Restaging oesophageal cancer after neoadjuvant therapy with 18F-FDG PET-CT: identifying interval metastases and predicting incurable disease at surgery

Findlay, John M., Gillies, Richard S., Franklin, James M., Teoh, Eugene J., Jones, Greg E., di Carlo, Sara, Gleeson, Fergus V., Maynard, Nicholas D., Bradley, Kevin M. ORCID: https://orcid.org/0000-0003-1911-3382 and Middleton, Mark R. 2016. Restaging oesophageal cancer after neoadjuvant therapy with 18F-FDG PET-CT: identifying interval metastases and predicting incurable disease at surgery. European Radiology 26 (10) , pp. 3519-3533. 10.1007/s00330-016-4227-4

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Abstract

Objectives It is unknown whether restaging oesophageal cancer after neoadjuvant therapy with positron emission tomography-computed tomography (PET-CT) is more sensitive than contrast-enhanced CT for disease progression. We aimed to determine this and stratify risk. Methods This was a retrospective study of patients staged before neoadjuvant chemotherapy (NAC) by 18F-FDG PET-CT and restaged with CT or PET-CT in a single centre (2006-2014). Results Three hundred and eighty-three patients were restaged (103 CT, 280 PET-CT). Incurable disease was detected by CT in 3 (2.91 %) and PET-CT in 17 (6.07 %). Despite restaging unsuspected incurable disease was encountered at surgery in 34/336 patients (10.1 %). PET-CT was more sensitive than CT (p = 0.005, McNemar’s test). A new classification of FDG-avid nodal stage (mN) before NAC (plus tumour FDG-avid length) predicted subsequent progression, independent of conventional nodal stage. The presence of FDG-avid nodes after NAC and an impassable tumour stratified risk of incurable disease at surgery into high (75.0 %; both risk factors), medium (22.4 %; either), and low risk (3.87 %; neither) groups (p < 0.001). Decision theory supported restaging PET-CT. Conclusions PET-CT is more sensitive than CT for detecting interval progression; however, it is insufficient in at least higher risk patients. mN stage and response (mNR) plus primary tumour characteristics can stratify this risk simply.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Springer Verlag (Germany)
ISSN:	0938-7994
Date of Acceptance:	15 January 2016
Last Modified:	07 Nov 2022 10:21
URI:	https://orca.cardiff.ac.uk/id/eprint/132009

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