The therapeutic impact of 18F-FDG whole body PET

B. Dietl; J. Marienhagen

doi:10.1055/s-0038-1623920

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2005; 44(01): 8-14
DOI: 10.1055/s-0038-1623920

Original Article

Schattauer GmbH

The therapeutic impact of ¹⁸F-FDG whole body PET

A radiooncologist’s viewDer Einfluss der ¹⁸F-FDG-Ganzkörper-PET auf das therapeutische Management onkologischer Patienten aus strahlentherapeutischer Sicht

Authors

B. Dietl

¹Klinik für Strahlentherapie (Direktor: Prof. Dr. M. Herbst)
J. Marienhagen

²Abteilung für Nuklearmedizin (Leiter: Prof. Dr. Chr. Eilles), Klinikum der Universität Regensburg

Abstract

Summary

Aims: An explorative analysis of the diagnostic as well as therapeutic impact of ¹⁸F-FDG whole body PET on patients with various tumours in the setting of an university hospital radiation therapy was performed. Patients and methods: 222 FDG PET investigations (148 initial stagings, 74 restagings) in 176 patients with diverse tumour entities (37 lung carcinoma, 15 gastrointestinal tumours, 38 head and neck cancer, 30 lymphoma, 37 breast cancer, 19 sarcoma and 16 other carcinomas) were done. All PET scans were evaluated in an interdisciplinary approach and consecutively confirmed by other imaging modalities or biopsy. Unconfirmed PET findings were ignored. Proportions of verified PET findings, additional diagnostic information (diagnostic impact) and changes of the therapeutic concept intended and documented before PET with special emphasis on radiooncological decisions (therapeutic impact) were analysed. Results: 195/222 (88%) FDG-PET findings were verified, 104/222 (47%) FDG-PET scans yielded additional diagnostic information (38 distant, 30 additional metastasis, 11 local recurrencies, 10 primary tumours and 15 residual tumours after chemoptherapy). The results of 75/222 (34%) scans induced changes in cancer therapy and those of 58/222 (26%) scans induced modifications of radiotherapeutic treatment plan (esp. target volumes). Conclusion: ¹⁸F-FDG whole body PET is a valuable diagnostic tool for therapy planning in radiooncology with a high impact on therapeutic decisions in initial staging as well as in restaging. Especially in a curative setting it should be used for definition of target volumes.

Zusammenfassung

Ziele: Explorative Analyse des Einflusses der ¹⁸F-FDGPET auf das therapeutische Management von Patienten mit unterschiedlichen Tumorentitäten im Rahmen einer universitären Strahlentherapie. Patienten und Methoden: Insgesamt wurden bei 176 Patienten 222 FDGPET-Untersuchungen (148 primäres Staging, 74 Restaging) mit der Diagnose Bronchialkarzinom (n = 37), gastrointestinaler Tumor (n = 15), HNO-Tumor (n = 38), Lymphom (n = 30), Mammakarzinom (n = 67), Sarkom (n = 19) und sonstiges Malignom (n = 16) vorgenommen und interdisziplinär synoptisch befundet. Alle Befunde wurden einer Verifikation durch komplementäre Verfahren unterworfen. Ausgewertet wurden der Anteil bestätigter PET-Befunde, der Anteil der Untersuchungen, die eine neue diagnostische Information erbrachten (diagnostischer Impact), sowie der Anteil der Untersuchungen, die eine Änderung des ursprünglichen Therapiekonzeptes bzw. des Strahlentherapieplanes zur Folge hatte (therapeutischer Impact). Ergebnisse: 195/222 (88%) FDG-PET-Befunde konnten verifiziert werden, 104/222 (47%) FDG-PET-Untersuchungen erbrachten eine zusätzliche Informationen (38 Fernmetastasen, 30 zusätzliche Metastasen, 11 Lokalrezidive, 10 Primärtumore und 15 Residualbefunde nach Chemotherapie). 75/222 (34%) Befunden hatten Konsequenzen auf die onkologische Therapie, 58/222 (26%) erforderten eine Änderung der radiotherapeutischen Dosis (insbesondere der Zielvolumina). Schlussfolgerung: Die FDG-PET stellt sowohl im Rahmen des Primär- als auch des Restagings ein wertvolles diagnostisches Instrument in der Planung onkologischer Therapien, v. a. der Radiotherapie dar und sollte insbesondere bei kurativer Therapieintention zur Zielvolumendefinition herangezogen werden.

Keywords

FDG PET - radiation oncology - radiation therapy - patient management

Schlüsselwörter

FDG-PET - Strahlentherapie - Patientenmanagement - Radionkologie

Full Text

References

Literatur
1 Follow-up after treatment for breast cancer.. The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. CMAJ 1998; 158: S65-70.
2 ESMO Minimum Clinical Recommendations for diagnosis, adjuvant treatment and follow-up of primary breast cancer. Ann Oncol 2001; 12: 1047-8.
3 Dizendorf EV, Baumert BG, von Schulthess GK. et al. Impact of whole-body ¹⁸F-FDG PET on staging and managing patients for radiation therapy. J Nucl Med 2003; 44: 24-9.
4 Engert A, Schiller P, Josting A. et al. Involved-field radiotherapy is equally effective and less toxic compared with extended-field radiotherapy after four cycles of chemotherapy in patients with early-stage unfavorable Hodgkin’s lymphoma: results of the HD8 trial of the German Hodgkin’s Lymphoma Study Group. J Clin Oncol 2003; 21: 3601-8.
5 Erdi YE, Macapinlac H, Rosenzweig KE. et al. Use of PET to monitor the response of lung cancer to radiation treatment. Eur J Nucl Med 2000; 27: 861-6.
6 Erdi YE, Rosenzweig K, Erdi AK. et al. Radio-therapy treatment planning for patients with non-small cell lung cancer using positron emission tomography (PET). Radiother Oncol 2002; 62: 51-60.
7 Fertig DL, Hayes DF. Considerations in using tumor markers: what the psycho-oncologist needs to know. Psychooncology 2001; 10: 370-9.
8 Gambhir SS, Czernin J, Schwimmer J. et al. A tabulated summary of the FDG PET literature. J Nucl Med 2001; 42: 1S-93.
9 Hermanek P, Sobin LH, Fleming ID. What do we need beyond TNM?. Cancer 1996; 77: 815-7.
10 Kalff V, Hicks RJ, MacManus MP. et al. Clinical impact of ¹⁸F fluorodeoxyglucose positron emission tomography in patients with non-small-cell lung cancer: a prospective study. J Clin Oncol. 2001; 19: 111-8.
11 Mackillop WJ, O’Sullivan B, Gospodarowicz M. The role of cancer staging in evidence-based medicine. Cancer Prev Control 1998; 2: 269-77.
12 Marienhagen J, Eilles C. Critical appraisal of diagnostic studies in nuclear medicine. Nuklearmedizin 2003; 42: 129-34.
13 Reske SN, Kotzerke J. FDG-PET for clinical use. Results of the 3rd German Interdisciplinary Consensus Conference, »Onko-PET III«, 21 July and 19 September 2000. Eur J Nucl Med 2001; 28: 1707-23.
14 Thornbury JR. Intermediate outcomes: diagnostic and therapeutic impact. Acad Radiol 1999; 6: S58-65.
15 Tucker R, Coel M, Ko J. et al. Impact of fluorine-18 fluorodeoxyglucose positron emission tomography on patient management: first year’s experience in a clinical center. J Clin Oncol 2001; 19: 2504-8.
16 Vanuytsel LJ, Vansteenkiste JF, Stroobants SG. et al. The impact of ¹⁸F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) lymph node staging on the radiation treatment volumes in patients with non-small cell lung cancer. Radiother Oncol 2000; 55: 317-24.