Detection of interval distant metastases

Clinical utility of integrated CT-PET imaging in patients with esophageal carcinoma after neoadjuvant therapy

John F. Bruzzi, Stephen G. Swisher, Mylene T. Truong, Reginald F. Munden, Wayne L. Hofstetter, Homer A. Macapinlac, Arlene M. Correa, Osama Mawlawi, Jaffer A. Ajani, Ritsoko R. Komaki, Norio Fukami, Jeremy J. Erasmus

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Abstract

BACKGROUND. The objective of the study was to determine the utility of integrated computed tomography / positron emission tomography (CT-PET) imaging for detecting interval distant metastases and assessing therapeutic response in patients with locally advanced, potentially resectable esophageal carcinoma after neoadjuvant therapy. METHODS. A retrospective study was performed of 88 patients with potentially resectable esophageal carcinoma who received neoadjuvant therapy before planned surgical resection. CT-PET before and after completion of neoadjuvant was used for evaluating therapeutic response; response criteria were based on qualitative and semiquantitative analyses. RESULTS. Neoadjuvant therapy comprised chemoradiotherapy in 85 patients, with prior induction chemotherapy in 39 patients. Fifty-five patients proceeded to esophagectomy. Repeat CT-PET was performed after induction chemotherapy (n = 23) and after completing chemoradiotherapy (n = 85). CT-PET identified the interval appearance of metastatic disease in 7 (8%) patients. For assessment of locoregional therapeutic response, CT-PET was unable to predict pathological response to neoadjuvant therapy in the primary tumor or locoregional lymph nodes. CT-PET had sensitivity, specificity, and positive and negative predictive values of 57%, 46%, 39%, and 64%, respectively, for detection of residual macroscopic malignancy within the primary tumor; and sensitivity, specificity, and positive and negative predictive values of 0%, 90%, 0%, and 69% for detection of residual malignancy within resected lymph nodes. CONCLUSION. CT-PET performed after neoadjuvant therapy in patients with potentially resectable esophageal carcinoma is important for detecting interval metastases that preclude surgical resection, but is of limited utility for assessing locoregional therapeutic response.

Original languageEnglish (US)
Pages (from-to)125-134
Number of pages10
JournalCancer
Volume109
Issue number1
DOIs
StatePublished - Jan 1 2007
Externally publishedYes

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Neoadjuvant Therapy
Neoplasm Metastasis
Carcinoma
Induction Chemotherapy
Chemoradiotherapy
Neoplasms
Lymph Nodes
Sensitivity and Specificity
Esophagectomy
Therapeutics
Positron Emission Tomography Computed Tomography
Retrospective Studies

Keywords

  • CT-PET
  • Esophageal cancer
  • Neoadjuvant therapy
  • Staging

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Bruzzi, J. F., Swisher, S. G., Truong, M. T., Munden, R. F., Hofstetter, W. L., Macapinlac, H. A., ... Erasmus, J. J. (2007). Detection of interval distant metastases: Clinical utility of integrated CT-PET imaging in patients with esophageal carcinoma after neoadjuvant therapy. Cancer, 109(1), 125-134. https://doi.org/10.1002/cncr.22397

Detection of interval distant metastases : Clinical utility of integrated CT-PET imaging in patients with esophageal carcinoma after neoadjuvant therapy. / Bruzzi, John F.; Swisher, Stephen G.; Truong, Mylene T.; Munden, Reginald F.; Hofstetter, Wayne L.; Macapinlac, Homer A.; Correa, Arlene M.; Mawlawi, Osama; Ajani, Jaffer A.; Komaki, Ritsoko R.; Fukami, Norio; Erasmus, Jeremy J.

In: Cancer, Vol. 109, No. 1, 01.01.2007, p. 125-134.

Research output: Contribution to journalArticle

Bruzzi, JF, Swisher, SG, Truong, MT, Munden, RF, Hofstetter, WL, Macapinlac, HA, Correa, AM, Mawlawi, O, Ajani, JA, Komaki, RR, Fukami, N & Erasmus, JJ 2007, 'Detection of interval distant metastases: Clinical utility of integrated CT-PET imaging in patients with esophageal carcinoma after neoadjuvant therapy', Cancer, vol. 109, no. 1, pp. 125-134. https://doi.org/10.1002/cncr.22397
Bruzzi, John F. ; Swisher, Stephen G. ; Truong, Mylene T. ; Munden, Reginald F. ; Hofstetter, Wayne L. ; Macapinlac, Homer A. ; Correa, Arlene M. ; Mawlawi, Osama ; Ajani, Jaffer A. ; Komaki, Ritsoko R. ; Fukami, Norio ; Erasmus, Jeremy J. / Detection of interval distant metastases : Clinical utility of integrated CT-PET imaging in patients with esophageal carcinoma after neoadjuvant therapy. In: Cancer. 2007 ; Vol. 109, No. 1. pp. 125-134.
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abstract = "BACKGROUND. The objective of the study was to determine the utility of integrated computed tomography / positron emission tomography (CT-PET) imaging for detecting interval distant metastases and assessing therapeutic response in patients with locally advanced, potentially resectable esophageal carcinoma after neoadjuvant therapy. METHODS. A retrospective study was performed of 88 patients with potentially resectable esophageal carcinoma who received neoadjuvant therapy before planned surgical resection. CT-PET before and after completion of neoadjuvant was used for evaluating therapeutic response; response criteria were based on qualitative and semiquantitative analyses. RESULTS. Neoadjuvant therapy comprised chemoradiotherapy in 85 patients, with prior induction chemotherapy in 39 patients. Fifty-five patients proceeded to esophagectomy. Repeat CT-PET was performed after induction chemotherapy (n = 23) and after completing chemoradiotherapy (n = 85). CT-PET identified the interval appearance of metastatic disease in 7 (8{\%}) patients. For assessment of locoregional therapeutic response, CT-PET was unable to predict pathological response to neoadjuvant therapy in the primary tumor or locoregional lymph nodes. CT-PET had sensitivity, specificity, and positive and negative predictive values of 57{\%}, 46{\%}, 39{\%}, and 64{\%}, respectively, for detection of residual macroscopic malignancy within the primary tumor; and sensitivity, specificity, and positive and negative predictive values of 0{\%}, 90{\%}, 0{\%}, and 69{\%} for detection of residual malignancy within resected lymph nodes. CONCLUSION. CT-PET performed after neoadjuvant therapy in patients with potentially resectable esophageal carcinoma is important for detecting interval metastases that preclude surgical resection, but is of limited utility for assessing locoregional therapeutic response.",
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T1 - Detection of interval distant metastases

T2 - Clinical utility of integrated CT-PET imaging in patients with esophageal carcinoma after neoadjuvant therapy

AU - Bruzzi, John F.

AU - Swisher, Stephen G.

AU - Truong, Mylene T.

AU - Munden, Reginald F.

AU - Hofstetter, Wayne L.

AU - Macapinlac, Homer A.

AU - Correa, Arlene M.

AU - Mawlawi, Osama

AU - Ajani, Jaffer A.

AU - Komaki, Ritsoko R.

AU - Fukami, Norio

AU - Erasmus, Jeremy J.

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N2 - BACKGROUND. The objective of the study was to determine the utility of integrated computed tomography / positron emission tomography (CT-PET) imaging for detecting interval distant metastases and assessing therapeutic response in patients with locally advanced, potentially resectable esophageal carcinoma after neoadjuvant therapy. METHODS. A retrospective study was performed of 88 patients with potentially resectable esophageal carcinoma who received neoadjuvant therapy before planned surgical resection. CT-PET before and after completion of neoadjuvant was used for evaluating therapeutic response; response criteria were based on qualitative and semiquantitative analyses. RESULTS. Neoadjuvant therapy comprised chemoradiotherapy in 85 patients, with prior induction chemotherapy in 39 patients. Fifty-five patients proceeded to esophagectomy. Repeat CT-PET was performed after induction chemotherapy (n = 23) and after completing chemoradiotherapy (n = 85). CT-PET identified the interval appearance of metastatic disease in 7 (8%) patients. For assessment of locoregional therapeutic response, CT-PET was unable to predict pathological response to neoadjuvant therapy in the primary tumor or locoregional lymph nodes. CT-PET had sensitivity, specificity, and positive and negative predictive values of 57%, 46%, 39%, and 64%, respectively, for detection of residual macroscopic malignancy within the primary tumor; and sensitivity, specificity, and positive and negative predictive values of 0%, 90%, 0%, and 69% for detection of residual malignancy within resected lymph nodes. CONCLUSION. CT-PET performed after neoadjuvant therapy in patients with potentially resectable esophageal carcinoma is important for detecting interval metastases that preclude surgical resection, but is of limited utility for assessing locoregional therapeutic response.

AB - BACKGROUND. The objective of the study was to determine the utility of integrated computed tomography / positron emission tomography (CT-PET) imaging for detecting interval distant metastases and assessing therapeutic response in patients with locally advanced, potentially resectable esophageal carcinoma after neoadjuvant therapy. METHODS. A retrospective study was performed of 88 patients with potentially resectable esophageal carcinoma who received neoadjuvant therapy before planned surgical resection. CT-PET before and after completion of neoadjuvant was used for evaluating therapeutic response; response criteria were based on qualitative and semiquantitative analyses. RESULTS. Neoadjuvant therapy comprised chemoradiotherapy in 85 patients, with prior induction chemotherapy in 39 patients. Fifty-five patients proceeded to esophagectomy. Repeat CT-PET was performed after induction chemotherapy (n = 23) and after completing chemoradiotherapy (n = 85). CT-PET identified the interval appearance of metastatic disease in 7 (8%) patients. For assessment of locoregional therapeutic response, CT-PET was unable to predict pathological response to neoadjuvant therapy in the primary tumor or locoregional lymph nodes. CT-PET had sensitivity, specificity, and positive and negative predictive values of 57%, 46%, 39%, and 64%, respectively, for detection of residual macroscopic malignancy within the primary tumor; and sensitivity, specificity, and positive and negative predictive values of 0%, 90%, 0%, and 69% for detection of residual malignancy within resected lymph nodes. CONCLUSION. CT-PET performed after neoadjuvant therapy in patients with potentially resectable esophageal carcinoma is important for detecting interval metastases that preclude surgical resection, but is of limited utility for assessing locoregional therapeutic response.

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KW - Esophageal cancer

KW - Neoadjuvant therapy

KW - Staging

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