Role of Pre-therapeutic 18F-FDG PET/CT in Guiding the Treatment Strategy and Predicting Prognosis in Patients with Esophageal Carcinoma

Objective(s): The present study aimed to evaluate the role of pretherapeutic 18fluorinefluorodeoxyglucose positron emission tomographycomputed tomography (18FFDG PETCT) and maximum standardized uptake value (SUVmax) in guiding the treatment strategy and predicting the prognosis of esophageal carcinoma, using the survival data of thepatients.Methods: The present retrospective, cohort study was performed on 40 consecutive patients with esophageal carcinoma (confirmed by endoscopic biopsy), who underwent preoperative 18FFDG PETCTstaging between January 2009 and June 2014. All the patients underwent contrastenhanced CT and noncontrasted 18FFDG PETCT evaluations.The patients were followedup over 12 months to assess the changes in therapeutic strategies. Survival analysis was done considering the primary tumor SUVmax, using the Kaplan–Meier productlimit method.Results: In a total of 40 patients, 18FFDG PETCT scan led to changes in disease stage in 26n (65.0%) cases, with upstaging and downstaging reported in 10n (25.0%) and 16n (40.0%) patients, respectively. The management strategy changed from palliative to curative in 10 out of 24 patients and from curative to palliative in 7 out of 16 cases. Based on the18FFDG PETCT scan alone, the median survival of patients in the palliative group was 4.0n (95 % CI 3.05.0) months, whereas the median survival in the curative group has not been reached, based on the 12month followup.Selection of treatment strategy on the basis of 18FFDG PET/CT alone was significantly associated with the survival outcomes at nine months (P=0.03) and marginally significant at 12 months (P=0.05). On the basisof SUVmax, the relation between survival and SUV_max was not statistically significant.Conclusion: 18FFDG PET/CT scan had a significant impact on stage stratification and subsequently, selection of a stagespecific treatment approach and the overall survival outcome in patients with esophageal carcinoma. However, pretreatment SUV_max failed to stablish its usefulness in the assessment of patient prognosis and survival outcome.