A prospective evaluation of the utility of 2‐deoxy‐2‐[¹⁸F]fluoro‐D‐glucose positron emission tomography and computed tomography in staging locally advanced gastric cancer

Abstract

BACKGROUND: The aim of this study was to examine prospectively the utility of adding preoperative [18F]fluorodeoxyglucose positron emission tomography (FDG‐PET)/computed tomography (CT) to routine CT, endoscopic ultrasound (EUS), and laparoscopic staging of localized gastric cancer. METHODS: Patients with locally advanced gastric/gastroesophageal cancer were screened for 2 institutional review board–approved Memorial Sloan‐Kettering Cancer Center neoadjuvant chemotherapy protocols. Locally advanced disease was defined as T3 or T4, or lymph node–positive, based on EUS and high‐resolution CT scan. All patients underwent both standard FDG‐PET/CT and laparoscopy with cytological examination of washings. The sensitivity and specificity of FDG‐PET/CT for the identification of metastatic disease not seen on CT was determined. An economic model using Medicare/Medicaid reimbursement charges was developed to assess the cost‐effectiveness of these interventions. RESULTS: A total of 113 patients were enrolled from 2003 to 2010. All patients were assessed as having locally advanced disease by CT/EUS. FDG uptake in the primary tumor was associated with male sex, proximal tumors, and nondiffuse Lauren's subtype. 31 (27%) patients had occult metastatic disease detected by PET/CT (n = 11, 10%) and/or laparoscopy (n = 21, 19%), with a single overlap. Economic modeling suggests that the addition of FDG‐PET/CT to the standard staging evaluation of patients with locally advanced gastric cancer resulted in an estimated cost savings of ∼US $13,000 per patient. CONCLUSIONS: FDG‐PET/CT identifies occult metastatic lesions in approximately 10% of patients with locally advanced gastric cancer. Because of reduced morbidity from fewer futile surgeries and lower patient care costs, PET/CT should be considered as a component of the standard staging algorithm for localized gastric cancer. Cancer 2012. © 2012 American Cancer Society.

Advances in the management of esophageal cancer

“…The 5-year survival rate for patients treated with conventional doses of radiation therapy alone is 0-10% [1-3]. In the radiation therapy alone arm of the RTOG 85-01 trial in which patients received 64 Gy at 2 Gy/day with conventional techniques, all patients were all dead of disease by 3 years [4,5] …”

“…These included 58% grade 3, 26% grade 4, and 8% grade 5 (treatment-related death). The Minsky Advances in the management of esophageal cancer Marmara Medical Journal 2015; 28 (Special issue 1): [3][4][5][6][7][8][9][10] cumulative incidence of fistula was 18%/year and the crude incidence was 14%. Of the 6 treatment related fistulas, 3 were fatal.…”

“…Although 11 treatment-related deaths occurred in the high dose arm compared with two in the standard dose arm, seven of the 11 occurred in patients who had received ≤ 50. 4 Gy.…”

“…In this trial, 172 eligible patients < 70 years old with uT3-4N0-1M0 SCC were randomized to preoperative therapy (3 cycles of 5-FU, leucovorin, etoposide, and cisplatin, Minsky Advances in the management of esophageal cancer Marmara Medical Journal 2015; 28 (Special issue 1): [3][4][5][6][7][8][9][10] followed by concurrent etoposide, cisplatin, plus 40 Gy) followed by surgery versus chemoradiation alone (the same chemotherapy but the radiation dose was increased to 60-65 Gy +/-brachytherapy). The pCR rate was 33%.…”

Adjuvant or neoadjuvant therapy for operable esophagogastric cancer?

“…Many esophagogastric adenocarcinomas exhibit significant levels of FDG-uptake on PET-CT; however, this is less common in tumors of Lauren's diffuse subtype [31].…”