Evaluating the role of fluorodeoxyglucose positron emission tomography-computed tomography in multi-disciplinary team recommendations for oesophago-gastric cancer

• Published in: British journal of cancer 2013-09, Vol.109 (6), p.1445-1450
• Main Authors: Blencowe, N S, Whistance, R N, Strong, S, Hotton, E J, Ganesh, S, Roach, H, Callaway, M, Blazeby, J M
• Format: Article
• Language: English
• Subjects: 692/699/67/1504/1477; 692/700/1421/1846/2092; 692/700/1421/1846/2771; Aged; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cancer Research; Clinical Study; Decision making; Drug Resistance; Endoscopy; Epidemiology; Esophageal cancer; Esophageal Neoplasms - diagnosis; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - pathology; Female; Fluorodeoxyglucose F18; Gastric cancer; Gastroenterology. Liver. Pancreas. Abdomen; Hospitals; Humans; Male; Medical research; Medical sciences; Metastasis; Molecular Medicine; Multimodal Imaging - methods; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Oncology; Patients; Positron-Emission Tomography - methods; Prospective Studies; Radiopharmaceuticals; Retrospective Studies; Stomach Neoplasms - diagnosis; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - pathology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tomography; Tomography, X-Ray Computed - methods; Tumors
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.2013.478

Background: National guidelines recommend that fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) is performed in all patients being considered for radical treatment of oesophageal or oesophago-gastric cancer without computerised tomography scan (CTS) evidence of metastasis. Guidance also mandates that all patients with cancer have treatment decisions made within the context of a multi-disciplinary team (MDT) meeting. Little is known, however, about the influence of PET-CT on decision making within MDTs. The aim of this study was to assess the role of PET-CT in oesophago-gastric cancer on MDT decision making. Methods: A retrospective analysis of a prospectively held database of all patients with biopsy-proven oesophageal or oesophago-gastric cancer discussed by a specialist MDT was interrogated. Patients selected for radical treatment without CTS evidence of M1 disease were identified. The influence of PET-CT on MDT decision making was examined by establishing whether the PET-CT confirmed CTS findings of M0 disease (and did not change the patient staging pathway) or whether the PET-CT changed the pathway by showing unsuspected M1 disease, refuting CTS suspicious metastases, or identifying another lesion (needing further investigation). Results: In 102 MDT meetings, 418 patients were discussed, of whom 240 were initially considered for radical treatment and 238 undergoing PET-CT. The PET-CT confirmed CTS findings for 147 (61.8%) and changed MDT recommendations in 91 patients (38.2%) by (i) identifying M1 disease ( n =43), (ii) refuting CTS suspicions of M1 disease ( n =25), and (iii) identifying new lesions required for investigations ( n =23). Conclusion: The addition of PET-CT to standard staging for oesophageal cancer led to changes in MDT recommendations in 93 (38.2%) patients, improving patient selection for radical treatment. The validity of the proposed methods for evaluating PET-CT on MDT decision making requires more work in other centres and teams.