The integration of 18-fluoro-deoxy-glucose positron emission tomography and endoscopic ultrasound in the treatment-planning process for esophageal carcinoma

Journal Article · Tue Mar 15 04:00:00 EST 2005 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2004.07.717· OSTI ID:20696141

Konski, Andre ^[1]; Doss, Mohan ^[2]; Milestone, Barton ^[2]; Haluszka, Oleh ^[3]; Hanlon, Alexandra ^[4]; Freedman, Gary ^[1]; Adler, Lee ^[2]

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1. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)
2. Department of Diagnostic Imaging, Fox Chase Cancer Center, Philadelphia, PA (United States)
3. Division of Gastroenterology, Department of Internal Medicine, Fox Chase Cancer Center, Philadelphia, PA (United States)
4. Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA (United States)

Purpose: Accurate delineation of the gross tumor volume (GTV) is important in radiation therapy treatment planning. We evaluated the impact of PET and endoscopic ultrasound (EUS) compared with CT simulation in the planning of radiation fields for patients with esophageal carcinoma. Material and methods: Twenty-five patients presenting with esophageal carcinoma for radiation therapy underwent PET scans in the treatment position after conventional CT simulation. Patients underwent PET/CT scanning after being injected with 10 to 20 mCi of [F-18]-2-deoxy-2-fluro-D-glucose. The length of the abnormality seen on the CT portion of the PET/CT scan vs. the PET scan alone was determined independently by 2 separate investigators. The length of the GTV and detection of regional adenopathy by PET was also correlated with EUS in 18 patients. Of the 18 patients who had EUS, 2 had T2 tumors and 16 had T3 tumors. Eighteen patients had adenocarcinoma and 7 had squamous cell carcinoma. Nine tumors were located at the gastroesophageal junction, 8 at the lower esophagus, 7 in the middle esophagus, and 1 in the cervical esophagus. The PET scans were reviewed to determine the length of the abnormality by use of a standard uptake value (SUV) of 2.5 to delineate the tumor extent. Results: The mean length of the cancer was 5.4 cm (95% CI 4.4-6.4 cm) as determined by PET scan, 6.77 cm (95% CI, 5.6-7.9 cm) as determined by CT scan, and 5.1 cm (95% CI, 4.0-6.1 cm) for the 22 patients who had endoscopy. The length of the tumors was significantly longer as measured by CT scans compared with PET scans (p = 0.0063). EUS detected significantly more patients with periesophageal and celiac lymphadenopathy compared to PET and CT. The SUV of the esophageal tumors was higher in patients with peri-esophageal lymphadenopathy identified on PET scans. Conclusion: Endoscopic ultrasound and PET scans can add additional information to aid the radiation oncologist's ability to precisely identify the GTV in patients with esophageal carcinoma.

• OSTI ID: 20696141
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 61; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
COMPUTERIZED TOMOGRAPHY
ESOPHAGUS
FLUORINE 18
GLUCOSE
MEDICAL PERSONNEL
PATIENTS
PLANNING
POSITRON COMPUTED TOMOGRAPHY
RADIOTHERAPY
SIMULATION