Is there a role for PET/CT with esophagogastric junction adenocarcinoma? Clin Nucl Med. 2015;40:e201-e207. [PMID: 25546207 DOI: 10.1097/RLU.0000000000000661]

Prevention and treatment of a positive proximal margin after gastrectomy for cardia cancer

A tumour-positive proximal margin (PPM) after extended gastrectomy for oesophagogastric junction (OGJ) adenocarcinoma is observed in approximately 2-20% of patients. Although a PPM is an unfavourable prognostic factor, the clinical relevance remains unclear as it may reflect poor tumour biology. This narrative review analyses the most relevant literature on PPM after gastrectomy for OGJ cancers. Awareness of the risk factors and possible measures that can be taken to reduce the risk of PPM are important. In patients with a PPM, surgical and non-surgical treatments are available but the effectiveness remains unclear.

The impact of histology on recurrence patterns in esophageal cancer treated with definitive chemoradiotherapy

BACKGROUND

To assess the impact of histology on recurrence patterns and survival outcomes in patients with esophageal cancer (EC) treated with definitive chemoradiotherapy (CRT).

METHODS

We analyzed 590 consecutive EC patients who received definitive CRT from 1998 to 2014, including 182 patients (30.8%) with squamous cell carcinoma (SCC) and 408 (69.2%) with adenocarcinoma. Recurrence pattern and timing, survival, and potential prognostic factors were compared.

RESULTS

After a median follow-up time of 58.0months, the SCC group demonstrated a comparable locoregional recurrence rate (42.9% vs. 38.0%, P=0.264) but a significantly lower distant failure rate (27.5% vs. 48.0%, P<0.001) than adenocarcinoma group. No significant difference was found in overall survival or locoregional failure-free survival between groups, whereas the SCC group was associated with significantly more favorable recurrence-free survival (P=0.009) and distant metastasis-free survival (P<0.001). The adenocarcinoma group had higher hematogenous metastasis rates of bone, brain, and liver, whereas the SCC group had a marginally higher regional recurrence rate. Among patients who received salvage surgery after locoregional recurrence, no significant difference in survival was found between groups (P=0.12).

CONCLUSIONS

The patterns and sites of recurrence, survival outcomes, and prognostic factors were significantly different between esophageal SCC and adenocarcinoma.

Application of PET/CT in gastrointestinal cancers

Fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography (¹⁸F-FDG PET) is an imaging tool which reflects tumor metabolism. The integration of PET with computed tomography (CT) can provide precise anatomical information along with metabolic data. Here, we review the application and potential role of ¹⁸F-FDG PET/CT imaging in staging, evaluation of chemoradiation therapy, and detection of recurrence in gastrointestinal cancers.

What is the role of radiological testing of lower esophageal sphincter function?

Radiological fluoroscopic evaluation remains the primary imaging modality of choice to evaluate patients with swallowing disorders, despite the increasing availability and technical advantages of nonradiological techniques and the current radiological focus on cross-sectional imaging studies, such as computed tomography and magnetic resonance imaging. The radiological swallowing evaluation should be tailored to assess the entire upper gastrointestinal tract, including the lower esophageal sphincter. Fluoroscopy enables the simultaneous assessment of esophageal motility disorders, as well as structural pathologies, including strictures, webs, rings, diverticula, and tumors. Mono- and double-contrast esophagrams and solid bolus tests together allow assessment of lower esophageal sphincter function and complement other methods, such as endoscopy, manometry, or impedance planimetry. Here we review the role of radiological studies for correct assessment of structural and functional pathologies at the level of the lower esophageal sphincter.

A study about different findings of PET-CT between neoadjuvant and non-neoadjuvant therapy: SUVmax is not a reliable predictor of lymphatic involvement after neoadjuvant therapy for esophageal cancer

BACKGROUND

No definitive findings or established guidelines have been published for the evaluation of esophageal tumors (tumor) and regional lymph nodes (LN) using positron emission tomography computed tomography (PET-CT) in patients with esophageal cancer. In addition, it remains unclear whether PET-CT findings vary between neoadjuvant (NT) and non-neoadjuvant (non-NT) therapy cases. Therefore, preoperative evaluation using PET-CT might provide unreliable information and influence the management plan for esophageal cancer. The purpose of the present study is to clarify the different findings of PET-CT between NT and non-NT in surgical esophageal cancer cases and to predict LN metastasis.

METHODS

We retrospectively reviewed the medical records of 192 consecutive cases that met this study's inclusion criteria from January 2009 to December 2014. All patients underwent curative and complete esophagectomy for intra-thoracic esophageal cancer at the department of thoracic and cardiovascular surgery in a single tertiary Korean hospital. We compiled and analyzed maximum standard uptake values (SUVmax) of tumor and LNs with other clinical information (chronic lung disease, history of previous other primary cancer, sex, pathological findings, NT, and other clinical data).

RESULTS

(I) In NT, a positive correlation between T stage and SUVmax was found (tumor SUVmax P<0.001, LN SUVmax P=0.010); however, no relationship between N stage and SUVmax was found. In non-NT, a positive correlation between pathological stage (T and N stage) and SUVmax was found (T stage, tumor SUVmax P<0.001, LN SUVmax P=0.001; N stage, tumor SUVmax P=0.003, LN SUVmax P=0.021); (II) In NT, the low SUVmax group had higher disease-free survival (DFS) and overall survival (OS) than the high SUVmax group (DFS, tumor SUVmax P<0.001, LN SUVmax P=0.142; OS, tumor SUVmax P<0.001, LN SUVmax P=0.002). In non-NT, the low SUVmax group also had higher DFS and OS than the high SUVmax group (DFS, tumor SUVmax P<0.001, LN SUVmax P=0.008; OS, tumor SUVmax P=0.029, LN SUVmax P=0.016). SUVmax values being equal, non-NT had significantly higher DFS and OS than NT (P=0.011, P=0.009, respectively), despite the absence of significant differences in pathological stage; (III) Tumor SUVmax had a positive correlation with LN SUVmax in both NT and non-NT (P=0.006, P<0.001, respectively); (IV) In NT, there were no diagnostic findings of LN metastases using SUVmax. However, in non-NT, significant cutoff values for diagnosis of LN metastases using both tumor and LN SUVmax were found (tumor SUVmax cutoff value 4.9, P=0.008; LN SUVmax cutoff value 2.5, P=0.045); (V) In NT, there was no significant difference in LN SUVmax between pathologically negative and positive LNs. However, in non-NT, the LN SUVmax of pathologically positive LNs was significantly higher than that of pathologically negative LNs (P=0.042); (VI) There were no significant differences in tumor and LN SUVmax according to various factors, including chronic lung disease (COPD, bronchiectasis), age, previous cancers, and sex, regardless of NT.

CONCLUSIONS

This study showed that there were some different findings of PET-CT using SUVmax between NT and non-NT. These findings should be clarified for further evaluation and management, especially of surgery, which should not be withheld out of ignorance of these different PET-CT findings and should be considered carefully in conjunction with other conditions. In addition, further studies about the effects of NT on PET-CT findings are required to improve the utility of PET-CT to evaluate the LNs in esophageal cancer.