Should FDG-PET imaging be considered on a routine basis in clinical trials for carcinoma of esophagus to assure uniformity of protocols among sites?

Personalized versus evidence-based medicine with PET-based imaging

In this Perspective the feasibility, scope and impact of integrating PET-based personalized medicine into the evidence-based clinical practice of oncology is discussed. The basic concepts of 'evidence-based medicine' and 'personalized medicine' at times seem contradictory; however, I will discuss, with specific clinical situations as examples, a synergistic and probably incremental link between the two and propose that the result of such integration will ultimately improve patient management. Tailoring therapeutic approaches and regimens by molecular imaging, with PET at its forefront, would enable disease management at the individual level and this modification would hopefully further strengthen the evidence-based approach in oncology.

Impact of fluorodeoxyglucose PET on the management of esophageal cancer

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.