BACKGROUND AND PURPOSE: To determine the additional value of FDG-positron emission tomography (PET) to optimize delineation of the clinical target volume (CTV) in patients with advanced esophageal carcinoma. METHODS AND MATERIALS: The imaging and radiotherapy data from 30 patients with an advanced esophageal carcinoma were analysed. The lymph node classification for esophageal cancer was modified and translated into anatomical volumes on computed tomography (CT). The so defined 14 different regions were scored individually for lymph node involvement on CT, endoscopic ultrasound (EUS) and FDG-PET. The influence of discordant findings between conventional and functional imaging on the decision as to what should be irradiated was assessed. RESULTS: In 14 of the 30 patients (47%) discordances were found in detection of the pathological lymph nodes between CT/EUS and FDG-PET. In 8 patients, 9 lymph node regions were found with pathologic nodes on conventional imaging only. In three of these patients the influence of FDG-PET findings would have led to a decrease of the irradiated volume. In 6 patients, 8 lymph node regions were found with a normal CT/EUS and pathologic nodes on FDG-PET. In three of these patients (10%) the influence of the FDG-PET would have led to enlargement of the irradiated volume. CONCLUSIONS: The chance of a false negative result on FGD-PET is not negligible; therefore, the irradiated volume should not be reduced based on a negative FDG-PET in a region with suspect nodes on other investigations. However, due to the high specificity of FDG-PET enlarging the irradiated volume based on a positive FDG-PET in a region without suspected lymph nodes on CT and/or EUS should be considered. This indicates a role for FDG-PET in radiotherapy planning for esophageal cancer.
BACKGROUND AND PURPOSE: To determine the additional value of FDG-positron emission tomography (PET) to optimize delineation of the clinical target volume (CTV) in patients with advanced esophageal carcinoma. METHODS AND MATERIALS: The imaging and radiotherapy data from 30 patients with an advanced esophageal carcinoma were analysed. The lymph node classification for esophageal cancer was modified and translated into anatomical volumes on computed tomography (CT). The so defined 14 different regions were scored individually for lymph node involvement on CT, endoscopic ultrasound (EUS) and FDG-PET. The influence of discordant findings between conventional and functional imaging on the decision as to what should be irradiated was assessed. RESULTS: In 14 of the 30 patients (47%) discordances were found in detection of the pathological lymph nodes between CT/EUS and FDG-PET. In 8 patients, 9 lymph node regions were found with pathologic nodes on conventional imaging only. In three of these patients the influence of FDG-PET findings would have led to a decrease of the irradiated volume. In 6 patients, 8 lymph node regions were found with a normal CT/EUS and pathologic nodes on FDG-PET. In three of these patients (10%) the influence of the FDG-PET would have led to enlargement of the irradiated volume. CONCLUSIONS: The chance of a false negative result on FGD-PET is not negligible; therefore, the irradiated volume should not be reduced based on a negative FDG-PET in a region with suspect nodes on other investigations. However, due to the high specificity of FDG-PET enlarging the irradiated volume based on a positive FDG-PET in a region without suspected lymph nodes on CT and/or EUS should be considered. This indicates a role for FDG-PET in radiotherapy planning for esophageal cancer.
Authors: Andre Konski; Tianyu Li; Michael Christensen; Jonathan D Cheng; Jian Q Yu; Kevin Crawford; Oleh Haluszka; Jeffrey Tokar; Walter Scott; Neal J Meropol; Steven J Cohen; Alan Maurer; Gary M Freedman Journal: Radiother Oncol Date: 2012-06-07 Impact factor: 6.280
Authors: Milan Vosmik; Jiri Petera; Igor Sirak; Miroslav Hodek; Petr Paluska; Jiri Dolezal; Marcela Kopacova Journal: World J Gastroenterol Date: 2010-11-28 Impact factor: 5.742
Authors: E Jimenez-Jimenez; P Mateos; N Aymar; R Roncero; I Ortiz; M Gimenez; J Pardo; J Salinas; S Sabater Journal: Clin Transl Oncol Date: 2018-05-02 Impact factor: 3.405
Authors: Christopher P Twine; Wyn G Lewis; Xavier Escofet; David Bosanquet; S Ashley Roberts Journal: Surg Endosc Date: 2009-05-14 Impact factor: 4.584