A Retrospective Study in the Utilization of 18F-FDG PET/CT in Staging Oesophagus Cancer at Charlotte Maxeke Johannesburg Academic Hospital (2012–2021)

Abstract

Introduction Cancer of the oesophagus has dramatically increased worldwide, and patients present with advanced disease in the South African context. Adequate staging investigations are imperative to guide treatment intent. Staging of oesophageal cancer requires a multimodality of investigations. Pre-treatment 18F-FDG PET/CT provides more accurate staging, assesses prognostic stratification, improves radiotherapy treatment planning, and can change management in more than one third of patients. Objective This study aimed to assess if there is a discordance between the initial TNM and group stage and post 18F-FDG PET/CT TNM and group stage in patients referred for radiation therapy at CMJAH. The secondary aim is to determine if additional information (such potential secondary cancers) is picked up on 18F- FDG PET/CT. Method A retrospective, cross-sectional analysis of all patients with cancer of the oesophagus, from 1st January 2012 to 31st December 2021, referred for radiation therapy at Charlotte Maxeke Johannesburg Academic Hospital. Patient clinical information was reviewed to extract data regarding demographics, histology, site, pre and post 18F-FDG PET/CT group stage and if any additional information was seen on the 18F-FDG PET/CT report. Results Four hundred and fifteen patients were identified of which 33 met the inclusion criteria. The median age was 60.5 (IQR 52.8-68.5) with males accounting for 8 63.6% (n=21/33) of the population. The thoracic oesophagus was the most prevalent location of primary lesion (78.8%), with histological subtype squamous cell carcinoma (93.9%). There was a discordance between the initial TNM and group stage and post 18F-FDG PET/CT TNM and group stage in the patients investigated. On 18F-FDG PET/CT, 12% (n=4/33) of study participants showed uptake in different sites suggesting potential secondary primaries. Conclusion 18F-FDG PET/CT imaging may provide additional staging information not observed in initial conventional staging studies. This additional information can change treatment strategies and treatment intent. Further studies are required to confirm the incremental staging value that 18F-FDG PET/CT could have in staging cancer of the oesophagus in the LMICs setting.