New research at Wake Forest University Baptist Medical Center shows that Positron Emission Tomography (PET) is more accurate than conventional imaging in identifying patients who have good responses to chemotherapy and radiation treatment - a finding that could one day help some patients avoid surgery.
The results, from a study of 64 patients with esophageal cancer, are published in the April issue of Annals of Surgery. PET, a technology that produces images of the metabolic function of tissue, was used to test patients for cancer after treatment with a combination of chemotherapy and radiation (chemoradiation).
"While additional multi-center studies are needed, the research clearly shows that PET is a useful tool for identifying patients who respond well to chemoradiation," said Edward A. Levine, M.D., lead investigator. "Being able to identify these responders may alter the need to take some patients to surgery."
Over the past two decades, the most common treatment for esophageal cancer has been chemoradiation followed by surgery. Even with these treatments, the prognosis is poor for most patients, with long-term control rates of 25 to 35 percent. Some patients, however, respond well to chemoradiation and have improved long-term survival.
Identifying which patients will respond to chemoradiation alone - and perhaps avoid surgery to remove part of the esophagus - has been difficult. Conventional imaging, including both computed tomography (CT) and endoscopic ultrasound (EUS), are poor predictors of response to chemoradiation.
Recently, PET was shown to be more accurate than CT and EUS in evaluating newly diagnosed patients to determine the extent of the disease. So, Wake Forest researchers decided to evaluate its ability to determine response to chemoradiation.