Detection of synchronous cancers by fluorodeoxyglucose positron emission tomography/computed tomography during primary staging workup for esophageal squamous cell carcinoma in Taiwan.

Xiaoyuan Chen,Shih-Hsin Chen,Yin-Kai Chao,Tzu-Chen Yen,Sheng-Chieh Chan

doi:10.1371/journal.pone.0082812

Xiaoyuan Chen, Shih-Hsin Chen + Show 3 more

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https://doi.org/10.1371/journal.pone.0082812

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Journal: PloS one	Publication Date: Nov 29, 2013
Citations: 43	License type: CC BY 3.0

Affiliation: Chang Gung Memorial Hospital

Abstract

AimThe aim of this retrospective study was to investigate the ability of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the detection of synchronous cancers during staging workup for esophageal squamous cell carcinoma.Materials and MethodsWe performed a retrospective chart review of 426 Taiwanese patients with esophageal cancer who received FDG-PET/CT during their primary staging workup between December 2006 and December 2011. We defined synchronous cancers as those occurring within 6 months of the FDG-PET/CT scan. All of the synchronous lesions were confirmed by histology or imaging follow-up. The study patients were followed for at least 18 months or were censored on the date of last follow-up.ResultsFifty patients were excluded from analysis because of the presence of distant metastases. Of the remaining 376 patients, 359 were diagnosed with squamous cell carcinoma (SCC). We identified 17 patients with synchronous cancers, and all of them had a diagnosis of SCC. Synchronous head and neck cancers were the most frequent (n=13, 76.4%), followed by gastrointestinal cancers (colon cancer, n=2; hepatocellular carcinoma, n=1), and renal cell carcinoma (n=1). FDG-PET/CT successfully detected 15 synchronous cancers (12 head and neck cancers, 2 colon cancers, and 1 renal cell carcinoma). In contrast, conventional workup detected only 9 synchronous cancers (7 head and neck cancers, 1 hepatocellular carcinoma and 1 renal cell carcinoma). The sensitivity of FDG-PET/CT and conventional workup in detecting synchronous cancers were 88.2% and 52.9% respectively.ConclusionThe most frequent synchronous lesions in patients with esophageal SCC were head and neck cancers in Taiwan. Our data indicate that FDG-PET/CT is superior to conventional workup in the detection of synchronous tumors during primary staging for esophageal squamous cell carcinoma.

Highlights

Esophageal cancer is the seventh most common cancer in Taiwanese males [1], and the sixth most frequently diagnosed cancer worldwide [2]
Patient population Of the 376 patients without distant metastases, 359 had a diagnosis of squamous cell carcinoma (SCC) (95.5%), and all of the patients with synchronous cancers were diagnosed with this histology type (Figure 1)
In our study conducted among 359 patients with potentially curable esophageal SCC, we identified 17 cases (4.7%) of synchronous cancers

Summary

Introduction

Esophageal cancer is the seventh most common cancer in Taiwanese males [1], and the sixth most frequently diagnosed cancer worldwide [2]. A significant increase in the incidence of esophageal cancer has been recently reported in Taiwan [1]. In light of these data, significant geographic disparities in esophageal cancer burden are evident. Esophageal cancer survival rate varies mainly according to the stage in which the malignancy is diagnosed. Therapy with curative intent is generally possible for patients with early-stage esophageal cancer, the presence of synchronous second primary tumors can influence treatment selection. Previous studies have shown that synchronous tumors are not uncommon in patients with esophageal cancer, with an incidence of second primary malignancies ranging between 4.3 and 11.6% [4,5,6,7,8,9,10]

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