CT Chest, Abdomen, and Pelvis There is no relevant literature to support the inclusion of the pelvis in CT examinations during treatment. FDG-PET/CT Skull Base to Mid-Thigh There are conflicting data on the use of FDG-PET/CT for the evaluation of patients undergoing neoadjuvant chemotherapy. A systematic review of the literature in 2004 by Westerterp et al [25] assessed 7 studies using FDG- PET for the assessment of response to neoadjuvant chemotherapy in esophageal cancer. The maximum joint sensitivity and specificity for FDG-PET for in detecting response was 85%, with an accuracy similar to esophageal US and superior to CT. Subsequent studies showed promising results for FDG-PET/CT. Gabrielson et al [26] prospectively evaluated 51 patients undergoing neoadjuvant chemotherapy for esophageal cancer and found that SUVs could be used to differentiate responders from nonresponders but were not found to demonstrate statistical significance in patients with complete versus subtotal response. Beukinga et al [27] prospectively evaluated 74 patients using a radiomics-based quantitative assessment of postneoadjuvant chemoradiation FDG-PET/CT examinations and concluded that posttreatment FDG-PET/CT orderliness combined with clinical T staging resulted in high discriminatory accuracy in predicting complete histopathologic response. Thurau et al [28] conducted a retrospective review of 83 patients with esophageal cancer who had FDG-PET/CT performed at 6 weeks after induction of neoadjuvant therapy. The authors reported that an SUV reduction of >50% correlated with major histomorphologic response and that patients with this reduction also showed significantly increased survival. Other authors, however, found fewer promising results when evaluating FDG-PET/CT for the assessment of response to neoadjuvant therapy.
Staging and Follow up of Esophageal Cancer. CT Chest, Abdomen, and Pelvis There is no relevant literature to support the inclusion of the pelvis in CT examinations during treatment. FDG-PET/CT Skull Base to Mid-Thigh There are conflicting data on the use of FDG-PET/CT for the evaluation of patients undergoing neoadjuvant chemotherapy. A systematic review of the literature in 2004 by Westerterp et al [25] assessed 7 studies using FDG- PET for the assessment of response to neoadjuvant chemotherapy in esophageal cancer. The maximum joint sensitivity and specificity for FDG-PET for in detecting response was 85%, with an accuracy similar to esophageal US and superior to CT. Subsequent studies showed promising results for FDG-PET/CT. Gabrielson et al [26] prospectively evaluated 51 patients undergoing neoadjuvant chemotherapy for esophageal cancer and found that SUVs could be used to differentiate responders from nonresponders but were not found to demonstrate statistical significance in patients with complete versus subtotal response. Beukinga et al [27] prospectively evaluated 74 patients using a radiomics-based quantitative assessment of postneoadjuvant chemoradiation FDG-PET/CT examinations and concluded that posttreatment FDG-PET/CT orderliness combined with clinical T staging resulted in high discriminatory accuracy in predicting complete histopathologic response. Thurau et al [28] conducted a retrospective review of 83 patients with esophageal cancer who had FDG-PET/CT performed at 6 weeks after induction of neoadjuvant therapy. The authors reported that an SUV reduction of >50% correlated with major histomorphologic response and that patients with this reduction also showed significantly increased survival. Other authors, however, found fewer promising results when evaluating FDG-PET/CT for the assessment of response to neoadjuvant therapy.