The predictive value of baseline fluoro-deoxy-glucose positron emission tomography (FDG-PET) standardized uptake value (SUV) for overall survival in patients (pts) with locally advanced esophageal and gastroesophageal junction (GEJ) cancer

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Background: The predictive value of FDG-PET SUV in pts with esophageal and GEJ cancer has been subject of recent interest. The heterogeneity of disease stages and treatments made interpretation of reported data difficult.We evaluated the value of baseline FDG-PET SUV in a homogeneous patient (pt) population treated in a uniform fashion. Methods: Retrospective analysis of 71 pts with stages II-IVa esophageal and GEJ cancer treated on 2 phase 2 trials at the Cleveland Clinic Foundation. Data was collected on baseline pt and tumor characteristics, baseline SUV uptake, and outcomes. Results: All pts were treated with preoperative concurrent fluorouracil/cisplatin chemoradiotherapy (CRT); 69 pts proceeded to esophagectomy and 58 pts received additional postoperative adjuvant CRT. Median pt age was 60 (range 33–75) years, 86% were male, 89% had adenocarcinoma, 35%, 41% and 24% had stage II, III and IVa disease respectively. Pts have been followed for a median of 14 (range 3–50) months. All pts underwent a baseline FDG-PET scan with a mean primary site SUV of 8.9 (range 0–28.2). Pathological response (complete or partial) was achieved after induction CRT in 54% and was more likely in those with a baseline primary site SUV ≥ 7.3 (OR: 3.95, 1.43–10.9, P=0.008). Recurrence developed in 33 pts (46.5%) with distant metastases identified in 31 of these 33. The Kaplan-Meier 2-year projected overall survival for all 71 pts is 58% with a median of 31 months. Mortality was less in pts with baseline SUV ≥ 5.0 (HR: 0.44, 0.20–0.94, P = 0.033). After adjusting for clinical stage at diagnosis, tumor location and histology, baseline SUV ≥ 5 was still predictive of improved survival in multivariate analysis (HR: 0.35, 0.15–0.85, P = 0.02). Conclusions: In this retrospective analysis, esophageal and GEJ cancer pts with a higher baseline primary site SUV were more likely to respond to induction CRT and had better overall survival. This observation suggests that the subset of pts with more metabolically active tumor may derive greater benefit from multimodality treatments that include CRT. A prospectively designed trial would be required to confirm this hypothesis.

No significant financial relationships to disclose.

PET Detection of Solitary Distant Skeletal Muscle Metastasis of Esophageal Adenocarcinoma

A 67-year-old man with progressive dysphagia was recently diagnosed with a gastroesophageal junction adenocarcinoma. Contrast-enhanced CT scans of the abdomen and pelvis reported a large GE junction tumor without evidence of metastatic disease. FDG positron emission tomography revealed intense tracer accumulation in the soft tissue mass at the GE junction consistent with the primary neoplasm. In addition, PET scan also identified a solitary focus of intense FDG accumulation at the musculotendinous junction of the right gluteus minimus muscle. Subsequent MRI demonstrated mild enhancement and could not differentiate between tumor versus inflammation. Needle biopsy was performed and confirmed metastatic esophageal adenocarcinoma. A case of skeletal muscle metastases from late-stage (IV) gastroesophageal adenocarcinoma was previously reported. However, a solitary metastasis to a distant skeletal muscle without evidence of other lymphatic and hematogenous metastasis is quite unusual. The case supports the previous report that PET is superior in detecting distant metastases for initial staging of esophageal carcinoma over CT.

Lymphoscintigraphy using (99m)Tc filtered sulfur colloid in chylothorax: a case report

OBJECTIVE

A 66-y-old man was diagnosed with esophageal carcinoma and underwent a right thoracotomy and esophagectomy. Postoperatively, a recurring right pleural effusion developed. Because an attempt at lymphangiography failed, lymphoscintigraphy was suggested. Because of the inability to obtain radiolabeled albumin, dextran, or nanocolloid, we used filtered sulfur colloid. (0.1 um). The study confirmed the diagnosis of chylothorax.

Contamination of a bracelet following iodine-131 therapy: a case report

A 73-y-old patient who had thyroid carcinoma had a post-treatment, whole-body 131I scan. The scan demonstrated an artifact caused by a bracelet contaminated with radioactive perspiration. This finding resulted in an artifact on the scan and had potential radiation safety implications.

Radiation safety when a patient dies after therapy

OBJECTIVE

When a patient dies a short time after radionuclide therapy, several issues arise due to the shifting of responsibility from patient care to protection of the public, while respecting societal values and rites. Such a situation occurred in our institution after administering a large therapeutic dose of 131I for metastatic thyroid cancer. The requirements of safe practice, the shift accountability, the ethical aspects and forthcoming changes in the regulatory constraints are discussed.

Intraperitoneal urine leak following renal transplant

A 47-year-old man with chronic renal failure underwent renal transplantation. He remained anuric and was diagnosed with an intraperitoneal urine leak by Tc-99m MAG3 renal scintigraphy. The diagnosis was confirmed by imaging fluid withdrawn via the peritoneal dialysis catheter.

Short-term memory and cognitive variability in adult fragile X females

We investigated the possibility that adult fragile X [fra(X)] heterozygotes have a distinct or specific cognitive profile, with a particular focus on visuospatial and/or memory deficits. With a sample of 13 adult fra(X) female carriers (2 fra(X) positive) and age-matched control women, we performed 2 tests: Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the Revised Visual Retention Test (RVRT). An identifiable cognitive profile was not evident in the study group, but significant differences were evident in RVRT performance in number correct and number of errors when compared to controls and normative data. The combination of the WAIS-R and RVRT data suggests that the short-term memory component of the tasks may be of more significance than visuospatial performance in the deficits observed.