Abstract
4534 Background: In localized EC, radical surgery may be curative. This study evaluated PET and conventional imaging techniques (CI) for staging, and the potential impact of PET on management and prognosis of EC. Methods: Subjects had confirmed EC (SCC or adenocarcinoma), were fit for investigation and surgery and/or chemoradiotherapy and had no unequivocal distant metastatic disease clinically or by CT and endoscopy at presentation. Sensitivity, including N and M staging of pre-operative CT, PET and endoscopic ultrasound (EUS) and clinical impact of confirmation or detection of metastases on intent (curative or palliative) were recorded. Management changes, including radiotherapy field determined by new information from PET, were recorded. Variables, including standardized uptake value (SUV) were compared with progression-free survival (PFS.) Results: 129 patients (104 male), mean age 66 (range 36- 87) were evaluated. 127 of 129 primary lesions were detected. In 41% of patients, PET detected a total of 148 additional lesions, 75 regional lymph nodes, 72 distant metastases and 1 second EC primary. 22% of patients were upstaged from M0 to M1. CT detected regional and distant metastases in 57% and 0% (entry criterion), PET in 70% and 44%. Of 20 patients who had EUS, it detected regional metastases in 67%, PET in 33%.The number of patients intended to be treated palliatively increased from 10 pre- to 32 post-PET. Of patients with curative management intent based on PET 34% progressed in 12 months, with palliative intent 59%. Significant changes in management (high or medium impact) occurred in 38%. The PFS of 54 patients below and 54 above the median SUV(8) was no different (p=0.79) Conclusions: PET influenced management in 38% of patients with EC already studied by CI. No significant financial relationships to disclose.
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