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Bohle W, Nowack L, Schaudt A, Koeninger J, Zoller WG, Albert JG. Endoscopic ultrasound for structured surveillance after curative treatment of esophageal cancer. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024. [PMID: 38198802 DOI: 10.1055/a-2125-6923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Structured surveillance after treatment of esophageal cancer is not established. Due to a paucity of data, no agreement exists on how surveillance should be performed. The main argument against intensive follow-up in esophageal cancer is that it may not lead to true survival advantage. METHODS Structured surveillance was performed in 42 patients after multimodal therapy with peri-operative chemotherapy (29) or definitive chemoradiotherapy (13) of esophageal cancer. The surveillance protocol included gastroscopy, endoscopic ultrasound, chest X-ray, abdominal ultrasound, and CEA measurement at regular intervals of up to five years. We analyzed relapse rate, time to relapse, localization of recurrence, diagnosis within or without structured surveillance, diagnostic method providing the first evidence of a relapse, treatment of recurrence, and outcome. RESULTS Median follow-up was 48 months; 18/42 patients suffered from tumor relapse, with 16 asymptomatic patients diagnosed within structured surveillance. Median time to recurrence was 9 months. Isolated local or locoregional recurrence occurred in 6, and isolated distant relapse in 9 patients. All patients with isolated locoregional recurrence were exclusively diagnosed with endoscopic ultrasound. Six patients received curatively intended therapy with surgery or chemoradiation, leading to long-lasting survival. CONCLUSION Structured surveillance offers the chance to identify limited and asymptomatic tumor relapse. Especially in cases of locoregional recurrence, long-lasting survival or even a cure can be achieved. Endoscopic ultrasound is the best method for the detection of locoregional tumor recurrence and should be an integral part of structured surveillance after curative treatment of esophageal cancer.
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Affiliation(s)
- Wolfram Bohle
- Department of Gastroenterology, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Lioba Nowack
- Deparment of Gastroenterology, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Andre Schaudt
- Department of Surgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Joerg Koeninger
- Department of Surgery, Klinikum Stuttgart Katharinenhospital, Stuttgart, Germany
| | - Wolfram G Zoller
- Department of Gastroenterology, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Jörg G Albert
- Department of Gastroenterology, Klinikum Stuttgart Katharinenhospital, Stuttgart, Germany
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2
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Xu ZC, Su BA, Li JC, Cheng WF, Chen J. Pattern of relapse following three-field lymphadenectomy of esophageal carcinoma and related factors predictive of recurrence. Cancer Radiother 2023; 27:189-195. [PMID: 36754752 DOI: 10.1016/j.canrad.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE For treatment of esophageal carcinoma, the optimal postoperative radiotherapy target volume after three-field lymph node dissection (3-FLD) had not been determined. We analyzed local recurrence pattern of thoracic esophageal carcinoma and risk factors of lymph node recurrence after 3-FLD without prophylactic radiotherapy. MATERIAL AND METHODS We reviewed 1282 patients with thoracic esophageal squamous cell carcinoma (ESCC) who were treated with 3-FLD without radiotherapy from 2010 to 2018 and analysed local recurrence patterns and risk factors of lymph node recurrence, in order to provide a reference for determination of the radiotherapy target volume for thoracic ESCC. RESULTS The lymph node recurrence accounted for 91.0% of treatment failures. The mediastinal, cervical and abdominal lymph node recurrence accounted for 84.92%, 36.07% and 22.30%, respectively (χ2=264.776, P=0.000). The superior, middle and inferior mediastinal lymph node recurrence rates were 67.54%, 27.87% and 0.98%, respectively (χ2=313.600, P=0.000). Cervical metastases were significantly associated with N stage and Preoperative cervical lymph node status. Abdominal metastases were significantly associated with the number of preoperative abdominal lymph node metastases (LNM), tumor location and N stage. CONCLUSIONS The main pattern of local-regional recurrence might be lymph node metastasis after radical 3-FLD without radiotherapy in esophageal carcinoma. The dangerous lymph node recurrence regions included neck, superior and middle mediastinum. The abdominal areas might be irradiated for lower TEC patients with preoperative abdominal LNM.
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Affiliation(s)
- Z-C Xu
- First Hospital of Quanzhou Affiliated to Fujian Medical University, 362000 Quanzhou, People's Republic of China
| | - B-A Su
- First Hospital of Quanzhou Affiliated to Fujian Medical University, 362000 Quanzhou, People's Republic of China
| | - J-C Li
- The Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, 350000 Fuzhou, People's Republic of China.
| | - W-F Cheng
- The Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, 350000 Fuzhou, People's Republic of China
| | - J Chen
- The Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, 350000 Fuzhou, People's Republic of China
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3
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Guo H, Tang HT, Hu WL, Wang JJ, Liu PZ, Yang JJ, Hou SL, Zuo YJ, Deng ZQ, Zheng XY, Yan HJ, Jiang KY, Huang H, Zhou HN, Tian D. The application of radiomics in esophageal cancer: Predicting the response after neoadjuvant therapy. Front Oncol 2023; 13:1082960. [PMID: 37091180 PMCID: PMC10117779 DOI: 10.3389/fonc.2023.1082960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Esophageal cancer (EC) is one of the fatal malignant neoplasms worldwide. Neoadjuvant therapy (NAT) combined with surgery has become the standard treatment for locally advanced EC. However, the treatment efficacy for patients with EC who received NAT varies from patient to patient. Currently, the evaluation of efficacy after NAT for EC lacks accurate and uniform criteria. Radiomics is a multi-parameter quantitative approach for developing medical imaging in the era of precision medicine and has provided a novel view of medical images. As a non-invasive image analysis method, radiomics is an inevitable trend in NAT efficacy prediction and prognosis classification of EC by analyzing the high-throughput imaging features of lesions extracted from medical images. In this literature review, we discuss the definition and workflow of radiomics, the advances in efficacy prediction after NAT, and the current application of radiomics for predicting efficacy after NAT.
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Affiliation(s)
- Hai Guo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Thoracic Surgery, Sichuan Tianfu New Area People’s Hospital, Chengdu, China
| | - Hong-Tao Tang
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Wen-Long Hu
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Jun-Jie Wang
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Pei-Zhi Liu
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Jun-Jie Yang
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Sen-Lin Hou
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Yu-Jie Zuo
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Zhi-Qiang Deng
- College of Medical Imaging, North Sichuan Medical College, Nanchong, China
| | - Xiang-Yun Zheng
- College of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Hao-Ji Yan
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kai-Yuan Jiang
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Heng Huang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hai-Ning Zhou
- Department of Thoracic Surgery, Suining Central Hospital, Suining, China
- *Correspondence: Dong Tian, ; Hai-Ning Zhou,
| | - Dong Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Dong Tian, ; Hai-Ning Zhou,
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4
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Raptis CA, Goldstein A, Henry TS, Porter KK, Catenacci D, Kelly AM, Kuzniewski CT, Lai AR, Lee E, Long JM, Martin MD, Morris MF, Sandler KL, Sirajuddin A, Surasi DS, Wallace GW, Kamel IR, Donnelly EF. ACR Appropriateness Criteria® Staging and Follow-Up of Esophageal Cancer. J Am Coll Radiol 2022; 19:S462-S472. [PMID: 36436970 DOI: 10.1016/j.jacr.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
This document provides recommendations regarding the role of imaging in the staging and follow-up of esophageal cancer. For initial clinical staging, locoregional extent and nodal disease are typically assessed with esophagogastroduodenoscopy and esophageal ultrasound. FDG-PET/CT or CT of the chest and abdomen is usually appropriate for use in initial clinical staging as they provide additional information regarding distant nodal and metastatic disease. The detection of metastatic disease is critical in the initial evaluation of patients with esophageal cancer because it will direct patients to a treatment pathway centered on palliative radiation rather than surgery. For imaging during treatment, particularly neoadjuvant chemotherapy, FDG-PET/CT is usually appropriate, because some studies have found that it can provide information regarding primary lesion response, but more importantly it can be used to detect metastases that have developed since the induction of treatment. For patients who have completed treatment, FDG-PET/CT or CT of the chest and abdomen is usually appropriate for evaluating the presence and extent of metastases in patients with no suspected or known recurrence and in those with a suspected or known recurrence. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Alan Goldstein
- Division Chief, Abdominal Imaging, Director of CT Colonography, UMass Medical School, Worcester, Massachusetts
| | - Travis S Henry
- Panel Chair; Division Chief of Cardiothoracic Imaging, Duke University, Durham, North Carolina; Co-Director, ACR Education Center HRCT Course
| | - Kristin K Porter
- Panel Chair, University of Alabama Medical Center, Birmingham, Alabama; ACR Council Steering Committee
| | - Daniel Catenacci
- The University of Chicago, Chicago, Illinois; American Society of Clinical Oncology
| | - Aine Marie Kelly
- Assistant Program Director Radiology Residency, Emory University Hospital, Atlanta, Georgia
| | | | - Andrew R Lai
- Hospitalist; University of California San Francisco (UCSF), San Francisco, California; Former Director of the UCSF Hospitalist Procedure Service; Former Director of the UCSF Division of Hospital Medicine's Case Review Committee; Former Director of Procedures/Quality Improvement Rotation for the UCSF Internal Medicine Residency
| | - Elizabeth Lee
- Director, M1 Radiology Education, University of Michigan Medical School; Associate Program Director, Diagnostic Radiology, Michigan Medicine; Director of Residency Education Cardiothoracic Division, Michigan Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Jason M Long
- Director of Robotic Thoracic Surgery, Director of Lung Cancer Screening, University of North Carolina Hospital, Chapel Hill, North Carolina; The Society of Thoracic Surgeons
| | - Maria D Martin
- Director, Diversity and Inclusion, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Michael F Morris
- Director of Cardiac CT and MRI, University of Arizona College of Medicine, Phoenix, Arizona
| | - Kim L Sandler
- Co-Director Vanderbilt Lung Screening Program, Vanderbilt University Medical Center, Nashville, Tennessee; Imaging Chair, Thoracic Committee, ECOG-ACRIN; Co-Chair, Lung Screening 2.0 Steering Committee
| | | | - Devaki Shilpa Surasi
- Patient Safety and Quality Officer, Department of Nuclear Medicine, Chair-Elect, Junior Faculty Committee, The University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Ihab R Kamel
- Specialty Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edwin F Donnelly
- Specialty Chair; Chief of Thoracic Radiology, Interim Vice Chair of Academic Affairs, Department of Radiology, Ohio State University Wexner Medical Center, Columbus, Ohio
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Yago A, Ohkura Y, Ueno M, Fujisawa K, Ogawa Y, Shimoyama H, Haruta S, Udagawa H. Importance of long-term surveillance after curative esophagectomy for esophageal squamous cell carcinoma. Dis Esophagus 2022; 35:6507829. [PMID: 35032162 DOI: 10.1093/dote/doab098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/20/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The long-term outcomes after esophagectomy for esophageal cancer remain uncertain and the optimal surveillance strategy after curative surgery remains controversial. METHODS In this study, the clinicopathological characteristics of patients who underwent curative thoracic esophagectomy between 1991 and 2015 at Toranomon Hospital were retrospectively analyzed and reviewed until December 2020. We evaluated the accumulated data regarding the pattern and rates of recurrence and second malignancy. RESULTS A total of 1054 patients were eligible for inclusion in the study. Of these, 97% were followed up for 5 years, and the outcomes after 25 years could be determined in 65.5%. Recurrence was diagnosed in 318 patients (30.2%), and the most common pattern was lymph node metastasis (n = 168, 52.8%). Recurrence was diagnosed within 1 year in 174 patients (54.7%) and within 3 years in 289 (90.9%). Second malignancy possibly occurred through the entire study period after esophagectomy even in early-stage cancer, keeping 2%-5% of the incidental risk. There was no significant difference in the prognosis between 3-year survivors with and without a second malignancy. CONCLUSIONS Most recurrences after resection of esophageal cancer occurred within 3 years regardless of disease stage. However, these patients have an ongoing risk of developing a second malignancy after esophagectomy. Further consideration is required regarding the efficacy of long-term surveillance.
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Affiliation(s)
- Akikazu Yago
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2, toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Yu Ohkura
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2, toranomon, Minato-ku, Tokyo 105-8470, Japan.,Okinaka Memorial Institute for Medical Research, 2-2-2, toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Masaki Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2, toranomon, Minato-ku, Tokyo 105-8470, Japan.,Okinaka Memorial Institute for Medical Research, 2-2-2, toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Kentoku Fujisawa
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2, toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Yusuke Ogawa
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2, toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Hayato Shimoyama
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2, toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Shusuke Haruta
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2, toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2, toranomon, Minato-ku, Tokyo 105-8470, Japan.,Okinaka Memorial Institute for Medical Research, 2-2-2, toranomon, Minato-ku, Tokyo 105-8470, Japan
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6
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Lee S, Choi Y, Park G, Jo S, Lee SS, Park J, Shim HK. 18F-FDG PET/CT Parameters for Predicting Prognosis in Esophageal Cancer Patients Treated With Concurrent Chemoradiotherapy. Technol Cancer Res Treat 2021; 20:15330338211024655. [PMID: 34227434 PMCID: PMC8264725 DOI: 10.1177/15330338211024655] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: This study evaluated the prognostic value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (18F-FDG PET/CT) performed before and after concurrent chemoradiotherapy (CCRT) in esophageal cancer. Methods: We analyzed the prognosis of 50 non-metastatic squamous cell esophageal cancer (T1-4N0-2) patients who underwent CCRT with curative intent at Inje University Busan Paik Hospital and Haeundae Paik Hospital from 2009 to 2019. Median total radiation dose was 54 Gy (range 34-66 Gy). Our aim was to investigate the relationship between PET/CT values and prognosis. The primary end point was progression-free survival (PFS). Results: The median follow-up period was 9.9 months (range 1.7-85.7). Median baseline maximum standard uptake value (SUVmax) was 14.2 (range 3.2-27.7). After treatment, 29 patients (58%) showed disease progression. The 3-year PFS and overall survival (OS) were 24.2% and 54.5%, respectively. PFS was significantly lower (P = 0.015) when SUVmax of initial PET/CT exceeded 10 (n = 22). However, OS did not reach a significant difference based on maximum SUV (P = 0.282). Small metabolic tumor volume (≤14.1) was related with good PFS (P = 0.002) and OS (P = 0.001). Small total lesion of glycolysis (≤107.3) also had a significant good prognostic effect on PFS (P = 0.009) and OS (P = 0.025). In a subgroup analysis of 18 patients with follow-up PET/CT, the patients with SUV max ≤3.5 in follow-up PET/CT showed longer PFS (P = 0.028) than those with a maximum SUV >3.5. Conclusion: Maximum SUV of PET/CT is useful in predicting prognosis of esophageal cancer patients treated with CCRT. Efforts to find more effective treatments for patients at high risk of progression are still warranted.
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Affiliation(s)
- Seokmo Lee
- Department of Nuclear Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Yunseon Choi
- Department of Radiation Oncology, Inje University Busan Paik Hospital, Busan, Korea
| | - Geumju Park
- Department of Radiation Oncology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Sunmi Jo
- Department of Radiation Oncology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Sun Seong Lee
- Department of Nuclear Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Jisun Park
- Department of Nuclear Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Hye-Kyung Shim
- Department of Nuclear Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
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7
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Pande SS, Purandare N, Puranik A, Shah S, Agrawal A, C S P, Prabhash K, Agarwal JP, Rangarajan V. Role of 18F-FDG PET/CT in restaging of esophageal cancer after curative-intent surgical resection. Nucl Med Commun 2020; 41:959-964. [PMID: 32796485 DOI: 10.1097/mnm.0000000000001229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate diagnostic performance of FDG PET-CT in suspected recurrence of carcinoma esophagus after curative-intent surgical resection and impact of FDG PET-CT on intended management. MATERIAL AND METHODS This was retrospective study of patients with clinical or radiological suspicion of recurrent esophageal carcinoma who were referred for PET-CT from January 2006 to December 2017. Diagnostic performance of PET-CT was evaluated for disease recurrence and its impact on management decisions. PET-CT findings were confirmed with tissue diagnosis. When tissue diagnosis was not available clinical and radiological follow-up was used as reference standard. RESULTS Relevant clinical data were available in 68 patients which were considered for analysis. In 91% (62/68) patients FDG PET-CT findings were suggestive of disease recurrence. Histopathological confirmation was available in 43 patients, whereas in remaining patients recurrence was confirmed by radiological and clinical follow-up. Forty percent (28/68) patients were detected with distant metastases. Sensitivity, specificity, positive and negative predictive values of FDG PET-CT was found to be 98.4, 80, 98 and 80% with accuracy of 97%. Change in management was observed in 41% (28/68) of patients from salvage radiotherapy/surgery to palliative chemotherapy/best supportive care based on evidence of distant metastases seen on FDG PET-CT. CONCLUSION FDG PET-CT is highly sensitive in detection of recurrent disease in esophageal cancer patients after surgical resection. It can detect distant metastases in high proportion of patients thus changing the intent of management from radical salvage to palliative chemotherapy/best supportive care.
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Affiliation(s)
- Shantanu S Pande
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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8
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Elsherif SB, Andreou S, Virarkar M, Soule E, Gopireddy DR, Bhosale PR, Lall C. Role of precision imaging in esophageal cancer. J Thorac Dis 2020; 12:5159-5176. [PMID: 33145093 PMCID: PMC7578477 DOI: 10.21037/jtd.2019.08.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Esophageal cancer is a major cause of morbidity and mortality worldwide. Recent advancements in the management of esophageal cancer have allowed for earlier detection, improved ability to monitor progression, and superior treatment options. These innovations allow treatment teams to formulate more customized management plans and have led to an increase in patient survival rates. For example, in order for the most effective management plan to be constructed, accurate staging must be performed to determine tumor resectability. This article reviews the multimodality imaging approach involved in making a diagnosis, staging, evaluating treatment response and detecting recurrence in esophageal cancer.
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Affiliation(s)
- Sherif B Elsherif
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA.,Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sonia Andreou
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Mayur Virarkar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erik Soule
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | | | - Priya R Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
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9
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Nakajima M, Kato H, Muroi H, Kikuchi M, Takahashi M, Yamaguchi S, Sasaki K, Ishikawa H, Sakurai H, Kuwano H. Minimally Invasive Salvage Operations for Esophageal Cancer after Definitive Chemoradiotherapy. Digestion 2018; 97:64-69. [PMID: 29393232 DOI: 10.1159/000484034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Because salvage surgery after definitive chemoradiotherapy for esophageal cancer is associated with high postoperative mortality and morbidity, minimally invasive methods are desirable. We analyzed the validity of minimally invasive salvage operations (MISO). METHODS Twenty-five patients underwent salvage operation between 2010 and 2016 in our institution, 10 having undergone right transthoracic salvage esophagectomy (TTSE group), 6 transhiatal salvage esophagectomy (THSE), 6 salvage lymphadenectomy (SLA), and 3 salvage endoscopic submucosal dissection (SESD). Patients who had undergone THSE, SLA, or SESD were categorized as the MISO group. Short- and long-term outcomes were assessed. RESULTS The mean duration of surgery was significantly shorter in the SLA groups than in the TTSE group (p = 0.0248). Blood loss was significantly less in the SLA than the TTSE group (p = 0.0340). Intensive care unit stay was shorter in the THSE than the TTSE group (p = 0.0412). There was no significant difference in postoperative mortality between the MISO and THSE groups. Postoperative hospital stay was significantly shorter in the SLA than the TTSE group (p = 0.0061). Patients' survivals did not differ significantly between the MISO and TTSE groups (p = 0.752). Multivariate analysis revealed that residual disease (R0; HR 4.872, 95% CI 1.387-17.110, p = 0.013) was the only independent factor influencing overall survival. CONCLUSION MISO is preferable because short-term outcomes are better and long-term outcomes do not differ from those of TTSE.
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Affiliation(s)
| | - Hiroyuki Kato
- First Department of Surgery, Dokkyo Medical University, Mibu, Japan
| | - Hiroto Muroi
- First Department of Surgery, Dokkyo Medical University, Mibu, Japan
| | - Maiko Kikuchi
- First Department of Surgery, Dokkyo Medical University, Mibu, Japan
| | | | - Satoru Yamaguchi
- First Department of Surgery, Dokkyo Medical University, Mibu, Japan
| | - Kinro Sasaki
- First Department of Surgery, Dokkyo Medical University, Mibu, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Japan
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10
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Betancourt Cuellar SL, Palacio DP, Benveniste MF, Carter BW, Hofstetter WL, Marom EM. Positron Emission Tomography/Computed Tomography in Esophageal Carcinoma: Applications and Limitations. Semin Ultrasound CT MR 2017; 38:571-583. [PMID: 29179897 DOI: 10.1053/j.sult.2017.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Squamous cell carcinoma and adenocarcinoma represent approximately 98% of esophageal malignant tumors. During the last 30 years, the incidence of adenocarcinoma has increased in Western countries (including the USA) where adenocarcinoma currently represents more than 60% of esophageal malignancies, although, worldwide, squamous cell carcinoma continues to be the predominant histologic type. Integrated positron emission tomography or computed tomography with 2-[fluorine18] fluro-2-deoxy-d-glucose is used in many institutions routinely as a tool in the initial staging and then repeated after therapy for the assessment of response to neoadjuvant therapy and detection of recurrent disease in patients with esophageal carcinoma. As with any other imaging modality, 2-[fluorine18] fluro-2-deoxy-d-glucose-positron emission tomography or computed tomography has strengths and limitations that should be understood in order to maximize its utility.
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Affiliation(s)
- Sonia L Betancourt Cuellar
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX; Address reprint request to Sonia L. Betancourt Cuellar, MD, Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030..
| | - Diana P Palacio
- Department of Diagnostic Radiology, University of Arizona, Medical Center, Tucson, AZ
| | - Marcelo F Benveniste
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Wayne L Hofstetter
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Edith M Marom
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX; Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated with the Tel Aviv University, Israel
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11
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Betancourt Cuellar SL, Palacio DP, Wu CC, Carter BW, Correa AM, Hofstetter WL, Marom EM. 18FDG-PET/CT is useful in the follow-up of surgically treated patients with oesophageal adenocarcinoma. Br J Radiol 2017; 91:20170341. [PMID: 29125331 DOI: 10.1259/bjr.20170341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate fludeoxyglucose-positron emission ;tomography/CT's (FDG-PET/CT) performance in the follow ;up of patients with surgically treated oesophageal adenocarcinoma. METHODS The follow-up FDG-PET/CT scans of 162 consecutive patients with surgically treated oesophageal adenocarcinoma were retrospectively reviewed. Histopathological and/or imaging examinations confirmed recurrent disease. The accuracy, sensitivity, specificity and negative and positive predictive values were calculated. RESULTS Recurrence occurred in 71 (43%) patients, usually within the first year following surgery (60%) and in more than one site (76%). The sensitivity, specificity, positive-predictive value, negative-predictive value and accuracy of FDG-PET/CT for anastomotic recurrence were 77, 76, 16, 98 and 76%; for regional nodal recurrence were 88, 85, 43, 97 and 86%; and for distant metastatic recurrence were: 97, 96, 91, 99 and 96%. In 5 of the 42 patients (12%) with distant metastases, the metastatic sites were outside the area covered by a conventional follow-up chest-abdomen CT and in 4 patients (9%) metastases were barely perceptible on the CT component of the FDG-PET/CT and consequently were unlikely to be detected without the aid of the FDG uptake. CONCLUSION FDG PET/CT is accurate in detecting oesophageal adenocarcinoma recurrence, especially within the first post-operative year when most recurrences occur, and is useful in identifying patients with a solitary metastasis. Advances in knowledge: FDG-PET/CT should be considered as a valuable tool in the routine follow ;up of surgically treated oesophageal cancer patients within the first 2 years after surgery.
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Affiliation(s)
- Sonia L Betancourt Cuellar
- 1 Department of Diagnostic Radiology,The University of Texas, Anderson Cancer Center , The University of Texas, Anderson Cancer Center , Houston, TX , USA
| | - Diana P Palacio
- 2 Department of Diagnostic Radiology,University of Arizona, Medical Center , University of Arizona, Medical Center , Chicago, IL , USA
| | - Carol C Wu
- 1 Department of Diagnostic Radiology,The University of Texas, Anderson Cancer Center , The University of Texas, Anderson Cancer Center , Houston, TX , USA
| | - Brett W Carter
- 1 Department of Diagnostic Radiology,The University of Texas, Anderson Cancer Center , The University of Texas, Anderson Cancer Center , Houston, TX , USA
| | - Arlene M Correa
- 3 Department of Thoracic & Cardio Surgery-Rsch,The University of Texas, Anderson Cancer Center , The University of Texas, Anderson Cancer Center , Houston, TX , USA
| | - Wayne L Hofstetter
- 4 Department of Thoracic & Cardiovasc Surgery,The University of Texas, Anderson Cancer Center , The University of Texas, Anderson Cancer Center , Houston, TX , USA
| | - Edith M Marom
- 1 Department of Diagnostic Radiology,The University of Texas, Anderson Cancer Center , The University of Texas, Anderson Cancer Center , Houston, TX , USA.,5 Department Diagnostic Imaging,The Chaim Sheba Medical Center, Tel Aviv University , The Chaim Sheba Medical Center, Tel Aviv University , Ramat-Gan , Israel
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12
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Chen J, Cai W, Lin Y, Chen Y, Zheng Q, Pan J, Chen C. Patterns and rates of abdominal lymphatic metastasis following esophageal carcinoma. PLoS One 2017; 12:e0185424. [PMID: 29016614 PMCID: PMC5634562 DOI: 10.1371/journal.pone.0185424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/12/2017] [Indexed: 11/18/2022] Open
Abstract
Aim To determine the rate of abdominal lymph node metastasis after radical surgery for esophageal cancer and define the radiotherapy target area. Methods Of the 1593 patients who underwent R0 radical esophagectomy for thoracic esophageal squamous cell carcinoma (TE-SCC), 148 developed abdominal lymph node (LN) metastases within three years of surgery. During that time interval, patients were examined by various imaging methods (enhanced computer tomography, magnetic resonance imaging, and positron emission tomography–CT) at set time points. The emerging recurrence pattern, preferred sites for abdominal metastasis, and correlation with added clinical factors were carefully recorded, to permit for delineation of a target area for radiotherapy. Results We found postoperative metastatic abdominal LNs in 9.3% of the patients treated for esophageal cancer. Lesions in the upper, middle, and lower esophageal segments metastasized to abdominal LNs at 2.3%, 7.8%, and 26.6% (P < 0.0001), respectively. Of all cases, 4.8% had fewer than two affected LNs, while 20.1% had more than three metastatic LNs (P< 0.0001). The metastasis rates of negative and positive celiac LNs were 4.6% and 22.7%, respectively. Abdominal LN metastasis rates for the following LNs: 16a2 and 16a1 of para-aortic, celiac artery, posterior surface of the pancreatic head and common hepatic artery were 64.9%, 41.2%, 37.8%, 32.4%, and 20.9%, respectively. The overall rate of metastasis to these groups of LNs was 91.9%. Conclusion This study determined that stations 16a1 and 16a2 of the para-aortic, truncus coeliacus, posterior surface of the pancreatic head, and arteria hepatica communis lymph nodes were the preferred sites for abdominal LN metastasis, thus defining target areas for postoperative radiotherapy.
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Affiliation(s)
- Junqiang Chen
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
- * E-mail:
| | - Wenjie Cai
- Departments of Radiation Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Yu Lin
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yuanmei Chen
- Departments of Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Qingfeng Zheng
- Departments of Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jianji Pan
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Chuanben Chen
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
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13
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Liu S, Zhu H, Li W, Zhang B, Ma L, Guo Z, Huang Y, Song P, Yu J, Guo H. Potential impact of (18)FDG-PET/CT on surgical approach for operable squamous cell cancer of middle-to-lower esophagus. Onco Targets Ther 2016; 9:855-62. [PMID: 26955283 PMCID: PMC4768887 DOI: 10.2147/ott.s97896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Fluorodeoxyglucose-positron emission tomography (PET)/computed tomography (CT) is reported to have a significant advantage over CT for staging esophageal cancer (EC). However, whether PET/CT may play a useful role in guiding surgical approach remains undetermined. Methods Patients with potentially resectable squamous cell EC were randomized into either PET/CT group or CT group. The surgical data and survival outcomes were compared. Results Compared to the CT group, the right-sided approach was more frequently used (42.6% versus 25.5%, P=0.065) in the PET/CT group in order to allow surgical access to radiographically suspicious lymph nodes inaccessible from the left, thus enabling the removal of more involved lymph nodes (2.83 versus 1.76; P=0.039) as well as their stations (1.65 versus 1.08; P=0.042). Although the overall survival between the two groups was similar, the PET/CT group had a longer disease-free survival (DFS) than the CT group (27.1 months versus 18.9 months; P=0.019), especially in the subgroup of node-positive patients (22.5 months versus 13.5 months; P=0.02). Preoperative imaging arm was the only prognostic factor found to independently influence DFS. Conclusion For patients with middle-to-lower EC, surgical approaches directed by PET/CT may increase the likelihood of complete resection and affect DFS.
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Affiliation(s)
- Sujing Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China; Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China
| | - Wanghu Li
- Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China
| | - Baijiang Zhang
- Department of Thoracic Surgery, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China
| | - Li Ma
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China
| | - Zhijun Guo
- Department of Intensive Care Unit, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China
| | - Yong Huang
- Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China
| | - Pingping Song
- Department of Thoracic Surgery, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China
| | - Hongbo Guo
- Department of Thoracic Surgery, Shandong Cancer Hospital and Institute, Jinan, Shandong Province, People's Republic of China
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Chang S, Kim SJ. Prediction of Recurrence and Mortality of Locally Advanced Esophageal Cancer Patients Using Pretreatment F-18 FDG PET/CT Parameters: Intratumoral Heterogeneity, SUV, and Volumetric Parameters. Cancer Biother Radiopharm 2016; 31:1-6. [DOI: 10.1089/cbr.2015.1932] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Samuel Chang
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Seong-Jang Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Korea
- Medical Research Institute, Pusan National University, Busan, Korea
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Gauthé M, Richard-Molard M, Cacheux W, Michel P, Jouve JL, Mitry E, Alberini JL, Lièvre A. Role of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography in gastrointestinal cancers. Dig Liver Dis 2015; 47:443-54. [PMID: 25766918 DOI: 10.1016/j.dld.2015.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/06/2015] [Indexed: 12/11/2022]
Abstract
Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become a routine imaging modality for many malignancies and its use is currently increasing. In the present review article, we will summarize the evidence for FDG-PET/CT use in digestive cancers (excluding neuroendocrine tumours), and review the existing recommendations. While PET/CT is nowadays considered to be an important tool in the initial workup of oesophageal and anal cancers, new data are emerging regarding its use in assessing therapeutic efficacy, radiotherapy treatment planning, and detection of recurrence in case of isolated tumour marker elevation. Moreover, PET/CT may help decision making by detecting distant metastatic sites especially in potentially resectable metastatic colorectal cancer and, to a lesser extent, in localized gastric and pancreatic cancers. Finally, incidental focal colonic FDG uptakes require exploration by colonoscopy, as they are often associated with premalignant or malignant lesions.
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Affiliation(s)
- Mathieu Gauthé
- Institut Curie, René Huguenin Hospital, Department of Nuclear Medicine, Saint-Cloud, France; Department of Nuclear Medicine, Centre Oscar Lambret, Lille, France.
| | - Marion Richard-Molard
- Institut Curie, René Huguenin Hospital, Department of Radiation Therapy, Saint-Cloud, France
| | - Wulfran Cacheux
- Institut Curie, Department of Medical Oncology, Paris, France
| | - Pierre Michel
- Department of Gastroenterology, Rouen University Hospital, France; University of Rouen, Rouen, France
| | - Jean-Louis Jouve
- Department of Gastroenterology, Dijon University Hospital, University of Burgundy, INSERM U866, Dijon, France
| | - Emmanuel Mitry
- Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
| | - Jean-Louis Alberini
- Institut Curie, René Huguenin Hospital, Department of Nuclear Medicine, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
| | - Astrid Lièvre
- Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
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16
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Goense L, van Rossum PSN, Reitsma JB, Lam MGEH, Meijer GJ, van Vulpen M, Ruurda JP, van Hillegersberg R. Diagnostic Performance of ¹⁸F-FDG PET and PET/CT for the Detection of Recurrent Esophageal Cancer After Treatment with Curative Intent: A Systematic Review and Meta-Analysis. J Nucl Med 2015; 56:995-1002. [PMID: 25952733 DOI: 10.2967/jnumed.115.155580] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/25/2015] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED The aim of this study was to assess the diagnostic performance of (18)F-FDG PET and integrated (18)F-FDG PET/CT for diagnosing recurrent esophageal cancer after initial treatment with curative intent. METHODS The PubMed, Embase, and Cochrane library were systematically searched for all relevant literature using the key words "(18)F-FDG PET" and "esophageal cancer" and synonyms. Studies examining the diagnostic value of (18)F-FDG PET or integrated (18)F-FDG PET/CT, either in routine clinical follow-up or in symptomatic patients in whom recurrence of esophageal cancer was suspected, were deemed eligible for inclusion. The primary outcome was the presence of recurrent esophageal cancer as determined by histopathologic biopsy or clinical follow-up. Risk of bias and applicability concerns were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Sensitivities and specificities of individual studies were meta-analyzed using bivariate random-effects models. RESULTS Eight eligible studies were included for meta-analysis, comprising 486 patients with esophageal cancer who underwent (18)F-FDG PET or PET/CT after previous treatment with curative intent. The quality of the included studies assessed by the QUADAS-2 tool was considered reasonable; there were few concerns with regard to the risk of bias and applicability. Integrated (18)F-FDG PET/CT and standalone (18)F-FDG PET were used in 4 and 3 studies, respectively. One other study analyzed both modalities separately. In 4 studies, (18)F-FDG PET or PET/CT was performed as part of routine follow-up, whereas in 4 other studies the diagnostic test was performed on indication during clinical follow-up. Pooled estimates of sensitivity and specificity for (18)F-FDG PET and PET/CT in diagnosing recurrent esophageal cancer were 96% (95% confidence interval, 93%-97%) and 78% (95% confidence interval, 66%-86%), respectively. Subgroup analysis revealed no statistically significant difference in diagnostic accuracy according to type of PET scanner (standalone PET vs. integrated PET/CT) or indication of scanning (routine follow-up vs. on indication). CONCLUSION (18)F-FDG PET and PET/CT are reliable imaging modalities with a high sensitivity and moderate specificity for detecting recurrent esophageal cancer after treatment with curative intent. The use of (18)F-FDG PET or PET/CT particularly allows for a minimal false-negative rate. However, histopathologic confirmation of (18)F-FDG PET- or PET/CT-suspected lesions remains required, because a considerable false-positive rate is noticed.
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Affiliation(s)
- Lucas Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter S N van Rossum
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; and
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert J Meijer
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marco van Vulpen
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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van Rossum P, van Lier A, Lips I, Meijer G, Reerink O, van Vulpen M, Lam M, van Hillegersberg R, Ruurda J. Imaging of oesophageal cancer with FDG-PET/CT and MRI. Clin Radiol 2015; 70:81-95. [DOI: 10.1016/j.crad.2014.07.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/14/2014] [Accepted: 07/25/2014] [Indexed: 12/13/2022]
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18
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Diagnostic accuracy of 18F-FDG PET/CT for detection of suspected recurrence in patients with oesophageal carcinoma. Eur J Nucl Med Mol Imaging 2014; 41:1084-92. [DOI: 10.1007/s00259-013-2664-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/03/2013] [Indexed: 11/26/2022]
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19
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Hagiwara N, Matsutani T, Nomura T, Miyashita M, Yamashita N, Wachi E, Uchida E. Discovery of the primary site of esophageal squamous cell carcinoma based on axillary lymph nodes metastasis detected with fluorodeoxyglucose positron-emission tomography: report of a case. J NIPPON MED SCH 2014; 81:395-400. [PMID: 25744485 DOI: 10.1272/jnms.81.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 60-year-old Japanese man with no chief complaints underwent 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET) during a medical check-up. FDG-PET revealed high tracer uptake in the left supraclavicular and axillary regions but no significant uptake in the esophageal region. However, upper gastrointestinal endoscopy revealed an ulcerative tumor in the middle third of the esophagus. Endoscopic biopsy revealed moderately differentiated squamous cell carcinoma. The patient underwent chemoradiotherapy. Follow-up FDG-PET and computed tomography after therapy revealed a complete response in the lymph nodes. The patient underwent subtotal esophagectomy with gastric tube reconstruction through the posterior mediastinum. However, metastasis to the axillary lymph nodes was detected 16 months after surgery, and lymph node dissection was performed. To our knowledge, this is the first reported case in which the primary site of esophageal squamous cell carcinoma was discovered on the basis of axillary lymph node metastasis detected with FDG-PET.
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Affiliation(s)
- Nobutoshi Hagiwara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
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Matsutani T, Nomura T, Hagiwara N, Yoshida H, Yokoyama T, Katayama H, Hosone M, Matsuda A, Uchida E. A Case of Carcinosarcoma of the Esophagus Detected on Fluorodeoxyglucose Positron Emission Tomography. J NIPPON MED SCH 2014; 81:401-5. [DOI: 10.1272/jnms.81.401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Takeshi Matsutani
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
| | - Tsutomu Nomura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
| | - Nobutoshi Hagiwara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Surgery, Nippon Medical School Tama Nagayama Hospital
| | - Tadashi Yokoyama
- Department of Surgery, Nippon Medical School Tama Nagayama Hospital
| | - Hironori Katayama
- Department of Pathology, Nippon Medical School Tama Nagayama Hospital
| | - Masaru Hosone
- Department of Pathology, Nippon Medical School Tama Nagayama Hospital
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
| | - Eiji Uchida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
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Miyata H, Yamasaki M, Takahashi T, Murakami K, Kurokawa Y, Nakajima K, Takiguchi S, Mori M, Doki Y. Relevance of [18F]fluorodeoxyglucose positron emission tomography-positive lymph nodes after neoadjuvant chemotherapy for squamous cell oesophageal cancer. Br J Surg 2013; 100:1490-7. [DOI: 10.1002/bjs.9253] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2013] [Indexed: 12/22/2022]
Abstract
Abstract
Background
Several studies have examined the clinical significance of metabolic response in primary tumours by [18F]fluorodeoxyglucose positron emission tomography (18F-FDG-PET) in patients with oesophageal cancer who undergo neoadjuvant therapy. The relevance of the metabolic response in lymph nodes is unclear.
Methods
Consecutive patients with oesophageal cancer who underwent neoadjuvant chemotherapy followed by surgery were studied. 18F-FDG-PET was performed before and 2–3 weeks after completion of neoadjuvant chemotherapy, assessing FDG uptake in primary tumours and lymph nodes considered to be metastatic.
Results
Before therapy, 156 (73·9 per cent) of 211 patients had PET-positive nodes, of whom 89 (57.1 per cent) had no evidence of metabolic activity in these lymph nodes following chemotherapy. There was a significant relationship between post-treatment lymph node status assessed by FDG-PET and numbers of pathologically confirmed metastatic lymph nodes. Patients with post-treatment PET-positive nodes had shorter survival than those without (5-year survival rate 25 versus 62·6 per cent; P < 0·001). There was no difference in survival between patients with PET-positive nodes before but not after therapy and patients who had PET-negative nodes throughout (5-year survival rate 59 versus 71 per cent respectively; P = 0·207). Multivariable analysis identified post-treatment nodal status assessed by FDG-PET and tumour depth as independent prognostic factors.
Conclusion
Identification of PET-positive lymph nodes after completion of chemotherapy is a predictor of poor prognosis of patients with oesophageal cancer scheduled for surgery. FDG-PET lymph node status after neoadjuvant chemotherapy is more important than that before chemotherapy.
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Affiliation(s)
- H Miyata
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - M Yamasaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - T Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - K Murakami
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - K Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - S Takiguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - M Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Saeki H, Morita M, Tsuda Y, Hidaka G, Kasagi Y, Kawano H, Otsu H, Ando K, Kimura Y, Oki E, Kusumoto T, Maehara Y. Multimodal Treatment Strategy for Clinical T3 Thoracic Esophageal Cancer. Ann Surg Oncol 2013; 20:4267-73. [DOI: 10.1245/s10434-013-3192-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Indexed: 01/04/2023]
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YAMAMOTO YUSUKE, KONISHI HIROTAKA, ICHIKAWA DAISUKE, ARITA TOMOHIRO, SHODA KATSUTOSHI, KOMATSU SHUHEI, SHIOZAKI ATSUSHI, IKOMA HISASHI, FUJIWARA HITOSHI, OKAMOTO KAZUMA, OCHIAI TOSHIYA, INOUE JUN, INAZAWA JOHJI, OTSUJI EIGO. Significance of GSTP1 for predicting the prognosis and chemotherapeutic efficacy in esophageal squamous cell carcinoma. Oncol Rep 2013; 30:1687-94. [DOI: 10.3892/or.2013.2606] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 06/12/2013] [Indexed: 11/05/2022] Open
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GRIERSON C, UPPONI S. Patterns of tumour recurrence after luminal tumour resection. IMAGING 2013. [DOI: 10.1259/imaging/73678953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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I H, Kim K, Kim SJ, Kim IJ, Pak K, Kim H. Prognostic value of metabolic volume measured by F-18 FDG PET-CT in patients with esophageal cancer. Thorac Cancer 2012; 3:255-261. [PMID: 28920313 DOI: 10.1111/j.1759-7714.2012.00120.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the usefulness of the metabolic tumor volume (MTV) measured by F-18 Fluorodeoxyglucose positron emission tomography (FDG PET-CT) in predicting recurrence free survival (RFS) in patients with esophageal cancer. METHODS Forty-five patients with squamous cell carcinoma, who had undergone whole-body F-18 FDG PET-CT scans before surgical resection, were included in this study. All patients were treated with Ivor-Lewis esophagectomy. The MTV was quantified within the primary tumor using the 50% threshold of the maximum standardized uptake value (SUVmax ) of the FDG uptake areas. The cutoff value of MTV50 was determined through receiver-operating characteristic curve. The Kaplan Meier method was used to find out the relationship between RFS and MTV50 . Univariate analysis and multivariate proportional hazards regression analysis were applied to test the significance of volumetric parameter of F-18 FDG PET-CT and other conventional prognostic factors for the prediction of RFS. RESULTS Overall median follow up period was 17.87 months (range: 1.07-63.27 months). The median survival between treatment completion and recurrence was 15.5 months (range: 1.37-72.43 months). Recurrence was found in eight patients. On univariate analysis, MTV50 (P = 0.0032), N stage (P = 0.0004), American Joint Committee on Cancer stage (P = 0.0101), tumor location (P = 0.0054) and adjuvant treatment (P = 0.0373) were significant predictors of RFS. Multivariate analysis showed that the independent prognostic factors were MTV50 (P = 0.0465), N stage (P = 0.0303) and tumor location (P = 0.0270). CONCLUSION Volume based parameter of F-18 FDG PET-CT may have a role in providing prognostic information in esophageal cancer patients who received esophagectomy.
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Affiliation(s)
- Hoseok I
- Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Republic of KoreaBiomedical Research Institute, Pusan National University Hospital, Busan, Republic of KoreaDepartment of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Keunyoung Kim
- Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Republic of KoreaBiomedical Research Institute, Pusan National University Hospital, Busan, Republic of KoreaDepartment of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Seong-Jang Kim
- Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Republic of KoreaBiomedical Research Institute, Pusan National University Hospital, Busan, Republic of KoreaDepartment of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - In-Joo Kim
- Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Republic of KoreaBiomedical Research Institute, Pusan National University Hospital, Busan, Republic of KoreaDepartment of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Kyoungjune Pak
- Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Republic of KoreaBiomedical Research Institute, Pusan National University Hospital, Busan, Republic of KoreaDepartment of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Heeyoung Kim
- Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Republic of KoreaBiomedical Research Institute, Pusan National University Hospital, Busan, Republic of KoreaDepartment of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
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Wu LM, Hu JN, Hua J, Gu HY, Zhu J, Xu JR. 18 F-fluorodeoxyglucose positron emission tomography to evaluate recurrent gastric cancer: a systematic review and meta-analysis. J Gastroenterol Hepatol 2012; 27:472-80. [PMID: 21916986 DOI: 10.1111/j.1440-1746.2011.06919.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM We aimed to explore the role of the diagnostic accuracy of (18) F-fluorodeoxyglucose positron emission tomography ((18) F-FDG PET) in detecting recurrent gastric cancer through a systematic review and meta-analysis. METHODS The MEDLINE, EMBASE, Cancerlit, and Cochrane Library database, from January 2001 to July 2011, were searched for studies evaluating the diagnostic performance of (18) F-FDG PET in detecting recurrent gastric cancer. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves. We also compared the performance of (18) F-FDG PET with computed tomography (CT) by analyzing studies that had also used these diagnostic methods on the same patients. RESULTS Across nine studies (526 patients), the overall sensitivity of (18) F-FDG PET was 0.78 (95% confidence interval [CI]: 0.68-0.86), and the overall specificity was 0.82 (95% CI: 0.76-0.87). Overall, LR+ was 3.52 (95% CI: 2.68-4.63) and LR- was 0.32 (95% CI: 0.22-0.46). In studies in which both (18) F-FDG PET and other diagnostic tests were performed, the sensitivity and specificity of (18) F-FDG PET were 0.72 (95% CI: 0.62-0.80) and 0.84 (95% CI: 0.77-0.90), respectively; of contrast CT, they were 0.74 (95% CI: 0.64-0.83) and 0.85 (95% CI: 0.78-0.90), respectively; and of combined PET and CT, they were 0.75 (95% CI: 0.67-0.82) and 0.85 (95% CI 0.79-0.90), respectively. Study sensitivity was not correlated with the prevalence of recurrent gastric cancer. CONCLUSION (18) F-FDG PET has good diagnostic performance in the overall evaluation of recurrent gastric cancer, but still has some limited performance compared with contrast CT. (18) F-FDG PET combined with CT might improve the diagnostic performance in detecting recurrent gastric cancer.
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Affiliation(s)
- Lian-Ming Wu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kumar P, Damle NA, Bal C. Role of F18-FDG PET/CT in the Staging and Restaging of Esophageal Cancer: A Comparison with CECT. Indian J Surg Oncol 2012. [PMID: 23204793 DOI: 10.1007/s13193-012-0128-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Esophageal cancer is one of the most fatal cancers principally because of its late presentation. CECT plays an important role in the staging of esophageal cancer but has some limitations. PET/CT which provides physiological information along with anatomical information and is a whole body imaging technique may therefore be a better alternative and thereby can facilitate selection or exclusion of patients for resection. The aim was to evaluate the performance of F18 FDG PET/CT in the staging and restaging of esophageal carcinoma compared to CECT using histopathologic findings and clinical follow-up as gold standard. Twenty eight patients with proven esophageal carcinoma, both preoperative and postoperative, were studied with CECT and F18 FDG PET/CT scan within an interval of 2 weeks. The PET/CT scan was acquired after injection of 370 MBq (10 mCi) F18-FDG and was evaluated for areas of increased focal uptake. CECT scan of chest and abdomen was done after injection of iodinated non-ionic contrast media. CECT findings suggested stage-IV disease in 16/28 (57.14%) patients and non stage-IV disease in 12/28 (42.86%) patients, whereas PET/CT suggested stage-IV disease in 23/28 (82.14%) patients and non stage-IV disease in 5/28 (17.86%) patients. Total nine patients were upstaged by PET/CT compared to CECT, out of which 7 (25%) were correctly upstaged and 2 (7.14%) were falsely upstaged. PET/CT improved our ability to detect distant metastases in 25% of patients that was missed by CECT. So, the use of F18 FDG PET/CT in esophageal cancer can alter management in significant number of patients.
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Affiliation(s)
- Praveen Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Kato H, Nakajima M. The Efficacy of FDG-PET for the Management of Esophageal Cancer: Review Article. Ann Thorac Cardiovasc Surg 2012; 18:412-9. [DOI: 10.5761/atcs.ra.12.01954] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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29
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Tanabe S, Naomoto Y, Shirakawa Y, Fujiwara Y, Sakurama K, Noma K, Takaoka M, Yamatsuji T, Hiraki T, Okumura Y, Mitani M, Kaji M, Kanazawa S, Fujiwara T. F-18 FDG PET/CT contributes to more accurate detection of lymph nodal metastasis from actively proliferating esophageal squamous cell carcinoma. Clin Nucl Med 2011; 36:854-9. [PMID: 21892033 DOI: 10.1097/rlu.0b013e318217adc9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Evaluating the status of disease progression is critical for planning a therapeutic strategy for esophageal cancer. In this regard, F-18 fluorodeoxyglucose-labeled positron emission tomography (PET) is one of the most useful diagnostic modalities. However, there is room to improve its diagnostic performance, such as distinguishing lymph nodal metastases from false positives. In this study, we examined the diagnostic accuracy of fluorodeoxyglucose PET accompanied by computed tomography imaging (PET/CT) to detect regional lymph nodal metastasis from esophageal squamous cell carcinoma (ESCC). METHODS A total of 102 patients diagnosed as ESCC were subjected to this study. These patients had a preoperative PET/CT examination to evaluate the existence of metastasis. The values of maximum standardized uptake value (SUVmax) in primary tumors and in metastasized lymph nodes were measured to analyze their relationship with various clinicopathologic characteristics including the status of tumor cell proliferation, which was assessed by immunohistochemistry for Ki-67. RESULTS The SUVmax of the primary tumor was positively correlated with tumor size and vessel invasion, and was positively related with the SUVmax of lymph nodal metastasis, especially in cases of poorly differentiated ESCC. The SUVmax of metastasized lymph nodes was higher in larger-sized metastasized lymph nodes, whereas the Ki-labeling index of lymph nodal metastasis was positively related with the SUVmax per unit area (SUVmax/mm). The diagnostic accuracy of PET/CT (87.3%) was higher than that of conventional CT scans (78.4%). CONCLUSIONS The improved diagnostic accuracy of PET/CT can be explained by its ability to detect actively progressive metastasis at an early phase regardless of size.
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Affiliation(s)
- Shunsuke Tanabe
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Video-assisted surgery for gastric carcinoma arising in a gastric tube reconstructed retrosternally. Surg Today 2011; 42:209-13. [PMID: 22075659 DOI: 10.1007/s00595-011-0029-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 02/09/2011] [Indexed: 12/30/2022]
Abstract
Advances in diagnostic and surgical techniques have improved the prognosis of esophageal cancer, but there is growing concern about gastric tube cancer after esophagectomy. Gastric carcinoma arising in tubes that were reconstructed retrosternally is usually resected through a median sternotomy; however, this is invasive and carries a risk of osteomyelitis after suture-line failure. We performed video-assisted gastric tube resection, eliminating the need for sternotomy by using a sternal lifting method, on a 71-year-old man who had previously undergone esophagectomy and reconstruction retrosternally. The tumor was a Borrmann type 1 advanced cancer located near the esophagogastric anastomosis. Neck collar and upper abdominal incisions were made, and the sternum was lifted using a Kent retractor to extend the retrosternal space. Under videoscope assistance, we stripped the adhesions around the gastric tube carefully and performed total gastric tube resection. For the reconstruction, the ileocolon was lifted through the retrosternal space, and an ileoesophagostomy and Roux-en-Y reconstruction were performed. Despite leakage from an esophago-ileoanastomosis on postoperative day 6, the patient recovered well without mediastinitis or osteomyelitis of the sternum. Thus, our surgical procedure provides a good surgical view, decreases surgical stress, and reduces the risk of fatal postoperative complications.
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Clinical significance of salvage esophagectomy for remnant or recurrent cancer following definitive chemoradiotherapy. J Gastroenterol 2011; 46:1284-91. [PMID: 21818602 DOI: 10.1007/s00535-011-0448-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 07/04/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to clarify the effect of preoperative chemoradiotherapy (CRT) for esophageal cancer on the postoperative course, and to determine the clinical significance of salvage esophagectomy after definitive CRT. METHODS Based on their preoperative treatment, 477 patients with esophageal cancer were classified into three groups: 253 patients who received surgery alone (Group I), 197 who received planned CRT (30-45 Gy, Group II), and 27 who received a salvage esophagectomy (radiation ≥60 Gy, Group III). RESULTS Postoperative complications developed in 25, 40, and 59% of the patients in Groups I, II, and III, respectively, with pulmonary complications developing in 10, 15, and 30%, and anastomotic leakage developing in 13, 23, and 37%, respectively. Mortality rates were 2.4, 2.0, and 7.4%, respectively. Multivariate analysis revealed preoperative therapy to be an independent factor associated with postoperative risks: the odds ratios (ORs) of Groups II and III compared to Group I were 1.8 and 4.0 for pulmonary complications, while they were 1.9 and 2.8, respectively, for anastomotic leakage. No critical complications developed in the 14 patients who received salvage surgery performed with strict surgical indications after 2005. The survival of Group III was not significantly different from that of Groups I and II. Most patients who received an R1/R2 resection after definitive CRT died within 2 years after salvage surgery. CONCLUSIONS Preoperative CRT is associated with postoperative complications especially in patients with R2 resection, while long-term survival can be achieved after R0 resections. Salvage surgery should be considered for carefully selected patients in whom R0 resection can be achieved.
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Lymphadenectomy via a cervical approach for upper mediastinal lymph node recurrence of esophageal cancer: Report of a case. Surg Today 2011; 41:1562-6. [DOI: 10.1007/s00595-010-4521-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 11/08/2010] [Indexed: 10/17/2022]
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Kosuga T, Shiozaki A, Fujiwara H, Ichikawa D, Okamoto K, Komatsu S, Otsuji E. Treatment outcome and prognosis of patients with lymph node recurrence of thoracic esophageal squamous cell carcinoma after curative resection. World J Surg 2011; 35:798-804. [PMID: 21312037 DOI: 10.1007/s00268-011-0978-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study aimed to assess treatment outcome and factors influencing survival after lymph node recurrence of thoracic esophageal squamous cell carcinoma (SCC) after curative resection. METHODS A total of 207 patients who underwent curative resection of thoracic esophageal SCC between March 1999 and March 2009 were retrospectively analyzed. Of these, lymph node recurrence was observed in 45 (21.7%) patients. Twenty-nine patients received intensive treatment (radiation therapy, chemoradiotherapy, or lymphadenectomy) directed at recurrent nodes, 9 patients received chemotherapy, and 7 patients received best supportive care (BSC). Treatment outcome and prognostic factors of these patients were investigated. RESULTS Patients who received intensive treatment had significantly higher survival rates after recurrence than those who received chemotherapy or BSC (P = 0.0049 and 0.0004, respectively). In univariate analysis of survival after recurrence, the number of recurrent nodes (a single node or multiple nodes), the region of recurrent nodes (limited to a single region or extended to multiple regions), and the presence of simultaneous organ recurrence (present or absent) were prognostic factors (P = 0.0004, 0.0017, and <0.0001, respectively). Multivariate analysis demonstrated that the region of recurrent nodes and simultaneous organ recurrence were independent prognostic factors (P = 0.0396 and 0.0006, respectively). CONCLUSIONS Our findings suggest that the region of recurrent nodes (limited to a single region or extended to multiple regions) and simultaneous organ recurrence are factors influencing survival after lymph node recurrence of thoracic esophageal SCC after curative resection.
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Affiliation(s)
- Toshiyuki Kosuga
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
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Nakajo M, Nakajo M, Tani A, Kajiya Y, Shimaoka S, Matsuda A, Nioh T, Nihara T, Suenaga T, Tanaka S, Shirahama H, Higashi M, Koriyama C. Clinical significance of primary lesion FDG uptake for choice between oesophagectomy and endoscopic submucosal dissection for resectable oesophageal squamous cell carcinomas. Eur Radiol 2011; 21:2396-407. [PMID: 21750887 DOI: 10.1007/s00330-011-2196-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 04/21/2011] [Accepted: 05/13/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To correlate primary oesophageal squamous cell carcinoma (SCC) (18)F-fluoro-deoxyglucose (FDG) uptake with pathological factors and examine its significance regarding choice of therapy. METHODS We retrospectively examined the factors affecting visible and non-visible FDG uptake in 37 primary lesions in 32 oesophageal SCC patients who underwent PET/CT before oesophagectomy or endoscopic submucosal dissection (ESD). We divided the lesions into pathological depth invasion ≥sm2 oesophagectomy (n = 18) and ≤sm1 ESD (n = 19) indicated groups and compared the diagnostic accuracy of FDG-PET with that of endoscopic ultrasound (EUS) performed for 23 superficial lesions to discriminate between these groups. RESULTS There were 17 visible and 20 non-visible lesions. The lesion visibility was significantly higher in the larger (≥40 mm), non-flat type, more deeply invaded, positive vascular invasion (P < 0.001 each), positive nodal metastasis (P = 0.04) and higher Glut-1 score (P = 0.005) tumour groups. When the visible and non-visible lesions indicated a need for oesophagectomy and ESD respectively, the sensitivity, specificity and accuracy of oesophagectomy were 94% (17/18), 100% (19/19) and 97% (36/37) and those of EUS were 75% (3/4), 79% (15/19) and 78% (18/23) respectively. CONCLUSIONS Primary lesion FDG visibility can be one of the indicators for choosing between oesophagectomy and ESD for resectable oesophageal SCCs.
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Affiliation(s)
- Masatoyo Nakajo
- Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
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Tu CH, Muto M, Horimatsu T, Taku K, Yano T, Minashi K, Onozawa M, Nihei K, Ishikura S, Ohtsu A, Yoshida S. Submucosal tumor appearance is a useful endoscopic predictor of early primary-site recurrence after definitive chemoradiotherapy for esophageal squamous cell carcinoma. Dis Esophagus 2011; 24:274-8. [PMID: 21087347 DOI: 10.1111/j.1442-2050.2010.01141.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chemoradiotherapy (CRT) for esophageal cancer is disadvantageous because of a high locoregional failure rate. Detecting early small recurrent cancers at the primary site is necessary for potential salvage treatment. However, most endoscopists are inexperienced and therefore, a role for surveillance endoscopy after complete remission (CR) has not been established. We retrospectively evaluated serial surveillance endoscopic images from patients eventually proved to have primary-site recurrence in order to identify useful endoscopic features for early diagnosis. From January 2000 to December 2004, 303 patients with esophageal squamous cell carcinoma underwent definitive CRT, and 133 of them achieved CR. The surveillance endoscopic images stored at intervals of 1-3 months for the 16 patients with recurrence only at the primary tumor site and the 61 patients with no recurrence were collected for reexamination. Among 133 patients who achieved CR, 16 (12%) developed only local recurrence at the primary site. Thirteen of the 16 primary-site recurrent tumors (81%) appeared as submucosal tumors (SMT), with the remaining appearing as erosions or mild strictures. Of biopsy-proven recurrences, 81% were preceded by newly developed lesions such as SMT, erosions, or mild strictures detected by earlier surveillance endoscopies. For all 77 patients achieving CR with no metastasis, 86% of the evolving SMT with negative biopsies were eventually confirmed as cancer at later endoscopies. Thirteen of the 21 evolving lesions were subsequently confirmed as recurrent cancer. Early primary-site recurrence of esophageal cancer after a complete response to CRT is detectable with frequent endoscopic surveillance. SMT appearance is a useful endoscopic sign of early recurrence, as well as a predictor of subsequent diagnosis of recurrence.
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Affiliation(s)
- C-H Tu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
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Maruyama K, Motoyama S, Anbai A, Usami S, Sato Y, Shibuya K, Yoshino K, Nakatsu T, Minamiya Y, Ogawa JI. Therapeutic strategy for the treatment of postoperative recurrence of esophageal squamous cell carcinoma: clinical efficacy of radiotherapy. Dis Esophagus 2011; 24:166-71. [PMID: 20946135 DOI: 10.1111/j.1442-2050.2010.01119.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We investigated the effectiveness of chemoradiotherapy for the treatment of lymph node recurrence and hematogenous metastasis after esophagectomy for esophageal squamous cell carcinoma. Between 2001 and 2006, 216 patients with thoracic esophageal squamous cell carcinoma had curative esophagectomy. Of those, 23 with lymph node recurrence received chemoradiotherapy (50.0-68.8 Gy). In addition, five patients had isolated recurrences in a distant organ and received chemoradiotherapy (50.0-60.0 Gy). We analyzed outcomes from the radiotherapy for recurrent esophageal cancer. The 1-, 2-, and 5-year survival rates after recurrence for the 23 patients whose lymph node recurrence was treated with chemoradiotherapy were 52, 31, and 24%, respectively, and the median survival time was 13 months. Among the five patients with recurrent tumors in a distant organ, chemoradiotherapy produced a complete response in two patients, a partial response in one patient, and stable disease in two patients, giving an effectiveness rate of 60% (complete response + partial response). Chemoradiotherapy has a beneficial prognostic effect in patients with lymph node recurrence of esophageal squamous cell carcinoma. Chemoradiotherapy for a metastatic tumor in a distant organ may be the treatment of choice in cases where systemic chemotherapy has proven ineffective.
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Affiliation(s)
- K Maruyama
- Department of Surgery, Akita University School of Medicine, Hondo, Akita, Japan.
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Morita M, Nakanoko T, Fujinaka Y, Kubo N, Yamashita N, Yoshinaga K, Saeki H, Emi Y, Kakeji Y, Shirabe K, Maehara Y. In-hospital mortality after a surgical resection for esophageal cancer: analyses of the associated factors and historical changes. Ann Surg Oncol 2011; 18:1757-65. [PMID: 21207167 DOI: 10.1245/s10434-010-1502-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Resections for esophageal cancer are invasive, with high mortality and morbidity rates. The object of this study was to clarify the factors associated with in-hospital death while also evaluating any associated historical changes in the characteristics of such deaths. METHODS The factors associated with mortality were examined by logistic regression analysis in 1106 patients who underwent an esophagectomy for esophageal cancer. The historical changes in the characteristics of in-hospital deaths were also evaluated. RESULTS A multivariate analysis revealed that not only undergoing an esophagectomy before 1979, but also a patient's age (odds ratio 1.070 for every increase in age by year) and an incomplete resection (odds ratio 2.265) were independent factors associated with in-hospital death. The in-hospital mortality rates were 16.1%, 5.8%, 2.5%, and 3.1%, while the 30-day mortality rates were 9.2%, 2.2%, 0.8%, and 0.3% during 1964-1979, the 1980s, the 1990s, and the 2000s, respectively. Eight patients had preoperative comorbidities among 11 patients who died in the hospital after 1997. The mortality rate was 5.5% in patients with any comorbidities, while it was 1.3% in patients without any comorbidities (P = 0.026). The most common direct cause of in-hospital death was previous pulmonary complications; however, cancer progression has recently become the most common cause. CONCLUSIONS To prevent in-hospital mortality after an esophagectomy, strict indications for surgery and careful perioperative management are important, especially in high-risk patients with advanced esophageal cancer.
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Affiliation(s)
- Masaru Morita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Abstract
Esophageal cancer ranks among the ten most common malignancies in the world and is a frequent cause of cancer-related death. Almost all therapeutic modalities for esophageal cancer are associated with considerable mortality and morbidity. Consequently, there has been growing concern regarding effective management of esophageal cancer. Imaging plays an important role in the initial selection of patients. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) is playing an increasing role in the management of esophageal cancer. The role of FDG-PET in diagnosis, preoperative staging, monitoring of response to neoadjuvant therapy, and detection of disease recurrence is evaluated in this chapter.
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Affiliation(s)
- Hinrich A Wieder
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
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Follow-up and recurrence after a curative esophagectomy for patients with esophageal cancer: the first indicators for recurrence and their prognostic values. Esophagus 2010. [DOI: 10.1007/s10388-009-0221-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
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18F-fluorodeoxyglucose positron emission tomography immediately after chemoradiotherapy predicts prognosis in patients with locoregional postoperative recurrent esophageal cancer. Int J Clin Oncol 2010; 15:184-90. [DOI: 10.1007/s10147-010-0044-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 11/16/2009] [Indexed: 11/25/2022]
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Kato H, Nakajima M, Sohda M, Tanaka N, Inose T, Miyazaki T, Fukuchi M, Oriuchi N, Endo K, Kuwano H. The clinical application of (18)F-fluorodeoxyglucose positron emission tomography to predict survival in patients with operable esophageal cancer. Cancer 2009; 115:3196-203. [PMID: 19472406 DOI: 10.1002/cncr.24399] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Metabolic tumor activity using (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) was believed to have a predictive value for patient outcome in malignancies. The objective of the current study was to assess the prognostic effectiveness of the highest standardized uptake value (SUV) in the primary or regional area (peak SUV) and the number of PET-positive lymph nodes in esophageal cancer. METHODS The authors retrospectively reviewed their experience with 184 consecutive esophageal cancer patients imaged preoperatively using FDG-PET scanning. RESULTS The median peak SUV was 4.5 (range, 1.4-21.9). The survival curve was analyzed using the median peak SUV as the cutoff value. Comparison of each group and clinicopathologic characteristics revealed significant associations between peak SUV and each of the following factors: tumor status (P < .001), lymph node status (P < .001), metastatic status (P < .05), stage of disease (P < .001), number of PET-positive lymph nodes (P < .001), and the number of histologically positive lymph nodes (P < .001). The 5-year overall survival (OS) rate for patients having FDG uptake with a peak SUV > or =4.5 was 47% and that for patients with a peak SUV <4.5 was 76% (P < .0001). On multivariate survival analysis using the Cox proportional hazards model, peak SUV and the number of PET-positive lymph nodes were found to be independent predictive factors for OS. The number of PET-positive lymph nodes was a single prognostic factor predicting both disease-free survival and OS. CONCLUSIONS Pretreatment PET cannot only potentially diagnose the extent of disease, but also may be predictive of patient survival after esophageal cancer resection.
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Affiliation(s)
- Hiroyuki Kato
- Department of General Surgical Science (Surgery I), Gunma University, Graduate School of Medicine, Maebashi, Japan.
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Jadvar H, Henderson RW, Conti PS. 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography/computed tomography imaging evaluation of esophageal cancer. Mol Imaging Biol 2009; 8:193-200. [PMID: 16565910 DOI: 10.1007/s11307-006-0036-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We evaluated the clinical utility of 2-deoxy-2-[F-18]fluoro-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) on the precise localization of pathologic foci and exclusion of normal variants in the imaging evaluation of patients with esophageal carcinoma. Combined PET/CT scans were performed in 60 patients (50 males, 10 females, age range 47-84 years) with history of esophageal carcinoma either at the time of initial diagnosis (group I, n=14) or for surveillance and/or detection of recurrent and metastatic disease (group II, n=46). Prior treatments included esophagectomy with gastric pull-up (n=23), surgery and chemotherapy (n=3), surgery and chemoradiation therapy (n=10), chemotherapy alone (n=5), radiation therapy alone (n=2), and chemoradiation without surgery (n=3). Diagnostic validation was by tissue sampling in three patients and clinical/radiological follow-up for up to 1.5 years in the remaining patients. In group I, discordant abnormalities were noted in seven patients. PET demonstrated hypermetabolism in normal-size lymph nodes on CT in three patients that were considered likely true positive in view of concurrent existence of other adjacent enlarged hypermetabolic lymph nodes in the same nodal basin. Hypometabolic incidental CT abnormalities of up to 1-cm lung nodules were noted in three patients and pleural effusion in one patient, which were considered true negative in view of no change on follow-up PET/CT studies. In group II, both PET and CT showed concordant abnormalities in 23 patients. The precise image fusion of hypermetabolism in a liver lesion allowed a diagnostic CT-guided biopsy in one patient. PET demonstrated true positive hypermetabolic abnormalities in four patients that localized to structures, which were normal by noncontrast CT criteria, and true negative in one patient with hepatic fatty deposits. PET showed decline in metabolic activity of the primary lesion in one patient after chemotherapy, while the corresponding CT abnormality remained unchanged. PET/CT image fusion provided relevant complementary diagnostic information in 14 patients with discordant findings (23% of total) that resulted in biopsy in three cases, institution of chemotherapy in four cases, and a wait-and-watch strategy in seven cases. In conclusion, our findings add to the current body of literature that suggests that FDG-PET/CT scanning may improve the imaging evaluation of patients with esophageal cancer by providing complementary structural-metabolic information. In particular, our findings support the notion that PET/CT may be the most appropriate imaging modality in the evaluation of patients of esophageal cancer that may impact patient management.
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Affiliation(s)
- Hossein Jadvar
- PET Imaging Science Center, Division of Nuclear Medicine, Department of Radiology, University of Southern California, Los Angeles, CA, USA.
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Sun L, Su XH, Guan YS, Pan WM, Luo ZM, Wei JH, Zhao L, Wu H. Clinical usefulness of 18F-FDG PET/CT in the restaging of esophageal cancer after surgical resection and radiotherapy. World J Gastroenterol 2009; 15:1836-42. [PMID: 19370780 PMCID: PMC2670410 DOI: 10.3748/wjg.15.1836] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical usefulness of 18F-fluorodeoxyglucose positron emission and computed tomography (18F-FDG PET/CT) in restaging of esophageal cancer after surgical resection and radiotherapy.
METHODS: Between January 2007 and Aug 2008, twenty histopathologically diagnosed esophageal cancer patients underwent 25 PET/CT scans (three patients had two scans and one patient had three scans) for restaging after surgical resection and radiotherapy. The standard reference for tumor recurrence was histopathologic confirmation or clinical follow-up for at least ten months after 18F-FDG PET/CT examinations.
RESULTS: Tumor recurrence was confirmed histopathologically in seven of the 20 patients (35%) and by clinical and radiological follow-up in 13 (65%). 18F-FDG PET/CT was positive in 14 patients (68.4%) and negative in six (31.6%). 18F-FDG PET/CT was true positive in 11 patients, false positive in three and true negative in six. Overall, the accuracy of 18F-FDG PET/CT was 85%, negative predictive value (NPV) was 100%, and positive predictive value (PPV) was 78.6%. The three false positive PET/CT findings comprised chronic inflammation of mediastinal lymph nodes (n = 2) and anastomosis inflammation (n = 1). PET/CT demonstrated distant metastasis in 10 patients. 18F-FDG PET/CT imaging-guided salvage treatment in nine patients was performed. Treatment regimens were changed in 12 (60%) patients after introducing 18F-FDG PET/CT into their conventional post-treatment follow-up program.
CONCLUSION: Whole body 18F-FDG PET/CT is effective in detecting relapse of esophageal cancer after surgical resection and radiotherapy. It could also have important clinical impact on the management of esophageal cancer, influencing both clinical restaging and salvage treatment of patients.
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Abstract
Esophageal cancer is the third most common malignancy of the alimentary tract. The incidence of esophageal cancer has steadily increased over the past three decades. Almost all therapeutic modalities for esophageal cancer are associated with a considerable mortality and morbidity. Consequently, there has been growing concern regarding effective management of esophageal cancer. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is playing an increasing role in the management of esophageal cancer, offering potential advantages in the accuracy of disease assessment at a number of decision points in the management pathway. This review evaluates the critical role of FDG-PET in (i) diagnosis, (ii) preoperative staging, (iii) monitoring of response to neoadjuvant therapy, (iv) assessment of recurrence and (v) prediction of prognosis of esophageal cancer. We have also compared diagnostic performance of FDG-PET and other current technologies such as computed tomography scan and endoscopic ultrasonography based on available evidence.
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Nakamoto Y, Togashi K, Kaneta T, Fukuda H, Nakajima K, Kitajima K, Murakami K, Fujii H, Satake M, Tateishi U, Kubota K, Senda M. Clinical value of whole-body FDG-PET for recurrent gastric cancer: a multicenter study. Jpn J Clin Oncol 2009; 39:297-302. [PMID: 19269991 DOI: 10.1093/jjco/hyp010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The purpose of this multicenter study was to evaluate the clinical usefulness of positron emission tomography (PET) using (18)F-fluorodeoxyglucose (FDG) for suspected recurrent gastric cancer. METHODS We performed a retrospective review of 92 consecutive patients who underwent PET [either integrated PET/computed tomography (CT) or manual fusion of dedicated PET and CT] scans for post-treatment surveillance of gastric cancer between June 2006 and December 2007. Of these patients, 46 patients were suspected of recurrence by other imaging modalities (Group A), 19 patients were suspected of recurrence by tumor markers without definite findings (Group B) and the remaining 27 patients underwent a PET scan without evidence of recurrence (Group C). The diagnostic performance and prevalence of the clinical impact of FDG-PET were analyzed. RESULTS Recurrence of gastric cancer was confirmed in 31 patients (67%) in Group A, in 11 patients (58%) in Group B and in 2 patients (7%) in Group C. In addition, colon cancer (n = 3), lung cancer (n = 1) and pulmonary carcinoid (n = 1) were identified in five patients (5%). In patient-basis, the sensitivity, specificity and diagnostic accuracy of PET for recurrence were 81%, 87% and 83%, respectively, in Group A, 73%, 88% and 79%, respectively, in Group B and 50%, 88% and 85%, respectively, in Group C. Therapeutic management was influenced by PET results in 22 patients (48%) in Group A, in 8 patients (42%) in Group B and in 2 patients (7%) in Group C, including cases in which PET was helpful for detecting second primary cancer. CONCLUSIONS PET with FDG yielded useful information in patients with suspected recurrent gastric cancer, especially when recurrence was suspected in the clinical setting.
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Affiliation(s)
- Yuji Nakamoto
- Department of Diagnostic Radiology, Kyoto University Hospital, Kyoto, Japan.
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Use of positron emission tomography in surgery follow-up of esophageal cancer. J Gastrointest Surg 2009; 13:451-8. [PMID: 19023632 DOI: 10.1007/s11605-008-0749-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 10/28/2008] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Although the prognosis of patients with esophageal cancer has been improved by extended dissection, the incidence of recurrence still remains high. In esophageal cancer, positron emission tomography (PET) using (18)F-fluorodeoxyglucose (FDG) already demonstrated to be useful for initial staging and monitoring response to therapy. This prospective study compared the ability of FDG-PET and conventional imaging to detect early recurrence of esophageal cancer after initial surgery in asymptomatic patients. MATERIALS AND METHODS Between October 2003 and September 2006, 41 patients with esophageal cancer were included in a prospective study after initial radical esophagectomy. FDG-PET, thoracoabdominal computed tomography (CT), abdominal ultrasonography, and endoscopy were performed every 6 months after initial treatment. RESULTS AND DISCUSSION Twenty-three patients had recurrent disease (56%), mostly within the first 6 months after surgery (70%). Despite two false-positive scans due to postoperative changes, FDG-PET was more accurate than CT (91% vs. 81%, p = 0.02) for the detection of recurrence with a sensitivity of 100% (vs. 65%), a specificity of 85% (vs. 91%), and a negative predictive value of 100% on a patient-by-patient-based analysis. For the detection of locoregional recurrence, FDG-PET was more accurate than CT (96.2% vs. 88.9%). FDG-PET was also more accurate than CT for the detection of distant metastases (92.5% vs. 84.9%), especially when involving either bones (100%) or liver (98.1%). A lower sensitivity of FDG-PET (57%) for the early detection of small lung metastases did not affect patient management (accuracy = 92.5%). CONCLUSION FDG-PET appears to be very useful for the systematic follow-up of asymptomatic patients after esophagectomy with an initial scan performed 6 months after surgery.
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Chowdhury F, Bradley K, Gleeson F. The role of 18F-FDG PET/CT in the evaluation of oesophageal carcinoma. Clin Radiol 2008; 63:1297-309. [DOI: 10.1016/j.crad.2008.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2008] [Revised: 05/27/2008] [Accepted: 05/29/2008] [Indexed: 12/19/2022]
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Nakamura T, Ota M, Narumiya K, Sato T, Ohki T, Yamamoto M, Mitsuhashi N. Multimodal treatment for lymph node recurrence of esophageal carcinoma after curative resection. Ann Surg Oncol 2008; 15:2451-7. [PMID: 18592318 DOI: 10.1245/s10434-008-0016-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 05/22/2008] [Accepted: 05/23/2008] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although esophagectomy with extended lymph node dissection can improve survival of patients with esophageal carcinoma, lymph node metastasis has remained one of the main recurrence patterns. The aim of this study was to evaluate the outcome of intensive treatment for recurrent lymph node metastasis. METHODS Recurrent lymph node metastasis was detected in 68 patients with thoracic esophageal carcinoma after curative esophagectomy (R0, International Union Against Cancer criteria). Multimodal treatment was performed in 41 patients: 19 patients underwent lymphadenectomy with adjuvant therapy, and 22 received definitive chemoradiotherapy and repeated chemotherapy. The remaining 27 patients (40%) received chemotherapy or best supportive care. RESULTS Survival of the lymphadenectomy and the chemoradiotherapy groups was significantly better than that of the patients who received chemotherapy or best supportive care (P < .0001). Fifteen patients (79%) underwent curative lymph node dissection (R0) in the lymphadenectomy group. Complete response, partial response, and stable disease were obtained in 8 (37%), 10 (45%), and 4 (18%) patients who received chemoradiotherapy, respectively. There was no statistically significant difference in survival between the lymphadenectomy and the chemoradiotherapy groups. Although the location of lymph node metastasis did not influence survival significantly, seven patients with nodes around the abdominal aorta did not survive longer than 3 years. The most common repeat recurrence pattern was organ metastasis after the treatment. Multivariate analysis showed that the number of metastatic nodes and tumor marker were independent prognostic factors. CONCLUSION Multimodal treatment including lymphadenectomy and chemoradiotherapy could improve survival of the patients with lymph node recurrence of esophageal carcinoma after curative resection.
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Affiliation(s)
- Tsutomu Nakamura
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Saga T, Nakamoto Y, Higashi T, Yoshikawa K. Positron emission tomography for the diagnosis and management of patients with gastrointestinal malignancies. Gastrointest Endosc Clin N Am 2008; 18:479-93, ix. [PMID: 18674698 DOI: 10.1016/j.giec.2008.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) can play an important role in evaluating patients who have locally advanced diseases and in recurrence detection and restaging in patients who have gastrointestinal tract malignancies. Introduction of an integrated PET/CT system enabled the precise co-evaluation of function and morphology and improved the diagnostic ability of FDG-PET. Application of FDG-PET for treatment response evaluation and prognosis prediction is becoming important. Development of novel PET probes is expected to improve the characterization of individual cancer and to contribute to individualized patient management.
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Affiliation(s)
- Tsuneo Saga
- Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, Japan.
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Paudyal B, Oriuchi N, Paudyal P, Higuchi T, Nakajima T, Endo K. Expression of glucose transporters and hexokinase II in cholangiocellular carcinoma compared using [18F]-2-fluro-2-deoxy-D-glucose positron emission tomography. Cancer Sci 2008; 99:260-6. [PMID: 18271924 PMCID: PMC11159204 DOI: 10.1111/j.1349-7006.2007.00683.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Cholangiocellular carcinoma (CCC) has been reported to have a high glucose uptake; however, the mechanism of glucose entry into these cells is still unclear. We investigated the relationship between [(18)F]-2-fluro-2-deoxy-D-glucose ((18)F-FDG) uptake and the expression of facilitative glucose transporters (Glut) and hexokinase (HK) II, as well as the association between the expression of different histological types of CCC. The expression of Glut (1-5) and HK II was studied using immunohistochemistry of 26 patients with CCC who underwent whole-body (18)F-FDG positron emission tomography before surgery or biopsy. CCC expressed immunohistochemically detectable Glut 1 in 81%, Glut 2 in 54%, Glut 3 in 19%, and HK II in 77% of the total cases. Glut 1, Glut 2, Glut 3, and HK II were more often detected in moderately differentiated and poorly differentiated than in well-differentiated CCC. A significant correlation was observed between (18)F-FDG uptake and the staining scores of Glut 1 and HK II (P = 0.02, rho = 0.45 and P = 0.001, rho = 0.59). The staining scores of Glut 1 and HK II were also significantly correlated (P = 0.002, rho = 0.3). Multivariate regression analysis revealed that lymph-node metastasis was independently associated with (18)F-FDG uptake. Our study showed a significant association between the expression of Glut 1 and HK II with (18)F-FDG uptake, indicating that Glut 1 is a major glucose transporter expressed in CCC and that HK II contributes to the increased metabolism of glucose, especially in moderately and poorly differentiated CCC.
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Affiliation(s)
- Bishnuhari Paudyal
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
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