Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-09T13:56:28.044Z Has data issue: false hasContentIssue false

6 - FDG-PET and PET/CT in Esophageal Cancer

Published online by Cambridge University Press:  08 August 2009

By
Sheila C. Rankin
Edited by
Sheila C. Rankin
Sheila C. Rankin
Affiliation:
Consultant Radiologist, Guy's and St. Thomas' Foundation Trust, London, UK
Sheila C. Rankin
Affiliation:
Guy's and St Thomas' Hospital
Get access

Summary

Introduction

The anatomical imaging techniques of computer tomography (CT) and endoscopic ultrasound (EUS) have limitations in the staging of esophageal cancer, in assessing response to therapy, and in predicting survival. Functional imaging using positron emission tomography (PET) has been shown to provide unique information in other tumors and is increasingly being used in oesophageal cancer.

Positron emission tomography

PET is an imaging technique that can map functional activity before structural changes have taken place and has established a recognized place in imaging cancer. The most commonly used isotope at the present time is 18F-fluoro-2-deoxy-d-glucose (FDG), which can differentiate malignant from normal tissue based on the enhanced glucose transport and glycolysis exhibited by many tumor cells. FDG is a glucose analogue, and both FDG and glucose are taken up by cells via the membrane glucose transporter system and are phosphorylated by hexokinase. Unlike glucose, FDG-6-phosphate does not cross the cell membrane and is trapped in cells and is visualized. It can be dephosphorylated, but this is a slow process particularly in cancer cells that lack or have reduced levels of glucose-6-phosphatase. FDG accumulation depends on the rate of transport through the cell membrane that is mediated by glucose transporters (GLUT). Many malignant cells, including gastrointestinal tumors, show increased expression of GLUT-1, contributing to increased FDG accumulation, and this correlates with tumor invasiveness and poor survival in some cancers.

Type
Chapter
Information
Carcinoma of the Esophagus , pp. 85 - 106
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fukunaga, T., Okazumi, S., Koide, Y., et al. Evaluation of esophageal cancers using fluorine-18-fluorodeoxyglucose PET. J Nucl Med, 39 (1998), 1002–7.Google ScholarPubMed
Czernin, J. and Phelps, M. E.. Positron emission tomography scanning: current and future applications. Annu Rev Med, 53 (2002), 89–112.CrossRefGoogle ScholarPubMed
Rampin, L., Nani, C., Fanti, S., et al. Value of PET-CT fusion imaging in avoiding potential pitfalls in the interpretation of 18 F-FDG accumulation in the distal oesophagus. Eur J Nucl Med Mol Imaging, 32 (2005), 990–2.CrossRefGoogle ScholarPubMed
Muden, R. F., Macapiniac, H. A., and Erasmus, J. J.. Esophageal cancer: the role of integrated CT-PET in initial staging and response assessment after preoperative therapy. J Thorac Imaging, 21 (2006), 137–45.CrossRefGoogle Scholar
Bar-Shalom, R., Guralnik, L., Tsalic, M., et al. The additional value of PET/CT over PET in FDG imaging of oesophageal cancer. Eur J Nucl Med Mol Imaging, 32 (2005), 918–24.CrossRefGoogle ScholarPubMed
Rankin, S., Taylor, H., Cook, G., et al. Computed tomography and positron emission tomography in the pre-operative staging of oesophageal carcinoma. Clin Radiol, 53 (1998), 659–65.CrossRefGoogle ScholarPubMed
Flanagan, F. L., Dehdashti, F., Siegal, B. A., et al. staging of esophageal cancer with 18F-fluorodeoxyglucose positron emission tomography. Am J Roentgenol, 168 (1997), 417–24.CrossRefGoogle ScholarPubMed
Kim, K., Park, S. J., Kim, B. T., Lee, K. S., and Shim, Y. M.. Evaluation of lymph node metastases in squamous cell carcinoma of the esophagus with positron emission tomography. Ann Thorac Surg, 71 (2001), 290–4.CrossRefGoogle ScholarPubMed
Kato, H., Miyazaki, T., Nakajima, M., et al. The incremental effect of positron emission tomography on diagnostic accuracy in the initial staging of esophageal carcinoma. Cancer, 103 (2005), 148–56.CrossRefGoogle ScholarPubMed
Yoon, Y. C., Lee, K. S., Shim, Y. M., et al. Metastasis to regional lymph nodes in patients with esophageal squamous cell carcinoma: CT vs FDG PET for presurgical detection – prospective study. Radiology, 227 (2003), 764–70.CrossRefGoogle Scholar
Flamen, P., Lerut, T., Haustermans, K., Cutsem, E., and Mortelmans, L.. Position of positron emission tomography and other imaging diagnostic modalities in esophageal cancer. Q J Nucl Med Mol Imaging, 48 (2004), 96–108.Google ScholarPubMed
Rasanen, J. V., Sihvo, E. I., Knuuti, M. J., et al. Prospective analysis of accuracy of positron emission tomography, computed tomography, and endoscopic ultrasonography in staging of adenocarcinoma of the esophagus and esophagogastric junction. Ann Surg Oncol, 10 (2003), 954–60.CrossRefGoogle ScholarPubMed
Stahl, A., Ott, K., Weber, W. A., et al. FDG PET imaging of locally advanced gastric carcinomas: correlation with endoscopic and histopathological findings. Eur J Nucl Med Mol Imaging, 30 (2003), 288–95.CrossRefGoogle ScholarPubMed
Kawamura, T., Kusakabe, T., Sugino, T., et al. Expression of glucose transporter-1 in human gastric carcinoma: Association with tumour aggressiveness, metastases and patient survival. Cancer, 92 (2001), 634–41.3.0.CO;2-X>CrossRefGoogle Scholar
Takita, K. H., Myazaki, T., Nakajima, M., et al. Correlation of 18-F-fluorodeoxyglucose (FDG) accumulation with glucose transporter (Glut-1) expression in esophageal squamous cell carcinoma. Anticancer Res, 23 (2003), 3263–72.Google Scholar
Flamen, P., Lerut, T., Cutsem, E., et al. Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol, 18 (2000), 3202–10.CrossRefGoogle ScholarPubMed
Liberale, G., Laethem, J. L., Gay, F., et al. The role of PET scan in the preoperative management of oesophageal cancer. Eur J Surg Oncol, 30 (2004), 942–7.CrossRefGoogle ScholarPubMed
Lowe, V. J., Booya, F., Fletcher, J. G., et al. Comparison of positron emission tomography, computed tomography and endoscopic ultrasound in the initial staging of patients with esophageal cancer. Mol Imaging Biol, 7 (2005), 422–30.CrossRefGoogle ScholarPubMed
Kelly, S., Harris, K. M., Berry, E., et al. A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut, 49 (2001), 534–9.CrossRefGoogle ScholarPubMed
Akiyama, H., Tsurumaru, M., Udagawa, H., and Kajiyama, Y.. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg, 220 (1994), 364–73.CrossRefGoogle ScholarPubMed
Lerut, T., Coosemans, W., Decker, G., et al. Cancer of the esophagus and gastr-esophageal junction: Potentially curative therapies. Surg Oncol, 10 (2001), 113–22.CrossRefGoogle ScholarPubMed
Eloubeidi, M. A., Desmond, R., Arguedas, M. R., Reed, C. E., and Wilcox, C. M.. Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node status. Cancer, 95 (2002), 1434–43.CrossRefGoogle ScholarPubMed
Rizk, N., Venkatraman, E., Park, B., et al. The prognostic importance of the number of involved lymph nodes in esophageal cancer: implications for revisions of the American Joint Committee on Cancer staging system. J Thorac Cardiovasc Surg, 132 (2006), 1374–81.CrossRefGoogle ScholarPubMed
Komori, T., Doki, Y., Kabuto, T., et al. Prognostic significance of the size of cancer nests in metastatic lymph nodes in human esophageal cancers. J Surg Oncol, 82 (2003), 19–27.CrossRefGoogle ScholarPubMed
Kole, A. C., Plukker, J. T., Nieweg, O. E., and Vaalburg, W.. Positron emission tomography for staging of esophageal and gastroesophageal malignancy. Br J Cancer, 78 (1998), 521–7.CrossRefGoogle ScholarPubMed
Kneist, W., Schreckenberger, M., Bartenstein, P, et al. Positron emission tomography for staging esophageal carcinoma: Does it lead to a different therapeutic approach?World J Surg, 27 (2003), 1105–12.CrossRefGoogle ScholarPubMed
Choi, J. Y., Lee, K. H., Shim, Y. M., et al. Improved detection of individual nodal involvement in squamous cell carcinoma of the esophagus by FDG PET. J Nucl Med, 41 (2000), 808–15.Google ScholarPubMed
Lerut, T., Coosemans, W., Leyn, P., et al. Reflections on 3-field lymphadenectomy in carcinoma of the esophagus and gastroesophageal junction. Hepatogastrenterology, 46 (1999), 717–25.Google Scholar
Westreenen, H. L., Westerterp, M., Bossuyt, P. M., et al. Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol, 22 (2004), 3805–12.CrossRefGoogle ScholarPubMed
Yuan, S., Yonghua, Y., Chao, K. S. Cliffoerd, et al. Additional value of PET/CT over PET in assessment of locoregional lymph nodes in thoracic esophageal squamous cell cancer. J Nucl Med, 47 (2006), 1255–9.Google ScholarPubMed
Vazquez-Sequeiros, E.. Nodal status: number or site of nodes? How to improve accuracy? Is FNA always necessary? Junctional tumors – what's N and what's M?Endoscopy, 38 (2006), 54–8.CrossRefGoogle ScholarPubMed
Luketich, J. D., Friedman, D. M., Weigel, T. L., et al. Evaluation of distant metastases in esophageal cancer: 100 consecutive positron emission tomography scans. Ann Thorac Surg, 68 (1999), 1133–7.Google ScholarPubMed
Kinkel, K., Lu, Y., Both, M., et al. Detection of hepatic metastases from cancers of the gastrointestinal tract by using non-invasive imaging methods (US, CT, MR Imaging, PET): A meta-analysis. Radiology, 224 (2002), 748–56.CrossRefGoogle Scholar
Selzner, M., Hany, T. F., Wilbrett, P., et al. Does the novel PET/CT imaging modality impact on the treatment of patients with metastatic colorectal cancer of the liver. Ann Surg, 240 (2004), 1027–36.CrossRefGoogle ScholarPubMed
Kato, H., Miyazaki, T., Nakajima, M., et al. Comparison between whole-body positron emission tomography and bone scintigraphy in evaluating bony metastases of esophageal carcinomas. Anticancer Res, 25 (2005), 4439–44.Google ScholarPubMed
Taira, A. V., Herfkens, R. J., Gambhir, S. S., and Quon, A.. Detection of bone metastases. Assessment of integrated FDG-PET/CT imaging. Radiology, 243 (2007), 204–11.CrossRefGoogle ScholarPubMed
Lerut, T., Flamen, P., Ectors, N., et al. Histopathologic validation of lymph node staging with FDG-PET scan in cancer of the esophageal gastroesophageal junction: a prospective study based on primary surgery with extensive lymphadenectomy. Ann Surg, 232 (2000), 743–51.CrossRefGoogle ScholarPubMed
Blackstock, A. W., Farmer, M. R., Lovato, J., et al. A prospective evaluation of the impact of 18-F-fluoro-deoxy-D-glucose positron emission tomography staging on survival for patients with locally advanced esophageal cancer. Int J Radiat Oncol Biol Phys, 64 (2006), 455–60.CrossRefGoogle ScholarPubMed
Duong, C. P., Demittiou, H., Weih, L., et al. Significant clinical impact and prognostic stratification provided by FDG-PET in the staging of oesophageal cancer. Eur J Nucl Med Mol Imaging, 33 (2006), 759–69.CrossRefGoogle ScholarPubMed
Stahl, A., Stollfus, J., Ott, K., et al. FDG PET and CT in locally advanced adenocarcinoma of the distal oesophagus. Nuklearmedizin, 44 (2005), 249–55.Google ScholarPubMed
[Jadvar, H., Henderson, R. W., and Conti, P. S.. 2-Deoxy-2-[F-18] fluoro-D-glucose-positron emission tomography/computed tomography imaging evaluation of esophageal carcinoma.] Mol Imaging Biol, 8 (2006), 193–200.CrossRefGoogle Scholar
Westreenen, H. L., Heeren, P. A., and Dullemen, H. M.. Positron emission tomography with F-18-fluorodeoxyglucose in a combined staging strategy of esophageal cancer prevents unnecessary surgical explorations. J Gastrointest Surg, 9 (2005), 54–61.CrossRefGoogle Scholar
Westreenen, H. L., Heeren, P. A., Jager, P. L., et al. Pitfalls of positive findings in staging esophageal cancer with F-18-fluorodeoxyglucose positron emission tomography. Ann of Surg Oncol, 10 (2003), 1100–5.CrossRefGoogle ScholarPubMed
Dehdashti, F. and Siegel, B. A.. Neoplasms of the esophagus and stomach. Semin Nuclear Med, 34 (2004), 198–208.CrossRefGoogle ScholarPubMed
Wallace, M. B., Nietert, P. J., Earle, C., et al. An analysis of multiple staging management strategies for carcinoma of the esophagus: Computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy. Ann Thorac Surg, 74 (2002), 1026–32.CrossRefGoogle ScholarPubMed
Imdahl, A., Hentschel, M., Kleimaier, M., et al. Impact of FDG-PET for staging of oesophageal cancer. Langenbecks Arch Surg, 389 (2004), 283–8.CrossRefGoogle ScholarPubMed
Shimada, H., Okazumi, S., Matsubara, H., et al. Impact of the number and extent of positive lymph nodes in 200 patients with thoracic esophageal squamous cell carcinoma after three-field lymph node dissection. World J Surg, 30 (2006), 1441–9.CrossRefGoogle ScholarPubMed
Gu, Y., Swisher, S. G., Ajani, J. A., et al. The number of lymph nodes with metastasis predicts survival in patients with esophageal or esophagogastric junction adenocarcinoma who receive preoperative chemoradiation. Cancer, 106 (2006), 1017–25.CrossRefGoogle ScholarPubMed
Choi, J. Y., Jang, H. J., Shim, Y. M., et al. 18F-FDG PET in patients with esophageal squamous cell carcinoma undergoing curative surgery: prognostic implications. J Nucl Med, 45 (2004), 1843–50.Google ScholarPubMed
Cerfolio, R. J. and Bryant, A. S.. Maximum standardized uptake values on positron emission tomography of esophageal cancer predicts stage, tumour biology, and survival. Ann Thorac Surg, 82 (2006), 391–5.CrossRefGoogle Scholar
Rizk, N., Downey, R. J., Akhurst, T., et al. Preoperative 18-F-fluorodeoxyglucose positron emission tomography standardized uptake values predict survival after esophageal adenocarcinoma resection. Ann Thorac Surg, 81 (2006), 1076–81.CrossRefGoogle ScholarPubMed
Vrieze, O., Haustermans, K., Wever, W., et al. Is there a role for FDG-PET in radiotherapy planning in esophageal carcinoma?Radiother Oncol, 73 (2004), 269–75.CrossRefGoogle Scholar
Leong, T., Everitt, C., Yuen, K., et al. A prospective study to evaluate the impact of FDG-PET on CT-based radiotherapy treatment planning for oesophageal cancer. Radiother Oncol, 78 (2006), 254–61.CrossRefGoogle ScholarPubMed
Moureau-Zabotto, L., Touboul, E., Lerouge, D., et al. Impact of CT and 18-deoxyglucose positron emission tomography image fusion for conformal radiotherapy in esophageal carcinoma. Int J Radiat Oncol Biol Phys, 63 (2005), 340–5.CrossRefGoogle Scholar
Konski, A., Doss, M., Milestone, B., et al. The integration of 18-fluoro-deoxy-glucose positron emission tomography and endoscopic ultrasound in the treatment-planning process for esophageal carcinoma. Int J Radiat Oncol Biol Phys, 61 (2005), 1123–8.CrossRefGoogle ScholarPubMed
Urschel, J. D. and Vasan, H.. A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg, 185 (2003), 538–43.CrossRefGoogle ScholarPubMed
Medical Research Oesophageal Cancer Working Group. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet, 359 (2002), 1727–33.CrossRef
Geh, J. I., Crellin, A. M., and Glynne-Jones, R.. Preoperative (neoadjuvant) chemoradiotherapy in oesophageal cancer. Br J Surg, 88 (2001), 338–56.CrossRefGoogle ScholarPubMed
Korst, R. J., Kansler, A. L., Port, J. L., et al. Downstaging of T or N predicts long-term survival after preoperative chemotherapy and radical resection for esophageal carcinoma. Ann Thorac Surg, 82 (2006), 480–4.CrossRefGoogle ScholarPubMed
Levine, E. A., Farmer, N. R., Clark, P., et al. Predictive value of 18-fluoro-deoxy-glucose-positron emission tomography (18F-FDG-PET) in the identification of responders to chemoradiation therapy for the treatment of locally advanced esophageal cancer. Ann Surg, 243 (2006), 472–8.CrossRefGoogle ScholarPubMed
Juweid, M. E. and Cheson, B. D.. Positron-emission tomography and assessment of cancer therapy. N Engl J Med, 354 (2006), 496–507.CrossRefGoogle ScholarPubMed
Kostakoglu, L. and Goldsmith, S. J.. PET in the assessment of therapy response in patients with carcinoma of the head and neck and of the esophagus. J Nucl Med, 45 (2004), 56–68.Google ScholarPubMed
Kostakoglu, L. and Goldsmith, S. J.. 18F-FDG PET evaluation of the response to therapy for lymphoma and for breast, lung, and colorectal carcinoma. J Nucl Med, 44 (2003), 224–39.Google ScholarPubMed
Weber, W. A., Ott, K., Becker, K., et al. Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol, 19 (2001), 3058–65.CrossRefGoogle ScholarPubMed
Ott, K., Weber, W. A., Lordick, F., et al. Metabolic imaging predicts response, survival, and recurrence in adenocarcinomas of the esophagogastric junction. J Clin Oncol, 24 (2006), 4692–8.CrossRefGoogle ScholarPubMed
Wieder, H. A., Beer, A. J., Lordick, F., et al. Comparison of changes in tumour metabolic activity and tumour size during chemotherapy of adenocarcinomas of the esophagogastric junction. J Nucl Med, 46 (2005), 2029–34.Google ScholarPubMed
Wieder, H. A., Brucher, B. L. D. M., Zimmermann, F., et al. Time course of tumour metabolic activity during chemoradiotherapy of esophageal squamous cell carcinoma and response to treatment. J Clin Oncol, 22 (2004), 900–8.CrossRefGoogle ScholarPubMed
Gillham, C. M., Lucey, J. A., Keogan, M., et al. 18FDDG uptake during induction chemoradiation for oesophageal cancer fails to predict histomorphological tumour. Br J Cancer, 95 (2006), 1174–9.CrossRefGoogle ScholarPubMed
Flamen, P., Cutsem, E., Lerut, T., et al. Positron emission tomography for assessment of the response to induction radiochemotherapy for locally advanced esophagus cancer. Ann Oncol, 13 (2002), 361–8.CrossRefGoogle Scholar
Brucher, B. L., Weber, W., Bauer, M., et al. Neoadjuvant therapy of esophageal squamous cell carcinoma: response evaluation by positron emission tomography. Ann Surg, 233 (2001), 300–9.CrossRefGoogle ScholarPubMed
Westerterp, M., Westreenen, H. L., Reitsma, J. B., et al. Esophageal cancer: CT, endoscopic US and FDG PET for assessment of response to neoadjuvant therapy – Systematic review. Radiology, 236 (2005), 841–51.CrossRefGoogle ScholarPubMed
Beer, A. J., Wieder, H. A., Lordick, F., et al. Adenocarcinomas of esophagogastric junction: multi-detector row CT to evaluate early response to neoadjuvant chemotherapy. Radiology, 239 (2006), 472–80.CrossRefGoogle ScholarPubMed
Swisher, S. G., Maish, M., Erasmus, J. J., et al. Utility of PET, CT and EUS to identify pathologic responders in esophageal cancer. Ann Thorac Surg, 78 (2004), 1152–60.CrossRefGoogle ScholarPubMed
Duong, C. P., Hicks, R. J., Weih, L., et al. FDG-PET status following chemoradiotherapy provides high management impact and powerful prognostic stratification in oesophageal cancer. Eur J Nucl Med Mol Imaging, 33 (2006), 770–8.CrossRefGoogle ScholarPubMed
Law, S. K. Y., Fok, M., and Wong, J.. Pattern of recurrence after esophageal resection for cancer: clinical implications. Br J Surg, 83 (1996), 107–11.CrossRefGoogle ScholarPubMed
Lee, S. J., Lee, K. S., Yim, Y. J., et al. Recurrence of squamous cell carcinoma of the oesophagus after curative surgery: rates and patterns on imaging studies correlated with tumour location and pathological stage. Clin Radiol, 60 (2005), 547–54.CrossRefGoogle ScholarPubMed
Raoul, J. L., Prise, E., Meunier, B., et al. Combined radiochemotherapy for postoperative recurrence of esophageal cancer. Gut, 37 (1995), 174–6.CrossRefGoogle Scholar
Flamen, P., Lerut, T., Cutsem, E., et al. The utility of positron emission tomography (PET) for the diagnosis staging of recurrent esophageal cancer. J Thorac Cardiovasc Surg, 120 (2000), 1085–92.CrossRefGoogle ScholarPubMed
Kato, H., Miyazaki, T., Nakajima, M., et al. Value of positron emission tomography in the diagnosis of recurrent esophageal carcinoma. Br J Surg, 91 (2004), 1004–9.CrossRefGoogle Scholar
Zhang, J. D., Yu, J. M., Guo, H. B., et al. [Clinical value of positron emission tomography-CT for the diagnosis of postoperative recurrence and metastasis in the patients with oesophageal cancer] [Article in Chinese]. Zhonhua Wei Chang Wai Ke Za Zhi, 9 (2006), 56–8.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×