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

被引:23
作者
Anderegg, Maarten C. J. [1 ]
de Groof, Elisabeth J. [1 ]
Gisbertz, Suzanne S. [1 ]
Bennink, Roel J. [2 ]
Lagarde, Sjoerd M. [1 ]
Klinkenbijl, Jean H. G. [1 ]
Dijkgraaf, Marcel G. W. [3 ]
Bergman, Jacques J. G. H. M. [4 ]
Hulshof, Maarten C. C. M. [5 ]
van Laarhoven, Hanneke W. M. [6 ]
Henegouwen, Mark I. van Berge [1 ]
机构
[1] Univ Amsterdam, Acad Med Ctr, Dept Surg, NL-1105 AZ Amsterdam, Netherlands
[2] Univ Amsterdam, Acad Med Ctr, Nucl Med, NL-1105 AZ Amsterdam, Netherlands
[3] Univ Amsterdam, Acad Med Ctr, Clin Res Unit, NL-1105 AZ Amsterdam, Netherlands
[4] Univ Amsterdam, Acad Med Ctr, Gastroenterl & Hepatol, NL-1105 AZ Amsterdam, Netherlands
[5] Univ Amsterdam, Acad Med Ctr, Radiat Oncol, NL-1105 AZ Amsterdam, Netherlands
[6] Univ Amsterdam, Acad Med Ctr, Med Oncol, NL-1105 AZ Amsterdam, Netherlands
关键词
POSITRON-EMISSION-TOMOGRAPHY; COMPUTED-TOMOGRAPHY; THORACIC ESOPHAGUS; CARCINOMA; IMPACT; INTERVAL; UTILITY; RECOMMENDATIONS; CHEMOTHERAPY; METASTASES;
D O I
10.1371/journal.pone.0133690
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
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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页数:14
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