Ist die ¹⁸F-FDG-PET zum Monitoring der palliativen photodynamischen Therapie von nichtresektablen Klatskin-Tumoren geeignet?

Zusammenfassung

Hintergrund: Die photodynamische Therapie (PDT, Laserbehandlung nach Applikation eines Photosensitizers) stellt mittlerweile eine etablierte Therapieform bei unzureichender Gallengangsdrainage bei fortgeschrittenen hilären Gallengangskarzinomen (so genannten Klatskin-Tumoren) dar, die das Überleben und die Lebensqualität verbessert. In mehreren Studien konnte für andere Tumorentitäten gezeigt werden, dass die ¹⁸F-FDG-PET (¹⁸F-Fluordesoxyglukose-Positronenemissionstomographie) ein valides Verfahren zur Beurteilung des Ansprechens auf die PDT darstellt. Da Klatskin-Tumoren ausreichend sensitiv und spezifisch mittels ¹⁸F-FDG-PET-Untersuchung nachgewiesen werden können, wurde in dieser Arbeit erstmalig untersucht, ob sich die ¹⁸F-FDG-PET auch für das Therapiemonitoring nach PDT bei hilären Gallengangskarzinomen eignet. Patienten und Methoden: 10 Patienten wurden vor und 4 - 6 Wochen nach einer PDT mittels ¹⁸F-FDG-PET untersucht. Bestimmt wurden jeweils der maximale und mittlere SUV (Standardized Uptake Value) im Tumor, der Quotient aus maximalem SUV des Tumors und mittlerem SUV der Leber, das vitale Tumorvolumen sowie der Bilirubin- und der CA-19 - 9-Wert. Ergebnisse: Alle Klatskin-Tumoren ließen sich mittels ¹⁸F-FDG-PET nachweisen. Der Vergleich der prä- und posttherapeutischen Befunde zeigte einen signifikanten Abfall des Cholestaseparameters Bilirubin. Die SUV-assoziierten Parameter veränderten sich dagegen nicht signifikant. Es war sogar ein Anstieg des geschätzten vitalen Tumorvolumens zu verzeichnen. Diskussion: Nach PDT ließ sich mittels ¹⁸F-FDG-PET keine wesentliche Reduktion der Tumormasse von nichtresektablen Gallengangstumoren nachweisen, was offenbar durch die zu geringe Eindringtiefe bedingt ist. Die Therapie bewirkt jedoch eine signifikante Reduktion der Cholestase.

Abstract

Background: If existing biliary drainage is insufficient, photodynamic therapy (PDT, laser treatment after application of a photosensitizer) is an already established adjunct to palliative therapy for progressing hilar cholangiocarcinoma (Klatskin tumours), since it prolongs survival and improves quality of life. Experimental studies of other tumour entities showed that ¹⁸F-FDG-PET (¹⁸F-fluorodeosxyglucose-positron emission tomography) may play a role in monitoring tumour response to PDT. Furthermore, previous studies have revealed a high accuracy of this method for the detection of hilar cholangiocarcinoma. Therefore, the aim of the present study was to investigate the feasibility of ¹⁸F-FDG-PET as a follow-up screening method in patients with hilar cholangiocarcinoma who underwent PDT. Patients and Methods: 10 patients were examined by ¹⁸F-FDG-PET before and 4 - 6 weeks after PDT. The following parameters were evaluated: maximum and mean SUV in the tumour, the ratio of maximum SUV in the tumour and mean SUV in the liver, the vital tumour volume, as well as bilirubin and CA 19 - 9 levels. Results: All tumours were detected by ¹⁸F-FDG-PET. Within a period of 4 - 6 weeks after PDT the cholestasis parameter bilirubin decreased significantly. However, SUV-associated parameters did not show a significant change after treatment while the estimated vital tumour volume even increased. Discussion: PDT does not effect a relevant reduction of tumour mass in non-resectable hilar cholangiocarcinoma. However, PDT leads to a significant reduction of cholestasis. If ¹⁸F-FDG-PET is suitable for monitoring the effect of new palliative therapeutic approaches, like brachytherapy, the use of modern chemotherapeuticals, COX-2 and receptor-tyrosine kinase inhibitors, perhaps also in combination with PDT, has to be further investigated.

Schlüsselwörter

Hiläres Gallengangskarzinom - photodynamische Therapie - ¹⁸F-FDG-PET

Key words

Hilar cholangiocarcinoma - photodynamic therapy - ¹⁸F-FDG-PET

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