Significant clinical impact and prognostic stratification provided by FDG-PET in the staging of oesophageal cancer

Purpose: To evaluate the clinical impact of FDG-PET in staging oesophageal cancer and whether this information improves prognostic stratification. Methods: Impact was based on comparison of a prospectively recorded pre-PET plan with post-PET treatment in 68 consecutive patients undergoing primary staging. Survival was analysed using the Kaplan-Meier product limit method and the Cox proportional hazards regression model. Results: FDG-PET findings impacted on the management of 27/68 patients (40%): in 12 therapy was changed from curative to palliative and in three from palliative to curative, while in 12 other patients there was a change in the treatment modality or delivery but not in the treatment intent. The median survival was 21 months, with post-PET stage and treatment intent both strongly associated with survival (p < 0.001). Conventional stage was not able to clearly stratify this population. Conclusion: The use of FDG-PET for primary staging of oesophageal cancer changed the clinical management of more than one-third of patients and provided superior prognostic stratification compared with conventional investigations.