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

Comparative studies on benefit are missing / Data on diagnostic and prognostic accuracy lack informative value

2013-08-28

(Press-News.org) 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 diagnosis, 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 consequences 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 quality of life, 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 diagnostic techniques and investigated treatment response (restaging) or diagnosis and prognosis of tumour recurrence. A reliable conclusion on the diagnostic and prognostic accuracy of PET or PET/CT in restaging or recurrence 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.

###

Process of report production

IQWiG published the preliminary results in the form of the preliminary report in May 2012 and interested parties were invited to submit comments. At the end of the commenting procedure, which included an oral scientific debate including parties who had submitted comments, the preliminary report was revised and sent as a final report to the contracting agency, the Federal Joint Committee (G-BA), in June 2013. The written comments were published in a separate document at the same time as the final report. The report was produced in collaboration with external experts.

The following German-language executive summary provides an overview of the background, procedure and further results of the report.

An English-language executive summary will be available soon. If you would like to be informed when the English document is available, please send an e-mail to info@iqwig.de.

ELSE PRESS RELEASES FROM THIS DATE:

Univ. of Maryland research could result in new approach to prevent diabetes-induced birth defects

2013-08-28

Baltimore, MD – August 28, 2013 – A research team at the University of Maryland School of Medicine has identified a cell signaling pathway which plays a significant role in causing developmental defects of the fetal spinal cord and brain in babies of women with diabetes. Using an animal model of disease, the team's results point to a potential new therapeutic target for preventing these defects in pregnant women having preexisting diabetes. The results of this study are published in the August 27th issue of Science Signaling. "Providing the best possible care for women ...

St. Jude Children's Research Hospital scientists identify ALS disease mechanism

2013-08-28

(MEMPHIS, Tenn. – August 28, 2013) Researchers have tied mutations in a gene that causes amyotrophic lateral sclerosis (ALS) and other neurodegenerative disorders to the toxic buildup of certain proteins and related molecules in cells, including neurons. The research, published recently in the scientific journal Cell, offers a new approach for developing treatments against these devastating diseases. Scientists at St. Jude Children's Research Hospital and the University of Colorado, Boulder, led the work. The findings provide the first evidence that a gene named VCP ...

GSA Today science: Biofilms, MISS, and stromatolites

2013-08-28

Boulder, Colorado, USA – In the September issue of GSA Today, Nora Noffke of Old Dominion University and Stan Awramik of the University of California, Santa Barbara, describe the interaction of carpet-like communities of benthic microorganisms (biofilms) with sediment dynamics at the sediment-water interface to form distinctive sedimentary structures called microbialites. The best known microbialite structures are stromatolites -- multilayered microbialites up to meters in thickness, built up by repetitive binding, biostabilization, baffling, and trapping of sediment ...

Autistic children can outgrow difficulty understanding visual cues and sounds

2013-08-28

VIDEO: Dr. John Foxe has shown that high-functioning autism spectrum disorder (ASD) children appear to outgrow a critical social communication disability. The paper was published online August 28, 2013, in Cerebral... Click here for more information. BRONX, NY -- Scientists at Albert Einstein College of Medicine of Yeshiva University have shown that high-functioning autism spectrum disorder (ASD) children appear to outgrow a critical social communication disability. Younger children ...

Dementia sufferers more likely to be diagnosed with urinary or fecal incontinence

2013-08-28

Patients with a diagnosis of dementia have approximately three times the rate of diagnosis of urinary incontinence, and more than four times the rate of fecal incontinence, compared with those without a diagnosis of dementia, according to a study in this week's issue of PLOS Medicine by Robert Grant (Kingston University and St. George's, University of London) and colleagues. Furthermore, patients with dementia and incontinence were more likely to receive incontinence medications and indwelling catheters than those with incontinence but without dementia, the authors state. ...

The importance of treating pediatric AIDS in the elimination agenda

2013-08-28

Scott Kellerman and colleagues argue that the scope of the current HIV elimination agenda must be broadened in order to ensure access to care and treatment for all children living with HIV. In 2011, despite the global initiative to eliminate mother-to-child transmission of HIV, 330,000 new pediatric infections were added worldwide to the existing pool of 3.4 million children living with the virus. Children are more vulnerable to HIV infection and have higher morbidity and mortality. Without treatment, half of those children infected will die before the age of 2 years, ...

T-cell targeted therapy tested in type 1 diabetes study

2013-08-28

WA, Seattle (August 28, 2013) – Results from the START clinical study (Study of Thymoglobulin to Arrest Newly Diagnosed Type 1 Diabetes), led by Dr. Steve Gitelman (University of California, San Francisco) and sponsored by the Immune Tolerance Network (ITN), are published today in The Lancet Diabetes & Endocrinology. The study did not meet its primary endpoint: at 12 months, insulin production, as measured by C-peptide responses, showed no difference in overall decline between the treatment and placebo groups. Thymoglobulin®, currently licensed for the treatment of organ ...

Broccoli could be key in the fight against osteoarthritis

2013-08-28

A compound found in broccoli could be key to preventing or slowing the progress of the most common form of arthritis, according to new research led by the University of East Anglia (UEA). Results from the laboratory study show that sulforaphane slows down the destruction of cartilage in joints associated with painful and often debilitating osteoarthritis. The researchers found that mice fed a diet rich in the compound had significantly less cartilage damage and osteoarthritis than those that were not. The study, which also examined human cartilage cells and cow cartilage ...

Joslin scientists identify genetic variant associated with coronary heart disease in type 2 diabetes

2013-08-28

BOSTON -- August 27, 2013 -- Joslin scientists, in collaboration with researchers from the Harvard School of Public Health and Italian research institutes, have identified a previously unknown genetic variant associated with an increased risk of coronary heart disease (CHD) in type 2 diabetic patients. This discovery has the potential to lead to the development of new treatments for CHD in diabetic patients. The findings appear in the [month] issue of the Journal of the American Medical Association (JAMA). CHD is the leading cause of morbidity and mortality among diabetic ...

Genetic variant identified that may increase heart disease risk among people with type 2 diabetes

2013-08-28

Boston, MA — A newly discovered genetic variant may increase the risk of heart disease in people with type 2 diabetes by more than a third, according to a study led by researchers at Harvard School of Public Health (HSPH) and Joslin Diabetes Center. It is the first genome-wide association study (GWAS) to identify a novel genetic variant associated with coronary heart disease (CHD) in people with type 2 diabetes, who have a two- to four-fold higher risk of heart disease compared with those without diabetes. The finding could lead to new interventions aimed at preventing ...

NFCR congratulates Dr. Robert C. Bast, Jr. on receiving the AACR-Daniel D. Von Hoff Award for Outstanding Contributions to Education and Training in Cancer Research

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

ELSE PRESS RELEASES FROM THIS DATE:

LAST 30 PRESS RELEASES: