TITLE

THE ACCURACY OF EUS, HCT AND PET IN RE-STAGING OF OESOPHAGEAL CANCER FOLLOWING CHEMOTHERAPY

AUTHOR(S)
Meenan, J.; Rankin, S.; Marx, G.; Harper, P.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA31
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
The best approach to re-staging oesophageal cancer following chemotherapy is unknown. Potential limitations exist for all imaging modalities: hCT and EUS cannot differentiate between viable tumour and inflammation, whereas although PET scanning may detect remnant malignancy, it lacks spatial resolution. The purpose of this study was to compare the accuracy of CT, EUS, and PET scanning in the assessment of oesophageal tumour response to chemotherapy using pathological correlation. Initial results are presented. 12 oesophageal cancer cases underwent CT, EUS, and FDG-PET before and after 3 cycles of ECF chemotherapy. The follow up FDG-PET was performed at least 4 weeks after the end of the 5FU and 8 weeks after the E/C. Quantitative PET data using standard uptake values (SUV) were measured. Results were compared with surgical pathological findings. Baseline EUS gave initial T stage as T4 in 2, T3 in 9 and T2 in 1 patient. Ten patients were staged as N1 and 2 as NO. CT and EUS concurred in all the patients for nodal status with CT understaging the T stage in 3 patients. Initial PET identified all the tumours but was unable to T stage accurately and identified only 5 of the N1 patients. 10 patients underwent oesophagectomy. The two remaining cases did not undergo surgery due to early death and disease progression. Of the 10 surgical patients, only 2 had responded. CT identified one of the responders correctly, overstaged the other and understaged 3/8 of the non-responders. EUS significantly overstaged one of the responders (1/2) and understaged 4/7 of the non-responders, particularly the N stage. Quantitative PET measurement of the reduction in tumour uptake was significantly different between the responders (-77% ± 6%) and the non-responders (-39% ± 22%), but FDG-PET underestimated nodal disease in 4 patients. Qualitative assessment alone using FDG-PET was unreliable as 2 non-responders were labelled responders. Neither CT nor EUS could accurately...
ACCESSION #
9747469

 

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