Upper GI 10

Abstract

Aims: From 1990 to 1999, 9 per cent (11/125) of patients undergoing radical oesophagectomy for node positive carcinoma re-presented with symptomatic bone metastases within 12 months of surgery. The aim of this study was to prospectively evaluate the introduction of preoperative bone scintigraphy. Methods: From 01 December 2000 to 30 November 2001, 159 patients with oesophageal carcinoma were assessed. Tc99-HDP bone scintigraphy was performed for patients identified as having transmural (T3) disease and lymph node involvement (N1) by conventional investigations (CT and endoscopic ultrasound), and who were otherwise suitable for radical treatment. Results: A total of 69 patients (43 per cent) were suitable for radical treatment and of these 45 patients (median age 62 years, M:F ratio 3:1) staged with T3N1 disease underwent bone scintigraphy. The histological diagnosis was adenocarcinoma in 76 per cent and squamous carcinoma in 24 per cent. Bone scintigraphy was normal or showed degenerative change in 33 patients (73 per cent), and demonstrated areas of abnormal radioisotope uptake requiring further investigation in 12 patients (27 per cent). In six patients (13 per cent) plain radiographs, MRI, and biopsy confirmed the presence of bone metastases; a single metastasis in five patients (iliac-2, humerus-2, femur-1) and multiple vertebral metastases in one patient. These six patients received palliative treatment. No patient undergoing bone scintigraphy has developed bone metastases following surgery (n = 35) or chemoradiotherapy (n = 4), after initial median follow-up of 5 months. Conclusions: Bone scintigraphy is essential to exclude metastatic disease prior to the radical treatment of advanced oesophageal carcinoma. Bone is frequently the first site of distant metastatic spread and these patients are most appropriately managed by nonsurgical palliation.