21 Background: The goal of surveillance after local therapy (trimodality or bimodality) is to salvage patients with actionable LRF, however, the benefits of current surveillance strategies are not well documented. We report on a large cohort of LEC patients with actionable LRF. Methods: Between 2000 and 2013, 127 patients with actionable LRF were assessed. Histologic/cytologic confirmation of LRF was the gold standard. All surveillance tools (imaging and endoscopy) were assessed. Results: The majority of the patients were men (89%), had adenocarcinoma (79%), had their LRF identified through surveillance (85%) and most had no new symptoms (72%). For the 41 LRFs after trimodality, the sensitivity of PET/CT alone was 93% but the specificity was 67%. In trimodality patients with a positive PET/CT for LRF, only 44% had LRF confirmed by endoscopy and 56% LRFs confirm by additional testing (e.g., FNA, etc). Alternatively, in bimodality patients, endoscopy confirmed LRF in 81% (n=85; 1 patient not evaluable). Trimodality patients were at higher risk of subsequent (e.g., distant) relapse after LRF was documented than were bimodality patients (p=0.03); 78% of the relapses were distant. In bimodality patients, 99% of relapses (LRF and/or distant) occurred within 36 months of therapy while in trimodality patients, 90% of relapses occurred within 36 months of surgery. Conclusions: Our data suggest that PET/CT is more likely to detect LRFs than endoscopy in trimodality patients. However, in bimodality patients, endoscopy is more valuable than PET/CT for documenting LRFs. At least 3 years of surveillance are needed for all LEC patients. However, even after the salvage, distant relapses are common. From U. T. M. D. Anderson Cancer Center (UTMDACC), Houston, Texas, USA. (Supported in part by UTMDACC, and CA 138671 and CA172741 from the NCI).
A black adrenal adenoma with high FDG uptake on PET/CT scan in a patient with esophageal carcinoma: A case report
