Impact of Clinical and Dosimetric Factors on Pericardial Effusion in Patients With Stage I Esophageal Cancer Treated With Definitive Chemoradiation Therapy

Abstract

Purpose/Objective(s): The aim of this study was to quantitatively evaluate the value of diagnostic information provided by both F-FDG and F-FLT PET and quantitatively investigated whether F-FLT PET had a better performance compared with F-FDG PET in esophageal squamous cell carcinoma (ESCC) staging and delineation. Materials/Methods: Twenty-six patients with newly diagnosed ESCC and underwent pretreatment F-FDG and F-FLT PET were included in this study. The indices such as the standardized uptake value (SUV), gross tumor length and extracted texture parameters between F-FDG and F-FLT PET were compared, respectively. Moreover, the indices’ relationship between F-FDG and F-FLT PET mentioned above, were analyzed using Spearman’s correlation coefficient and Paired T-test. Subsequently all patients received esophagectomy and the extracted PET indices’ capability in ESCC pathological staging were assessed by Kruskal-Wallis test and Mann-Whitney test. In addition, tumor delineation length on F-FDG (SUV threshold 2.5) and F-FLT (SUV threshold 1.4) PET were validated by pathologic gross tumor length. Results: F-FDG highly correlated with F-FLT possessing a high correlation coefficient value r approximate 0.8 and p < 0.001 in SUVmax or SUVmean. F-FDG uptake was significantly higher than F-FLT with respect to average SUVmax(F-FDG: 11.48, F-FLT: 6.07) or average SUVmean (F-FDG: 6.09, F-FLT: 3.80), with Paired T-test result p < 0.001. In terms of texture parameters’ relationship Entropy and Correlation (two derived texture parameters) showed statistically significant difference. Both of F-FDG and F-FLT PET SUV, some of texture parameters, gross tumor length and shape feature showed statistically significant difference with respect to their feasibility in ESCC staging. The mean standard deviation pathologic longitudinal tumor length was 5.52 2.56 cm and delineation length for F-FDG and F-FLT were 5.60 2.32 cm and 5.49 2.43 cm, respectively. Conclusions: The F-FDG and F-FLT PET scans have their own advantages in ESCC staging and tumors were well identified as the nonphysiologic distribution of radiotracers intensity typically higher than normal tissues on either PET scans. Delineation on the two types of PET with proper threshold can both provide accuracy estimation of pathologic tumor length. Those different indices extracted from PET scans can be potentially employed to differentiate AJCC and TNM in ESCC stage. Author Disclosure: C. Ma: None. Y. Yin: None.