Shashi Kumar K, Madan Rachna, Hammer Mark M, van Hedent Steven, Byrne Suzanne C, Schmidlin Eric J, Mamon Harvey, Hatabu Hiroto, Enzinger Peter C, Gerbaudo Victor H
Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Faber Cancer Center, and Harvard Medical School, Boston, MA, USA.
Eur J Radiol Open. 2020 Dec 1;7:100291. doi: 10.1016/j.ejro.2020.100291. eCollection 2020.
A multidisciplinary team approach to the management of esophageal cancer patients leads to better clinical decisions.
The contribution of CT, endoscopic and laparoscopic ultrasound to clinical staging and treatment selection by multidisciplinary tumor boards (MTB) in patients with esophageal cancer is well documented. However, there is a paucity of data addressing the role that FDG-PET/CT (PET/CT) plays to inform the clinical decision-making process at MTB conferences. The aim of this study was to assess the impact and contribution of PET/CT to clinical management decisions and to the plan of care for esophageal cancer patients at the MTB conferences held at our institution.
This IRB approved study included all the cases discussed in the esophageal MTB meetings over a year period. The information contributed by PET/CT to MTB decision making was grouped into four categories. , no additional information provided for clinical management; , equivocal and misguiding information; , complementary information to other imaging modalities, and , information that directly changed clinical management. The overall impact on management was assessed retrospectively from prospectively discussed clinical histories, imaging, histopathology, and the official minutes of the MTB conferences.
79 patients (61 males and 18 females; median age, 61 years, range, 33-86) with esophageal cancer (53 adenocarcinomas and 26 squamous cell carcinomas) were included. The contribution of PET/CT-derived information was as follows: in 50 patients (63%); in 3 patients (4%); in 8 patients (10%), and information in 18 patients (23%). Forty-five patients (57%) had systemic disease, and in 5 (11%) of these, metastatic disease was only detected by PET/CT. In addition, PET/CT detected previously unknown recurrence in 4 (9%) of 43 patients. In summary, PET/CT provided clinically useful information to guide management in 26 of 79 esophageal cancer patients (33%) discussed at the MTB.
The study showed that PET/CT provided additional information and changed clinical management in 1 out of 3 (33%) esophageal cancer cases discussed at MTB conferences. These results support the inclusion whenever available, of FDG-PET/CT imaging information to augment and improve the patient management decision process in MTB conferences.
采用多学科团队方法管理食管癌患者可做出更好的临床决策。
CT、内镜超声和腹腔镜超声在多学科肿瘤委员会（MTB）对食管癌患者进行临床分期和治疗选择中的作用已有充分记录。然而，关于氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT，PET/CT）在MTB会议的临床决策过程中所起作用的数据却很少。本研究的目的是评估PET/CT对临床管理决策以及在我们机构举行的MTB会议上对食管癌患者护理计划的影响和贡献。
本研究经机构审查委员会（IRB）批准，纳入了一年内食管MTB会议讨论的所有病例。PET/CT对MTB决策的贡献分为四类： ，未提供额外临床管理信息； ，模棱两可和误导性信息； ，对其他成像方式的补充信息； ，直接改变临床管理的信息。根据前瞻性讨论的临床病史、影像学、组织病理学以及MTB会议的官方记录，回顾性评估其对管理的总体影响。
纳入79例食管癌患者（男性61例，女性18例；中位年龄61岁，范围33 - 86岁），其中腺癌53例，鳞状细胞癌26例。PET/CT衍生信息的贡献如下：50例患者（63%）为 ；3例患者（4%）为 ；8例患者（10%）为 ；18例患者（23%）为 信息。45例患者（57%）有全身性疾病，其中5例（11%）的转移疾病仅通过PET/CT检测到。此外，PET/CT在43例患者中的4例（9%）检测到先前未知的复发。总之，在MTB讨论的79例食管癌患者中，PET/CT为26例（33%）患者提供了指导管理的临床有用信息。
研究表明，在MTB会议讨论的三分之一（33%）食管癌病例中，PET/CT提供了额外信息并改变了临床管理。这些结果支持在MTB会议上尽可能纳入FDG-PET/CT成像信息，以加强和改善患者管理决策过程。
