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. 2015 Nov 3;10(11):e0133690.
doi: 10.1371/journal.pone.0133690. eCollection 2015.

18F-FDG PET-CT after Neoadjuvant Chemoradiotherapy in Esophageal Cancer Patients to Optimize Surgical Decision Making

Maarten C J Anderegg  1 , Elisabeth J de Groof  1 , Suzanne S Gisbertz  1 , Roel J Bennink  2 , Sjoerd M Lagarde  1 , Jean H G Klinkenbijl  1 , Marcel G W Dijkgraaf  3 , Jacques J G H M Bergman  4 , Maarten C C M Hulshof  5 , Hanneke W M van Laarhoven  6 , Mark I van Berge Henegouwen  1
Affiliations

18F-FDG PET-CT after Neoadjuvant Chemoradiotherapy in Esophageal Cancer Patients to Optimize Surgical Decision Making

Maarten C J Anderegg et al. PLoS One. .

Abstract

Background: Prognosis of esophageal cancer patients can be significantly improved by neoadjuvant chemoradiotherapy (nCRT). Given the aggressive nature of esophageal tumors, it is conceivable that in a significant portion of patients treated with nCRT, dissemination already becomes manifest during the period of nCRT. The aim of this retrospective study was to determine the value and diagnostic accuracy of PET-CT after neoadjuvant chemoradiotherapy to identify patients with metastases preoperatively in order to prevent non-curative surgery.

Methods: From January 2011 until February 2013 esophageal cancer patients deemed eligible for a curative approach with nCRT and surgical resection underwent a PET-CT after completion of nCRT. If abnormalities on PET-CT were suspected metastases, histological proof was acquired. A clinical decision model was designed to assess the cost-effectiveness of this diagnostic strategy.

Results: 156 patients underwent a PET-CT after nCRT. In 31 patients (19.9%) PET-CT showed abnormalities suspicious for dissemination, resulting in 17 cases of proven metastases (10.9%). Of the patients without proven metastases 133 patients were operated. In 6 of these 133 cases distant metastases were detected intraoperatively, corresponding to 4.5% false-negative results. The standard introduction of a post-neoadjuvant therapy PET-CT led to a reduction of overall health care costs per patient compared to a scenario without restaging with PET-CT ($34,088 vs. $36,490).

Conclusion: In 10.9% of esophageal cancer patients distant metastases were detected by standard PET-CT after neoadjuvant chemoradiotherapy. To avoid non-curative resections we advocate post-neoadjuvant therapy PET-CT as a cost-effective step in the standard work-up of candidates for surgery.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of clinical course of patients who underwent restaging PET-CT.
Fig 2
Fig 2. Examples of metastatic disease detected with restaging PET-CT.
Examples of interval metastases on restaging PET-CT located in a supraclavicular lymph node (I), the right iliac body (II) and the liver (III). Panel A and B represent axial CT images before and after fusion with PET, respectively.
Fig 3
Fig 3. Decision model reflecting a non-restaging scenario and a scenario in which restaging with PET-CT is performed.
See this image and copyright information in PMC

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