Benefit of PET or PET/CT in oesophageal cancer is not proven

August 28, 2013

The patient-relevant benefit of positron emission tomography (PET) in oesophageal cancer, alone or in combination with computed tomography (CT), is not proven due to a lack of comparative studies. In terms of their diagnostic and prognostic accuracy, it also remains unclear whether these diagnostic techniques can detect the spreading of tumours better than conventional diagnostics. This is the conclusion of the final report of the German Institute for Quality and Efficiency in Health Care (IQWiG) published on 20 August 2013.

More reliable diagnosis ought to improve treatment

About 4800 men and 1400 women are newly diagnosed with oesophageal cancer in Germany each year. The average age of disease onset is 65 years. The 5-year survival rate in Germany is at most 20%; this means that 5 years after , at best 20 of 100 affected patients are still alive.

Many experts assume that an examination using PET or PET/CT, alone or in combination with other methods, is better able to evaluate how far a tumour has spread (staging) and whether it has responded to treatment (restaging). In addition, better detection of tumour recurrence ought to be possible. The desired goal: the more exactly it is known how advanced the tumour is, the more precisely and successfully patients can be treated.

Benefit for patients crucial

IQWiG therefore searched the international literature for studies that had examined the of diagnostic interventions using PET or PET/CT with regard to whether they were accompanied by perceptible improvements for patients, for example, whether they increased their chances of survival or improved their , or spared them unnecessary operations or further diagnostic interventions.

No direct comparative studies on benefit available

However, the search for such direct comparative intervention studies was unsuccessful, so that the question regarding the patient-relevant benefit of PET or PET/CT in oesophageal cancer still remains to be answered.

IQWiG also searched for studies in which the diagnostic accuracy and prognostic power of PET or PET/CT was compared with other examination methods.

19 studies directly compared test accuracy of PET and CT

A total of 48 studies were relevant for diagnostic and prognostic accuracy, of which most examined the accuracy of primary staging, that is, the classification of tumour stages before the start of treatment.

19 studies directly compared PET with CT. However, conclusions in favour of one or the two techniques cannot be drawn, as either no statistically significant difference was shown or the data could not be interpreted with sufficient certainty.

Advantage of visualization of metabolic activity is unclear

Too few studies are so far available that directly compared PET or PET/CT with other and investigated treatment response (restaging) or diagnosis and prognosis of recurrence. A reliable conclusion on the diagnostic and prognostic accuracy of PET or PET/CT in restaging or diagnostics is therefore not possible.

In particular the potential advantage of PET and PET/CT, which visualize metabolic activity, remains unclear versus morphologic imaging techniques such as CT or magnetic resonance imaging, which display anatomical structures.

Explore further: Benefit of PET or PET/CT in bone and soft tissue tumors is not proven

Related Stories

Benefit of PET or PET/CT in bone and soft tissue tumors is not proven

March 7, 2013
For patients with bone and soft tissue tumours, the study data currently available allow no robust conclusions as to the advantages and disadvantages of using positron emission tomography (PET), alone or in combination with ...

Benefit of PET and PET/CT in ovarian cancer is not proven

August 8, 2012
Due to the lack of studies, there is currently no proof that patients with ovarian cancer can benefit from positron emission tomography (PET) alone or in combination with computed tomography (CT). As regards diagnostic accuracy, ...

Benefit of PET or PET/CT in recurrent bowel cancer is not proven

December 10, 2012
For patients in whom a recurrence of bowel cancer is suspected, the study data currently available allow no robust conclusions as to the advantages and disadvantages of using positron emission tomography (PET), alone or in ...

PET/CT bests gold standard bone marrow biopsy for diagnosis and prognosis of lymphoma patients

August 1, 2013
A more precise method for determining bone marrow involvement in patients with diffuse large B-cell lymphoma (DLBCL)—a key factor in tailoring patient management plans—has been identified by researchers in a study published ...

PET/MR effective for imaging recurrent prostate cancer

June 11, 2013
When prostate cancer makes a comeback, it becomes increasingly important to have exceptional imaging available to find all possible regions where cancer has spread to other parts of the body, or metastasized, in order to ...

PET/CT shows clear advantages over conventional staging for breast cancer patients

January 2, 2013
New research published in the January issue of The Journal of Nuclear Medicine shows that 18F-fludeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) imaging offers significant prognostic stratification ...

Recommended for you

Could a green sponge hold cancer-fighting secrets?

July 27, 2017
A small green sponge discovered in dark, icy waters of the Pacific off Alaska could be the first effective weapon against pancreatic cancer, researchers said on Wednesday.

Stem cell therapy attacks cancer by targeting unique tissue stiffness

July 26, 2017
A stem cell-based method created by University of California, Irvine scientists can selectively target and kill cancerous tissue while preventing some of the toxic side effects of chemotherapy by treating the disease in a ...

Understanding cell segregation mechanisms that help prevent cancer spread

July 26, 2017
Scientists have uncovered how cells are kept in the right place as the body develops, which may shed light on what causes invasive cancer cells to migrate.

Study uncovers potential 'silver bullet' for preventing and treating colon cancer

July 26, 2017
In preclinical experiments, researchers at VCU Massey Cancer Center have uncovered a new way in which colon cancer develops, as well as a potential "silver bullet" for preventing and treating it. The findings may extend to ...

Compound shows promise in treating melanoma

July 26, 2017
While past attempts to treat melanoma failed to meet expectations, an international team of researchers are hopeful that a compound they tested on both mice and on human cells in a petri dish takes a positive step toward ...

Study may explain failure of retinoic acid trials against breast cancer

July 25, 2017
Estrogen-positive breast cancers are often treated with anti-estrogen therapies. But about half of these cancers contain a subpopulation of cells marked by the protein cytokeratin 5 (CK5), which resists treatment—and breast ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.