Esophageal cancer: The role of integrated CT-PET in initial staging and response assessment after preoperative therapy

Reginald F. Munden, Homer A. Macapinlac, Jeremy J. Erasmus

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42 Scopus citations


Esophageal cancer, an uncommon neoplasm, has been increasing in incidence over the past few decades. Optimal management of patients is determined by the stage of disease at presentation, patient performance status, and location of the primary cancer. Recently, there has been increasing use of multimodality therapy in suitable candidates that employs preoperative chemotherapy and/or radiation followed by surgical resection. This evolving treatment strategy together with the substantial morbidity and mortality associated with esophagectomy makes appropriate patient selection critical. Computed tomography (CT) and endoscopy/endoscopic ultrasonography are usually carried out to initially stage patients with esophageal cancer, to determine primary tumor response, and to detect nodal and distant metastases after preoperative therapy. Positron emission tomography (PET) with [18F]-fluoro-2-deoxy-D-glucose and integrated CT-PET are useful in the initial staging of patients with esophageal cancer and in the prediction of pathologic response, disease-free interval, and overall survival after preoperative therapy. Importantly, integrated CT-PET imaging decreases the number of futile attempts at surgical resection, mainly because of the detection of occult distant metastases. The following sections review the use of integrated CT-PET imaging in determining the T, N, and M descriptors of the American Joint Commission on Cancer's 2002 guidelines for pathologic and clinical staging at initial diagnosis and after chemoradiation therapy in those patients being considered for surgical resection.

Original languageEnglish (US)
Pages (from-to)137-145
Number of pages9
JournalJournal of Thoracic Imaging
Issue number2
StatePublished - May 2006


  • Esophageal cancer
  • Esophageal cancer staging
  • PET-CT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Pulmonary and Respiratory Medicine
  • Radiological and Ultrasound Technology


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