Contribution of FDG-PET/CT to the management of esophageal cancer patients at multidisciplinary tumor board conferences

Kumar K Shashi; Rachna Madan; Mark M Hammer; Steven van Hedent; Suzanne C Byrne; Eric J Schmidlin; Harvey Mamon; Hiroto Hatabu; Peter C Enzinger; Victor H Gerbaudo

doi:10.1016/j.ejro.2020.100291

Contribution of FDG-PET/CT to the management of esophageal cancer patients at multidisciplinary tumor board conferences

Eur J Radiol Open. 2020 Dec 1:7:100291. doi: 10.1016/j.ejro.2020.100291. eCollection 2020.

Affiliations

¹ Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
² Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Faber Cancer Center, and Harvard Medical School, Boston, MA, USA.
³ Medical Oncology, Brigham and Women's Hospital and Dana-Faber Cancer Center, and Harvard Medical School, Boston, MA, USA.

Abstract

Background: A multidisciplinary team approach to the management of esophageal cancer patients leads to better clinical decisions.

Purpose: 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.

Materials and methods: 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. Category I, no additional information provided for clinical management; category II, equivocal and misguiding information; category III, complementary information to other imaging modalities, and category IV, 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.

Results: 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: category I in 50 patients (63%); category II in 3 patients (4%); category III in 8 patients (10%), and category IV 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.

Conclusion: 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.

Keywords: Esophageal cancer; FDG; Neoadjuvant therapy; PET/CT; Radiation therapy; Tumor board.