FDG-PET/CT in Oesophageal and Gastric Cancer

  • Teresa A. SzyszkoEmail author
Part of the Clinicians’ Guides to Radionuclide Hybrid Imaging book series (CGRHI)


Oesophageal and gastric malignancy are considered together in the RCR-RCP guidelines for FDG-PET/CT imaging in the UK. Indications for use of FDG-PET/CT imaging in oesophagogastric malignancy include staging/restaging of patients suitable for radical treatment, including patients who have received neoadjuvant treatment. It also may be indicated in suspected recurrence, when other imaging is negative or equivocal, as biological changes in the tumour usually precede morphological changes. FDG PET-CT has a limited role in T stage, some use in detecting nodal disease and is most useful for evaluating distant metastases.


Imatinib Mesylate Gross Tumour Volume Oesophageal Cancer Total Lesion Glycolysis Radiotherapy Planning 
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  1. 1.
    Barrington S, Scarsbrook A, The Royal College of Physicians and the Royal College of Radiologists. Evidence-based indications for the use of PETCT in the UK. London: RCP, RCR; 2013.Google Scholar
  2. 2.
    Kostakoglu L, Agress Jr H, Stanley J. Goldsmith clinical role of FDG PET in evaluation of cancer patients. Radiographics. 2003;23(2):315–40.PubMedCrossRefGoogle Scholar
  3. 3.
    Marzola MC, De Manzoni G, Grassetto G, Cordiano C, Al-Nahhas A, Alavi A, Rubello D. Extended staging of oesophageal cancer using FDG-PET – a critical appraisal. Eur J Radiol. 2012;81(1):21–30.PubMedCrossRefGoogle Scholar
  4. 4.
    Kato H, Miyazaki T, Nakajima M, Takita J, Kimura H, Faried A, et al. The incremental effect of positron emission tomography on diagnostic accuracy in the initial staging of esophageal carcinoma. Cancer. 2005;103(1):148–56.PubMedCrossRefGoogle Scholar
  5. 5.
    Flamen P. Positron emission tomography in gastric and esophageal cancer. Curr Opin Oncol. 2004;16(4):359–63.PubMedCrossRefGoogle Scholar
  6. 6.
    Bruzzi JF, Truong MT, Marom EM, Mawlawi O, Podoloff DA, Macapinlac HA, Munden RF. Incidental findings on integrated PET/CT that do not accumulate 18F-FDG. AJR Am J Roentgenol. 2006;187(4):1116–23.PubMedCrossRefGoogle Scholar
  7. 7.
    Atsumi K, Nakamura K, Abe K, Hirakawa M, Shioyama Y, Sasaki T, et al. Prediction of outcome with FDG-PET in definitive chemoradiotherapy for esophageal cancer. J Radiat Res. 2013;54(5):890–8.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Foley KG, Fielding P, Lewis WG, Karran A, Chan D, Blake P, Roberts SA. Prognostic significance of novel 18F-FDG PET/CT defined tumour variables in patients with oesophageal cancer. Eur J Radiol. 2014;83(7):1069–73.PubMedCrossRefGoogle Scholar
  9. 9.
    Rankin SC, Taylor H, Cook GJ, Mason R. Computed tomography and positron emission tomography in the pre-operative staging of oesophageal carcinoma. Clin Radiol. 1998;53(9):659–65.PubMedCrossRefGoogle Scholar
  10. 10.
    Van Vliet E, Heijenbrok-Kal MH, Hunink MG, Kuipers EJ, Siersema PD. Staging investigations for oesophageal cancer: a meta-analysis. Br J Cancer. 2008;98:547–57.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Shi W, Wang W, Wang J, Cheng H, Huo X. Meta-analysis of 18 FDG PET-CT for nodal staging in patients with esophageal cancer. Surg Oncol. 2013;22(2):112–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Walker AJ, Spier BJ, Perlman SB, Stangl JR, Frick TJ, Gopal DV, et al. Integrated PET/CT fusion imaging and endoscopic ultrasound in the pre-operative staging and evaluation of esophageal cancer. Mol Imaging Biol. 2011;13(1):166–71.PubMedCrossRefGoogle Scholar
  13. 13.
    Lightdale CJ, Kulkarni KG. Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer. J Clin Oncol. 2005;23(20):4483–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Yoon HH, Lowe VJ, Cassivi SD, Romero Y. The role of FDG-PET and staging laparoscopy in the management of patients with cancer of the esophagus or gastroesophageal junction. Gastroenterol Clin North Am. 2009;38(1):105–20.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Dehdashti F, Siegel BA. Neoplasms of the esophagus and stomach. Semin Nucl Med. 2004;34(3):198–208.PubMedCrossRefGoogle Scholar
  16. 16.
    Lerut T, Flamen P, Ectors N, Van Cutsem E, Peeters M, Hiele M, et al. Histopathologic validation of lymph node staging with FDG-PET scan in cancer of the esophagus and gastroesophageal junction: a prospective study based on primary surgery with extensive lymphadenectomy. Ann Surg. 2000;232(6):743–52.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Flanagan FL, Dehdashti F, Siegel BA, Trask DD, Sundaresan SR, Patterson GA, Cooper JD. Staging of esophageal cancer with 18F-fluorodeoxyglucose positron emission tomography. AJR Am J Roentgenol. 1997;168(2):417–24.PubMedCrossRefGoogle Scholar
  18. 18.
    Bruzzi JF, Munden RF, Truong MT, Marom EM, Sabloff BS, Gladish GW, Iyer RB, Pan TS, Macapinlac HA, Erasmus JJ. PET/CT of esophageal cancer: its role in clinical management. Radiographics. 2007;27(6):1635–52.PubMedCrossRefGoogle Scholar
  19. 19.
    Roth JA, Putnam Jr JB, Rich T, Forastiere AA. Cancer of the esophagus. In: DeVita Jr VT, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. 5th ed. New York: Lippincott-Raven; 1997. p. 980–1021.Google Scholar
  20. 20.
    Quint LE, Hepburn LM, Francis IR, Whyte RI, Orringer MB. Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma. Cancer. 1995;76:1120–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Bruzzi JF, Truong MT, Macapinlac H, Munden RF, Erasmus JJ. Integrated CT-PET imaging of esophageal cancer: unexpected and unusual distribution of distant organ metastases. Curr Probl Diagn Radiol. 2007;36:21–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Flamen P, Lerut A, Van Cutsem E, De Wever W, Peeters M, Stroobants S. Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol. 2000;18:3202–10.PubMedGoogle Scholar
  23. 23.
    Heeren P, Jager PL, Bongaerts F, van Dullemen H, Sluiter W, Plukker JT. Detection of distant metastases in esophageal cancer with 18F FDG PET. J Nucl Med. 2004;45:980–7.PubMedGoogle Scholar
  24. 24.
    Bar-Shalom R, Guralnik L, Tsalic M, Leiderman M, Frenkel A, Gaitini D, et al. The additional value of PET/CT over PET in FDG imaging of oesophageal cancer. Eur J Nucl Med Mol Imaging. 2005;32(8):918–24.PubMedCrossRefGoogle Scholar
  25. 25.
    Van Westreenen HL, Westerterp M, Jager PL, van Dullemen HM, Sloof GW, Comans EF, et al. Synchronous primary neoplasms detected on 18F-FDG PET in staging of patients with esophageal cancer. J Nucl Med. 2005;46(8):1321–5.PubMedGoogle Scholar
  26. 26.
    Downey RJ, Akhurst T, Ilson D, et al. Whole body 18FDG-PET and the response of esophageal cancer to induction therapy: results of a prospective trial. J Clin Oncol. 2003;21:428–32.PubMedCrossRefGoogle Scholar
  27. 27.
    Flamen P, Van Cutsem E, Lerut A, et al. Positron emission tomography for assessment of the response to induction radiochemotherapy in locally advanced oesophageal cancer. Ann Oncol. 2002;13:361–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Wieder HA, Brucher BL, Zimmermann F, et al. Time course of tumor metabolic activity during chemoradiotherapy of esophageal squamous cell carcinoma and response to treatment. J Clin Oncol. 2004;22:900–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Kroep JR, Van Groeningen CJ, Cuesta MA, et al. Positron emission tomography using 2-deoxy-2-[18F]-fluoro-D-glucose for response monitoring in locally advanced gastroesophageal cancer: a comparison of different analytical methods. Mol Imaging Biol. 2003;5:337–46.PubMedCrossRefGoogle Scholar
  30. 30.
    Brucher BL, Weber W, Bauer M, et al. Neoadjuvant therapy of esophageal squamous cell carcinoma: response evaluation by positron emission tomography. Ann Surg. 2001;233:300–9.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Kelly S, Harris KM, Berry E, et al. A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut. 2001;49:534–9.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Kato H, Kuwano H, Nakajima M, et al. Usefulness of positron emission tomography for assessing the response of neoadjuvant chemoradiotherapy in patients with esophageal cancer. Am J Surg. 2002;184:279–83.PubMedCrossRefGoogle Scholar
  33. 33.
    Erasmus JJ, Munden RF, Truong MT, et al. Pre-operative chemoradiation-induced ulceration in patients with esophageal cancer: a confounding factor in tumor response assessment in integrated CT-PET imaging. J Thorac Oncol. 2006;1:478–86.PubMedCrossRefGoogle Scholar
  34. 34.
    Hautzel H, Müller-Gärtner HW. Early changes in fluorine-18-FDG uptake during radiotherapy. J Nucl Med. 1997;38(9):1384–6.PubMedGoogle Scholar
  35. 35.
    Weber WA, Ott K, Becker K, Dittler HJ, Helmberger H, Avril NE, et al. Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol. 2001;19(12):3058–65.PubMedGoogle Scholar
  36. 36.
    Pan T, Mawlawi O, Nehmeh SA, et al. Attenuation correction of PET images with respiration-averaged CT images in PET/CT. J Nucl Med. 2005;46:1481–7.PubMedGoogle Scholar
  37. 37.
    Wong R, Walker-Dilks C, Raifu A. Evidence-based guideline recommendations on the use of positron emission tomography imaging in oesophageal cancer. Clin Oncol (R Coll Radiol). 2012;24(2):86–104.CrossRefGoogle Scholar
  38. 38.
    Miyata H, Yamasaki M, Takahashi T, Murakami K, Kurokawa Y, Nakajima K, et al. Relevance of [18F]fluorodeoxyglucose positron emission tomography-positive lymph nodes after neoadjuvant chemotherapy for squamous cell oesophageal cancer. Br J Surg. 2013;100(11):1490–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Findlay JM, Gillies RS, Franklin JM, Teoh EJ, Jones GE, di Carlo S, et al Restaging oesophageal cancer after neoadjuvant therapy with (18) F-FDG PET-CT: identifying interval metastases and predicting incurable disease at surgery. Eur Radiol. 2016 Feb 16. [Epub ahead of print]Google Scholar
  40. 40.
    Yun M. Imaging of gastric cancer metabolism using 18 F-FDG PET/CT. J Gastric Cancer. 2014;14(1):1–6.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Kim YH, Choi JY, Do IG, Kim S, Kim BT. Factors affecting 18F-FDG uptake by metastatic lymph nodes in gastric cancer. J Comput Assist Tomogr. 2013;37(5):815–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Kluge R, Schmidt F, Caca K, et al. Positron emission tomography with [(18)F]fluoro-2-deoxydglucose for diagnosis and staging of bile duct cancer. Hepatology. 2001;33:1029–35.PubMedCrossRefGoogle Scholar
  43. 43.
    Tanaka T, Kawai Y, Kanai M, Taki Y, Nakamoto Y, Takabayashi A. Usefulness of FDG-positron emission tomography in diagnosing peritoneal recurrence of colorectal cancer. Am J Surg. 2002;184:433–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Turlakow A, Yeung HW, Salmon AS, Macapinlac HA, Larson SM. Peritoneal carcinomatosis: roleof (18)F-FDG PET. J Nucl Med. 2003;44:1407–12.PubMedGoogle Scholar
  45. 45.
    Lin EC, Lear J, Quaife RA. Metastatic peritoneal seeding patterns demonstrated by FDG positronemission tomographic imaging. Clin Nucl Med. 2001;26:249–50.PubMedCrossRefGoogle Scholar
  46. 46.
    Lim JS, Kim MJ, Yun MJ, Oh YT, Kim JH, Hwang HS, et al. Comparison of CT and 18F-FDG pet for detecting peritoneal metastasis on the preoperative evaluation for gastric carcinoma. Korean J Radiol. 2006;7:249–56.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Lim JS, Yun MJ, Kim MJ, Hyung WJ, Park MS, Choi JY, et al. CT and PET in stomach cancer: preoperative staging and monitoring of response to therapy. Radiographics. 2006;26(1):143–56.PubMedCrossRefGoogle Scholar
  48. 48.
    Gayed I, Vu T, Iyer R, Johnson M, Macapinlac H, Swanston N, Podoloff D. The role of 18F-FDG PET in staging and early prediction of response to therapy of recurrent gastrointestinal stromal tumors. J Nucl Med. 2004;45(1):17–21.PubMedGoogle Scholar
  49. 49.
    Basu S, Mohandas KM, Peshwe H, Asopa R, Vyawahare M. FDG-PET and PET/CT in the clinical management of gastrointestinal stromal tumor. Nucl Med Commun. 2008;29(12):1026–39.PubMedCrossRefGoogle Scholar
  50. 50.
    Moureau-Zabotto L, Touboul E, Lerouge D, Deniaud-Alexandre E, Grahek D, Foulquier JN, et al. Impact of CT and 18F-deoxyglucose positron emission tomography image fusion for conformal radiotherapy in esophageal carcinoma. Int J Radiat Oncol Biol Phys. 2005;63(2):340–5.PubMedCrossRefGoogle Scholar
  51. 51.
    Muijs CT, Schreurs LM, Busz DM, Beukema JC, van der Borden AJ, Pruim J, et al. Consequences of additional use of PET information for target volume delineation and radiotherapy dose distribution for esophageal cancer. Radiother Oncol. 2009;93(3):447–53.PubMedCrossRefGoogle Scholar
  52. 52.
    Schreurs LM, Busz DM, Paardekooper GM, Beukema JC, Jager PL, Van der Jagt EJ, et al. Impact of 18-fluorodeoxyglucose positron emission tomography on computed tomography defined target volumes in radiation treatment planning of esophageal cancer: reduction in geographic misses with equal inter-observer variability: PET/CT improves esophageal target definition. Dis Esophagus. 2010;23(6):493–501.PubMedCrossRefGoogle Scholar
  53. 53.
    Wang YC, Hsieh TC, Yu CY, Yen KY, Chen SW, Yang SN. The clinical application of 4D 18F-FDG PET/CT on gross tumor volume delineation for radiotherapy planning in esophageal squamous cell cancer. J Radiat Res. 2012;53(4):594–600.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Muijs CT, Pruim J, Beukema JC, Berveling MJ, Plukker JT, Langendijk JA. Oesophageal tumour progression between the diagnostic 18F-FDG-PET and the 18F-FDG-PET for radiotherapy treatment planning. Radiother Oncol. 2013;106(3):283–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.King’s College and Guy’s and St Thomas’ PET Centre, Division of Imaging Sciences and Biomedical EngineeringKings College London, St Thomas’ HospitalLondonUK

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