The utility of positron emission tomography in staging of potentially operable carcinoma of the thoracic esophagus: Results of the American College of Surgeons Oncology Group Z0060 trial Journal Article
| Authors: | Meyers, B. F.; Downey, R. J.; Decker, P. A.; Keenan, R. J.; Siegel, B. A.; Cerfolio, R. J.; Landreneau, R. J.; Reed, C. E.; Balfe, D. M.; Dehdashti, F.; Ballman, K. V.; Rusch, V. W.; Putnam, J. B. Jr |
| Article Title: | The utility of positron emission tomography in staging of potentially operable carcinoma of the thoracic esophagus: Results of the American College of Surgeons Oncology Group Z0060 trial |
| Abstract: | Objectives: The American College of Surgeons Oncology Group trial Z0060 is a prospective multi-institutional trial with a primary objective to evaluate whether positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) detects evidence of metastastic disease that precludes esophagectomy in patients with esophageal cancer who are surgical candidates after routine staging. Methods: Patients with resectable, biopsy-proven carcinoma were enrolled after computed tomography of chest and abdomen demonstrated no evidence of metastasis. FDG-PET was performed according to specified standards. FDG-PET findings suggesting metastases required confirmation and patients without metastases on PET were expected to proceed to surgery. Results: A total of 262 patients were registered. Of these, 199 were deemed eligible and of these, 189 patients were evaluable. Seventy-three patients were ineligible or unevaluable. Reasons for ineligibility included nonresectable disease by routine staging (39), missing or outdated staging procedures (12), PET technical protocol violations (10), no cancer (4), pre-PET induction therapy (3), claustrophobia (1), and other causes (4). There were 145 (78%) patients who went on to have surgery, 42 (22%) who did not, and 2 patients for whom the surgical status was not determined. The reasons for no resection included the following: M1 disease found by PET and confirmed (9), M1 disease found by PET and not confirmed (2), M1 disease at exploration not found by PET (7), decline or death before surgery (10), patient refusal of surgery (7), unresectable local tumor at exploration (5), and extensive N1 disease precluding operation (2). Eight (4.2%) patients undergoing resection had a recurrence in the first 6 months. Conclusions: Although 22% of eligible patients did not undergo esophagectomy, FDG-PET after standard clinical staging for esophageal carcinoma identified confirmed M1b disease in at least 4.8% (95% confidence interval: 2.2%-8.9%) of patients before resection. Unconfirmed PET evidence of M1 disease and regional adenopathy (N1 disease) led to definitive nonsurgical or induction therapy in additional patients. © 2007 The American Association for Thoracic Surgery. |
| Keywords: | immunohistochemistry; adult; aged; aged, 80 and over; middle aged; survival rate; unclassified drug; major clinical study; cancer recurrence; cancer staging; nuclear magnetic resonance imaging; positron emission tomography; neoplasm staging; diagnostic accuracy; sensitivity and specificity; metastasis; computer assisted tomography; image analysis; thoracotomy; age factors; diagnostic imaging; risk assessment; confidence intervals; diagnostic value; biopsy, needle; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; positron-emission tomography; carcinoma; esophagus resection; sex factors; treatment contraindication; esophagus carcinoma; gallium 68; esophageal neoplasms; esophagectomy; germanium 68; germanium |
| Journal Title: | Journal of Thoracic and Cardiovascular Surgery |
| Volume: | 133 |
| Issue: | 3 |
| ISSN: | 0022-5223 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2007-03-01 |
| Start Page: | 738 |
| End Page: | 745.e1 |
| Language: | English |
| DOI: | 10.1016/j.jtcvs.2006.09.079 |
| PUBMED: | 17320575 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 46" - "Export Date: 17 November 2011" - "CODEN: JTCSA" - "Source: Scopus" |
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