Blackstock A William, Farmer Michael R, Lovato James, Mishra Girish, Melin Susan A, Oaks Timothy, Aklilu Mabea, Clark Paige B, Levine Edward A
Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA.
Int J Radiat Oncol Biol Phys. 2006 Feb 1;64(2):455-60. doi: 10.1016/j.ijrobp.2005.07.959. Epub 2005 Oct 5.
To determine the impact of 18-F-fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) in the staging and prognosis of patients with locally advanced esophageal cancer (LAEC).
Between January 2000 and October 2004, all patients with LAEC evaluated in the Department of Radiation Oncology were considered for enrollment into a Phase II trial of preoperative chemoradiation. Entry required a staging whole-body FDG-PET scan.
One hundred ten consecutive patients were evaluated; 38 were ineligible for reasons including treatment elsewhere, prior malignancy, or refusal of treatment. After conventional staging (clinical examination, endoscopic ultrasound, and chest/abdominal computerized tomography), 33 patients were ineligible because of metastatic disease or poor performance status. Of the remaining 39 patients, 23 were confirmed to have LAEC after FDG-PET staging and were treated in the Phase II trial (Cohort I). Sixteen patients, however, had FDG-PET findings consistent with occult metastatic disease and were deemed ineligible for the trial but were treated with curative intent (Cohort II). The 2-year survival rate for the 23 patients in Cohort I was 64%, compared with 17% (p=0.003) for patients in Cohort II (FDG-PET positive).
More than one-third of patients determined to have LAEC with conventional staging were upstaged with the use of FDG-PET. Despite comparable therapy, upstaging with FDG-PET predicts poor 2-year survival.
确定18-F-氟脱氧-D-葡萄糖正电子发射断层扫描（FDG-PET）对局部晚期食管癌（LAEC）患者分期及预后的影响。
2000年1月至2004年10月期间，放射肿瘤学系评估的所有LAEC患者均被考虑纳入术前放化疗的II期试验。入组要求进行全身FDG-PET分期扫描。
连续评估了110例患者；38例因包括在其他地方接受治疗、既往有恶性肿瘤或拒绝治疗等原因而不符合条件。经过传统分期（临床检查、内镜超声和胸部/腹部计算机断层扫描）后，33例患者因转移性疾病或身体状况差而不符合条件。在其余39例患者中，23例经FDG-PET分期确诊为LAEC，并在II期试验中接受治疗（队列I）。然而，16例患者的FDG-PET检查结果与隐匿性转移性疾病一致，被认为不符合试验条件，但接受了根治性治疗（队列II）。队列I中23例患者的2年生存率为64%，而队列II（FDG-PET阳性）患者的2年生存率为17%（p = 0.003）。
超过三分之一经传统分期确定为LAEC的患者经FDG-PET检查后分期上调。尽管接受了类似的治疗，但FDG-PET分期上调预示着2年生存率较差。
