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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