemoradiation therapy for the treatment of locally advanced oesophageal cancer Ann Surg 243:472–478PubMedCrossRef Levine EA, et al. (2006) Predictive value of FDG PET in the identification of responders to chemoradiation therapy for the treatment of locally advanced oesophageal cancer Ann Surg 243:472–478PubMedCrossRef
41.
go back to reference Westerterp M, van Westreenen HL, Sloof GW, Plukker J, Th M, van Lanschot JJB (2006) Role of PET in the (re-) staging of oesophageal cancer Scaninavian J Gastroent 41(suppl 243):116–122 Westerterp M, van Westreenen HL, Sloof GW, Plukker J, Th M, van Lanschot JJB (2006) Role of PET in the (re-) staging of oesophageal cancer Scaninavian J Gastroent 41(suppl 243):116–122
42.
go back to reference van Westreenen et al. (2005) Synchronous primary neoplasms detected on FDG in staging of patients with oesophageal cancers J Nucl Med 46:1321–1325 van Westreenen et al. (2005) Synchronous primary neoplasms detected on FDG in staging of patients with oesophageal cancers J Nucl Med 46:1321–1325
43.
go back to reference Assessment(2000) In: Watkinson Gaze MN, Wilson JA, (eds). Stell & Maran’s Head and neck surgery, 4th edn. Butterworth Heinemann publication, Oxford, chap 2, pp 11–28 Assessment(2000) In: Watkinson Gaze MN, Wilson JA, (eds). Stell & Maran’s Head and neck surgery, 4th edn. Butterworth Heinemann publication, Oxford, chap 2, pp 11–28
44.
go back to reference Wong WL, et al. (1996) Validation and clinical application of computer combined CT and PET with FDG head and neck images Am J Surg 172:628–632PubMedCrossRef Wong WL, et al. (1996) Validation and clinical application of computer combined CT and PET with FDG head and neck images Am J Surg 172:628–632PubMedCrossRef
45.
go back to reference Lardinosis D, et al. (2003) Integrated PET CT imaging improves staging of NSCLC n Eng J Med Lardinosis D, et al. (2003) Integrated PET CT imaging improves staging of NSCLC n Eng J Med
46.
go back to reference Shim SS, et al. (2005) Non-small cell lung cancer prospective comparision of intergrated FDG PET CT and CT alone for pre-operative staging Radiology 1011:1019 Shim SS, et al. (2005) Non-small cell lung cancer prospective comparision of intergrated FDG PET CT and CT alone for pre-operative staging Radiology 1011:1019
47.
go back to reference Bar-Shalom R, et al. (2005) The additional valyue of PET/ CT over PET and FDG imaging of oesophageal cancer Eur J Nucl Med Mol Imaging 32:918–924PubMedCrossRef Bar-Shalom R, et al. (2005) The additional valyue of PET/ CT over PET and FDG imaging of oesophageal cancer Eur J Nucl Med Mol Imaging 32:918–924PubMedCrossRef
48.
go back to reference Rampin L, Rubello D, Nanni C, Fanti S (2005) Value of PET CT fusion imaging in avoiding potential pitfalls in the interpretation of 18-F-FDG accumulation in the distal oesophagus Eur J Nucl Med Mol Imaging 32:990–992PubMedCrossRef Rampin L, Rubello D, Nanni C, Fanti S (2005) Value of PET CT fusion imaging in avoiding potential pitfalls in the interpretation of 18-F-FDG accumulation in the distal oesophagus Eur J Nucl Med Mol Imaging 32:990–992PubMedCrossRef
49.
go back to reference O’Doherty MJ, Barrington S (2003) PET imaging in HIV infection. In: Valk P, Bailey DL, Townsend DW, Maisey MN, (eds). PET Basic science and clinical practice. Springer, London, chap 43, pp 741–752 O’Doherty MJ, Barrington S (2003) PET imaging in HIV infection. In: Valk P, Bailey DL, Townsend DW, Maisey MN, (eds). PET Basic science and clinical practice. Springer, London, chap 43, pp 741–752
50.
go back to reference Wohrer S, et al. (2006) FDG PET visualizes follicular lymphoma irrespective of grading Ann Oncol 17:780–784PubMedCrossRef Wohrer S, et al. (2006) FDG PET visualizes follicular lymphoma irrespective of grading Ann Oncol 17:780–784PubMedCrossRef
51.
go back to reference Hany TF (2003) PET and PET/CT of the liver and pancreas In: Von Schulthess GK, (ed). Clinical molecular imaging. Williams & Wilkins, Philadelphia, chap 46, pp 334–340 Hany TF (2003) PET and PET/CT of the liver and pancreas In: Von Schulthess GK, (ed). Clinical molecular imaging. Williams & Wilkins, Philadelphia, chap 46, pp 334–340
52.
go back to reference Strauss LG (1996) FDG and false positive results: a major problem in the diagnosis of oncology patients Eur J Nucl Med 23:1309–1414CrossRef Strauss LG (1996) FDG and false positive results: a major problem in the diagnosis of oncology patients Eur J Nucl Med 23:1309–1414CrossRef
53.
go back to reference Cook GJR (2003) Artifacts and normal variants in whole body PET imaging. In Valk P, Bailey DL, Townsend DW, Maisey MN, (eds). PET Basic science and clinical practice. Springer, London, chap 24, pp 495–505 Cook GJR (2003) Artifacts and normal variants in whole body PET imaging. In Valk P, Bailey DL, Townsend DW, Maisey MN, (eds). PET Basic science and clinical practice. Springer, London, chap 24, pp 495–505
54.
go back to reference Wong WL, Saunders M (2002) Role of FDG PET in the assessment of indeterminate pulmonary lesions Clin Oncol 14:123–128CrossRef Wong WL, Saunders M (2002) Role of FDG PET in the assessment of indeterminate pulmonary lesions Clin Oncol 14:123–128CrossRef
55.
go back to reference Van Westreenen HL, et al. (2003) Pitfalls of positive findings in staging oesophageal cancer with FDG PET Ann Surg Oncol 10:1100–1105PubMedCrossRef Van Westreenen HL, et al. (2003) Pitfalls of positive findings in staging oesophageal cancer with FDG PET Ann Surg Oncol 10:1100–1105PubMedCrossRef
56.
go back to reference Kobori et al. (1999) Positron emission tomography of esophageal carcinoma using 11C-choline and 18 F-fluorodoexyglucose Cancer 86:638–1648 Kobori et al. (1999) Positron emission tomography of esophageal carcinoma using 11C-choline and 18 F-fluorodoexyglucose Cancer 86:638–1648
57.
go back to reference Jager PL, et al. (2001) Carbon-11 choline or FDG-PET for staging of oesophageal cancer? Eur J Nucl Med 28:1845–1849PubMedCrossRef Jager PL, et al. (2001) Carbon-11 choline or FDG-PET for staging of oesophageal cancer? Eur J Nucl Med 28:1845–1849PubMedCrossRef
58.
go back to reference Stein HJ, Brucher BLDM, Sendler A, Siewert JR (2001) Oesopahageal cancer: patient evaluation and pre-treatment staging Surg Oncol 10:103–111PubMedCrossRef Stein HJ, Brucher BLDM, Sendler A, Siewert JR (2001) Oesopahageal cancer: patient evaluation and pre-treatment staging Surg Oncol 10:103–111PubMedCrossRef
59.
go back to reference Forshaw MJ, Gossage JA, Mason RC (2005) Neoadjuvant chemotherapy for oesophageal cancer: the need for accurate response prediction and evaluation Surgeon 3:6373–6382CrossRef Forshaw MJ, Gossage JA, Mason RC (2005) Neoadjuvant chemotherapy for oesophageal cancer: the need for accurate response prediction and evaluation Surgeon 3:6373–6382CrossRef
60.
go back to reference Minsky BD, (2006) Primary combined modality therapy for oesophageal cancer Oncol 20:497–505 Minsky BD, (2006) Primary combined modality therapy for oesophageal cancer Oncol 20:497–505
61.
go back to reference Vesselle et al. (2001) FLT PET imaging of non-small cell lung cancer: comparison to Ki67 proliferation index J Nucl Med 42:21 Vesselle et al. (2001) FLT PET imaging of non-small cell lung cancer: comparison to Ki67 proliferation index J Nucl Med 42:21
Metadata
Title
Role of PET/PET CT in the staging and restaging of thoracic oesophageal cancer and gastro-oesophageal cancer: a literature review
Authors
Wai Lup Wong
R. Jane Chambers
Publication date
01-03-2008
Publisher
Springer-Verlag
Published in
Abdominal Radiology / Issue 2/2008
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-007-9241-1

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