Download Protocol for the use of FDG-PET/CT scanning in the management of

PET 09/15
Protocol for the use of FDG-PET/CT scanning in the management of
oesophageal or oesophagogastric junctional (OGJ) cancer.
This protocol is based on best available evidence and has been produced with the
assistance of experts from across NHS Scotland. The PET Advisory Group and the
three Regional Cancer Advisory Groups have endorsed this protocol.
It has been designed to complement existing SIGN guidance (SIGN, 2006) and the
HTA - Overview of the clinical effectiveness of positron emission tomography
imaging in selected cancers (Facey et al, 2007).
There is insufficient evidence to support FDG-PET/CT in routine staging of all newly
diagnosed patients with oesophageal or OGJ cancers. There is developing interest
in the use of FDG-PET/CT in monitoring response to treatment but at present there
is insufficient evidence to justify its routine use.
Indications for FDG-PET/CT in oesophageal/OGJ cancer.
In the first instance, the focus should be on where a FDG-PET scan would/could
change management/treatment plans. FDG-PET scans are only appropriate on an
individual named patient basis where there was some indication that it would change
management. The diagnostic utility of the scans will be subject to detailed audit.
Newly Diagnosed Oesophageal/OGJ cases

All newly diagnosed patients with oesophageal/OGJ cancer being considered
for radical surgery/chemoradiotherapy should have primary staging with CT,
+/- EUS, +/- laparoscopy (depending on location of tumour).

Patients deemed suitable for radical concurrent chemoradiotherapy or surgery
should proceed to FDG-PET/CT on the basis of this staging and following
MDT assessment. There is no evidence to indicate the most effective strategy
for performing PET/CT in relation to locoregional staging with EUS and
PET/CT may be performed before or after EUS depending on local centre
policy and individual patient circumstances.
Detection of Recurrent Disease

FDG-PET/CT should be considered in patients with clinically suspected
recurrent disease in whom CT and/or endoscopy are equivocal/negative
following MDT assessment.
It is anticipated that if these indications are utilised this will amount to approximately
460 scans per year.
NOSCAN: 130/year,
SCAN:
150/ year
WOSCAN: 180/year
PET 09/15
References
Facey, K., Bradbury, I., Laking, G. and Payne, E. (2007) Overview of the clinical effectiveness of
positron emission tomography imaging in selected cancers. Health Technology Assessment. 11 (44)
Scottish Intercollegiate Guidelines Network (SIGN) (2006) Guideline 89 – Management of
oesophageal and gastric cancer patients A national clinical guideline.
http://www.sign.ac.uk/pdf/sign87.pdf
Cancer Strategies
August 2009