The evolving role of PET-CT in the management of esophageal cancer

Esophageal cancer, although uncommon in the United States, has been increasing in frequency, and despite advances in therapy, the diagnosis still carries a poor prognosis. Many patients present with locally advanced disease and receive multimodality therapy with combined chemoradiatlon before surgery. Imaging plays an important role in the initial selection of patients for tri-modality therapy and in evaluating responses to neoadjuvant chemoradiation prior to surgery. There is increasing use of 2-deoxy-2-[¹⁸F]fluoro-D- glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in management of esophageal cancer to identify distant metastasis at presentation and to assess response to therapy. Standardized imaging protocols with semiquantitative analysis may also provide prognostic information and be used to individualize patient therapy. This review will discuss the role of imaging studies in the management of esophageal cancer patients, with particular attention to FDG-PET/CT.