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 18fluorine-fluorodeoxyglucose positron emission tomographycomputed tomography (18f-fdg pet-ct) 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 pre-operative 18f-fdg pet-ctstaging between january 2009 and june 2014. all the patients underwent contrast-enhanced ct and non-contrasted 18f-fdg pet-ct evaluations.the patients were followed-up over 12 months to assess the changes in therapeutic strategies. survival analysis was done considering the primary tumor suvmax, using the kaplan–meier product-limit method.results: in a total of 40 patients, 18f-fdg pet-ct 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 the18f-fdg pet-ct scan alone, the median survival of patients in the palliative group was 4.0n (95 % ci 3.0-5.0) months, whereas the median survival in the curative group has not been reached, based on the 12-month followup.selection of treatment strategy on the basis of 18f-fdg 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 suvmax was not statistically significant.conclusion: 18f-fdg pet/ct scan had a significant impact on stage stratification and subsequently, selection of a stage-specific treatment approach and the overall survival outcome in patients with esophageal carcinoma. however, pre-treatment suvmax failed to stablish its usefulness in the assessment of patient prognosis and survival outcome.