PET Finds More Esophageal Cancer Metastases

WASHINGTON — Positron emission tomography findings significantly altered the course of disease management in more than one-third of a group of patients with potentially curable esophageal and gastroesophageal cancers, according to findings from a prospective, multicenter, single-arm study presented at the annual meeting of the Society of Nuclear Medicine.

Dr. Barry E. Chatterton of Royal Adelaide Hospital, South Australia, and his colleagues reported that PET influenced the management of 38% of 129 patients with confirmed esophageal cancers (squamous cell carcinoma or adenocarcinoma) whose disease had already been diagnosed with conventional imaging (barium study, endoscopy, or CT).

Patients were referred from five hospitals, and all had undergone endoscopy and biopsy, with proven histology. Most patients were male (104 patients), and the mean age was 67 years (range 36–87). Most tumors were in the distal esophagus.

To participate in the study, patients were required to have documented esophageal cancer and no unequivocal distant metastatic disease seen with other imaging modalities. Patients who were pregnant or had uncontrolled diabetes were excluded.

Referring physicians were asked for their management plans before and after receiving the PET results and were asked whether the treatment goal was cure or palliation. Impact of the PET results on disease management was classified as none, low, medium, or high.

The investigators found that PET revealed 148 additional lesions in 53 (41%) of the 129 patients. For an additional 22% of the total population, disease was upstaged from M0 to M1.

PET also detected local metastasis in 70% of patients and distant metastasis in 44% of patients, compared with 67% and 33%, respectively, in a subset of 20 patients who also underwent endoscopic ultrasound.

The impact on disease management was considered medium to high in 38% of cases. Curative intent was changed to palliative intent in 20% based on PET results, and from palliative to curative in 3%.

Surprisingly, Dr. Chatterton said, there was no difference in progression-free survival between patients with high and low standardized uptake values.

Dr. Chatterton cautioned that these results do not in his view warrant replacement of CT or ultrasound by PET, “because a lot of the patients with widespread disease were excluded by diagnostic CT beforehand. I think that with the relative costs of diagnostic CT and PET-CT in Australia … most patients will continue to have diagnostic CT with contrast before they come to [get] PET, because at least half of them will be found to have inoperable disease. So I don't think it will be regarded as the initial imaging study after biopsy.”

The study was funded by the Australian government as part of the Australian PET Data Collection Project.

Shown are FDG-PET maximum intensity projection (left) and orthogonal coronal, transverse, and sagittal PET/CT images of a patient with a primary esophageal cancer, with spread to the liver and lumbar vertebra. Images courtesy Dr. Barry E. Chatterton

PET influenced the management of 38% of 129 patients with confirmed esophageal cancers. DR. CHATTERTON

WASHINGTON — Positron emission tomography findings significantly altered the course of disease management in more than one-third of a group of patients with potentially curable esophageal and gastroesophageal cancers, according to findings from a prospective, multicenter, single-arm study presented at the annual meeting of the Society of Nuclear Medicine.

Dr. Barry E. Chatterton of Royal Adelaide Hospital, South Australia, and his colleagues reported that PET influenced the management of 38% of 129 patients with confirmed esophageal cancers (squamous cell carcinoma or adenocarcinoma) whose disease had already been diagnosed with conventional imaging (barium study, endoscopy, or CT).

Patients were referred from five hospitals, and all had undergone endoscopy and biopsy, with proven histology. Most patients were male (104 patients), and the mean age was 67 years (range 36–87). Most tumors were in the distal esophagus.

To participate in the study, patients were required to have documented esophageal cancer and no unequivocal distant metastatic disease seen with other imaging modalities. Patients who were pregnant or had uncontrolled diabetes were excluded.

Referring physicians were asked for their management plans before and after receiving the PET results and were asked whether the treatment goal was cure or palliation. Impact of the PET results on disease management was classified as none, low, medium, or high.

The investigators found that PET revealed 148 additional lesions in 53 (41%) of the 129 patients. For an additional 22% of the total population, disease was upstaged from M0 to M1.

PET also detected local metastasis in 70% of patients and distant metastasis in 44% of patients, compared with 67% and 33%, respectively, in a subset of 20 patients who also underwent endoscopic ultrasound.

The impact on disease management was considered medium to high in 38% of cases. Curative intent was changed to palliative intent in 20% based on PET results, and from palliative to curative in 3%.

Surprisingly, Dr. Chatterton said, there was no difference in progression-free survival between patients with high and low standardized uptake values.

Dr. Chatterton cautioned that these results do not in his view warrant replacement of CT or ultrasound by PET, “because a lot of the patients with widespread disease were excluded by diagnostic CT beforehand. I think that with the relative costs of diagnostic CT and PET-CT in Australia … most patients will continue to have diagnostic CT with contrast before they come to [get] PET, because at least half of them will be found to have inoperable disease. So I don't think it will be regarded as the initial imaging study after biopsy.”

The study was funded by the Australian government as part of the Australian PET Data Collection Project.

Shown are FDG-PET maximum intensity projection (left) and orthogonal coronal, transverse, and sagittal PET/CT images of a patient with a primary esophageal cancer, with spread to the liver and lumbar vertebra. Images courtesy Dr. Barry E. Chatterton

PET influenced the management of 38% of 129 patients with confirmed esophageal cancers. DR. CHATTERTON

WASHINGTON — Positron emission tomography findings significantly altered the course of disease management in more than one-third of a group of patients with potentially curable esophageal and gastroesophageal cancers, according to findings from a prospective, multicenter, single-arm study presented at the annual meeting of the Society of Nuclear Medicine.

Dr. Barry E. Chatterton of Royal Adelaide Hospital, South Australia, and his colleagues reported that PET influenced the management of 38% of 129 patients with confirmed esophageal cancers (squamous cell carcinoma or adenocarcinoma) whose disease had already been diagnosed with conventional imaging (barium study, endoscopy, or CT).

Patients were referred from five hospitals, and all had undergone endoscopy and biopsy, with proven histology. Most patients were male (104 patients), and the mean age was 67 years (range 36–87). Most tumors were in the distal esophagus.

To participate in the study, patients were required to have documented esophageal cancer and no unequivocal distant metastatic disease seen with other imaging modalities. Patients who were pregnant or had uncontrolled diabetes were excluded.

Referring physicians were asked for their management plans before and after receiving the PET results and were asked whether the treatment goal was cure or palliation. Impact of the PET results on disease management was classified as none, low, medium, or high.

The investigators found that PET revealed 148 additional lesions in 53 (41%) of the 129 patients. For an additional 22% of the total population, disease was upstaged from M0 to M1.

PET also detected local metastasis in 70% of patients and distant metastasis in 44% of patients, compared with 67% and 33%, respectively, in a subset of 20 patients who also underwent endoscopic ultrasound.

The impact on disease management was considered medium to high in 38% of cases. Curative intent was changed to palliative intent in 20% based on PET results, and from palliative to curative in 3%.

Surprisingly, Dr. Chatterton said, there was no difference in progression-free survival between patients with high and low standardized uptake values.

Dr. Chatterton cautioned that these results do not in his view warrant replacement of CT or ultrasound by PET, “because a lot of the patients with widespread disease were excluded by diagnostic CT beforehand. I think that with the relative costs of diagnostic CT and PET-CT in Australia … most patients will continue to have diagnostic CT with contrast before they come to [get] PET, because at least half of them will be found to have inoperable disease. So I don't think it will be regarded as the initial imaging study after biopsy.”

The study was funded by the Australian government as part of the Australian PET Data Collection Project.

Shown are FDG-PET maximum intensity projection (left) and orthogonal coronal, transverse, and sagittal PET/CT images of a patient with a primary esophageal cancer, with spread to the liver and lumbar vertebra. Images courtesy Dr. Barry E. Chatterton

PET influenced the management of 38% of 129 patients with confirmed esophageal cancers. DR. CHATTERTON