18F-FDG-PET/CT to Select Patients with Peritoneal Carcinomatosis for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Pfannenberg, Christina; Königsrainer, Ingmar; Aschoff, Philip; Öksüz, Mehmet Ö.; Zieker, Derek; Beckert, Stefan; Symons, Stephan; Nieselt, Kay; Glatzle, Jörg; Weyhern, Claus von; Brücher, Björn L.D.M.; Claussen, Claus D.; Königsrainer, Alfred

doi:10.1245/s10434-009-0387-7

Cited by 134 publications

(80 citation statements)

References 25 publications

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“…The prevalence of PC in our centre which is a regional reference centre for relapse cancer was 24% (35/146 patients). This rate is higher than those reported in the general colorectal cancer population [26], but of course lower than in series where suspicion of PC was an inclusion criterion [7][8][9].…”

Section: Discussioncontrasting

confidence: 60%

“…While Computed Tomodensitometry (CT) is currently the reference testing method [3], fluorine-18 fluorodeoxyglucose (18F-FDG) Positron Emission Tomography (PET) appears to have an important role to play. Promising results highlight the use of 18F-FDG PET to evaluate PC extension pre-operatively [7,8] although only a few reports have been published on the diagnostic performance of 18F-FDG PET/CT. Sensitivities reported have varied from unacceptably low (35%) to 100% [7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of (18) F-FDG PET/CT for the detection of peritoneal carcinomatosis of colorectal origins

Bullier¹,

Descat²,

Bonichon³

et al. 2013

J Cancer Res Ther

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Purpose: to evaluate the diagnostic accuracy of (18)F-FDG positron emission tomography/ computerized tomography (PET/CT) for the detection of peritoneal carcinomatosis (PC) of colorectal cancer (CRC). Methods: one hundred and forty six eligible patients referred for a PET/CT to evaluate CRC at a single institution were included consecutively and retrospectively. After joint training on 20 similar patient files, two nuclear physicians reviewed the PET/CT scans blindly and independently using a method specifically designed for PC detection. The gold standard was either histological results from surgical exploration for resected patients (n=65) or clinical follow up defined as the 3-month CT follow up supplemented by one year of clinical information and CT monitoring for non-resected patients (n=81). As secondary objectives we evaluated the interobserver reliability between the two PET/CT readings and the diagnostic accuracy of a contemporary ceCT (n=69) or CT component of the PET/CT (n=77) reviewed by an independent radiologist . The extent of PC according to a simplified Sugarbaker index (PCI) was examined for the operated subgroup, when PCI was available from the surgeon and PET/CT (n=12). Results: according to the gold standard, 35/146 patients had PC (including 19 of 65 patients with histological gold standard and 16 of 81 patients with clinical follow up gold standard). Sensitivity and specificity of PET/ CT were 88% and 96% respectively and positive and negative predictive values and accuracy, 88%, 96% and 94% respectively. For CT alone, the corresponding values were: 68%, 92%, 72%, 90% and 86%. The interobserver agreement for the detection of peritoneal carcinomatosis in PET/CT showed high agreement at 0.91 (Kappa). Median PCI was 3 [range: 1-13] when assessed by surgeons and 4 [range: 1-10] on PET/CT. Focal uptake was the most frequently observed sign on PET. Conclusions: PET/CT appears to be an accurate and reproducible test for PC diagnosis in colorectal cancer using an interpretation method specifically designed for PC detection. To confirm these results and to evaluate peritoneal carcinomatosis extension accurately, a prospective observational study using iodine contrast-enhanced PET/CT as a first imaging technique for pre-operative staging and potentially involving further independent reviewers remains to be undertaken.

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Section: Discussioncontrasting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of (18) F-FDG PET/CT for the detection of peritoneal carcinomatosis of colorectal origins

Bullier¹,

Descat²,

Bonichon³

et al. 2013

J Cancer Res Ther

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“…Among these, 499 patients from 8 studies have homogenous clinical characteristics and represent the most homogenous population, on which conclusions can be drawn with a higher level of interest. In this population, the median overall survival is 37.3 months (range 27-78), the median disease-free survival is 14.4 months (range [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], and the median 5-year overall survival is 40% (range .…”

Section: Topic 6: What Is the Best Timing As Far As Results Are Concementioning

confidence: 99%

“…Positron emission tomography/CT: The PET scan alone undervalues the PC while the 18 F-FDG-PET/CT reaches up to 70% sensitivity and 100% preoperative specificity for II and III degree cases but undervalues I degree lesions for nodules smaller than 5 mm in all quadrants (16,17). (Level II evidence).…”

Section: Radiologic Stagingmentioning

confidence: 99%

1^stEvidence-based Italian Consensus Conference on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinosis from Ovarian Cancer

Cavaliere

Cirocchi

Catena

et al. 2017

Tumori

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Ovarian cancer (OC) remains relatively rare, although it is among the top 4 causes of cancer death for women younger than 50. The aggressive nature of the disease and its often late diagnosis with peritoneal involvement have an impact on prognosis. The current scientific literature presents ambiguous or uncertain indications for management of peritoneal carcinosis (PC) from OC, both owing to the lack of sufficient scientific data and their heterogeneity or lack of consistency. Therefore, the Italian Society of Surgical Oncology (SICO), the Italian Society of Obstetrics and Gynaecology, the Italian Association of Hospital Obstetricians and Gynaecologists, and the Italian Association of Medical Oncology conducted a multidisciplinary consensus conference (CC) on management of advanced OC presenting with PC during the SICO annual meeting in Naples, Italy, on September 10-11, 2015. An expert committee developed questions on diagnosis and staging work-up, indications, and procedural aspects for peritonectomy, systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy for PC from OC. These questions were provided to 6 invited speakers who answered with an evidence-based report. Each report was submitted to a jury panel, representative of Italian experts in the fields of surgical oncology, gynecology, and medical oncology. The jury panel revised the reports before and after the open discussion during the CC. This article is the final document containing the clinical evidence reports and statements, revised and approved by all the authors before submission.

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“…Recent developments in patient treatment include total peritonectomy and multivisceral resection of all involved tissue combined with hyperthermic intraperitoneal chemotherapy (HIPEC) as an approach with curative intention [4 -6]. Several imaging modalities are used in the preoperative assessment of tumor extent including ultrasound [7], computed tomography (CT) [8,9], magnetic resonance imaging (MRI) [10,11] as well as F-18-FDG positron emission tomography/computed tomography (PET/CT) [9, 12,13]. Recent studies indicate good results especially for MRI and PET/CT due to its potential of functional and morphological tissue characterization [10,11].…”

mentioning

confidence: 99%

Assessment of Relapse in Patients with Peritoneal Carcinomatosis after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy using F-18-FDG-PET/CT

Klumpp

Schwenzer

Gatidis

et al. 2014

Fortschr Röntgenstr

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Purpose: In patients with peritoneal carcinomatosis (PC), cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an evolving therapeutic approach with curative intention. The differentiation between posttherapeutic findings after HIPEC and relapse of PC is challenging. We evaluated the diagnostic value of F-18-FDG-PET/CT in patients with relapse of PC after HIPEC. Materials and Methods: 36 patients with recurring PC after HIPEC were examined on a whole-body PET/CT system (44 examinations). The examination included 3?D F-18-FDG-PET and contrast-enhanced CT. Images were assessed by two experienced readers regarding the presence and the extent of PC using the peritoneal carcinomatosis index (PCI). Imaging results were correlated with surgical findings or follow-up. Results: Relapse was suspected in 40 of 44 examinations. Relapse was missed by F-18-FDG PET/CT in 4 patients and significantly underestimated in 8 patients. The diagnostic accuracy for the detection of PC on a patient basis was 91?%, the sensitivity was 91?% and the positive predictive value was 100?%. The mean PCI was 11.4???11.9 for PET/CT, 8.4???10.3 for CT and 16.6???15.0 in the case of surgical exploration. The extent of PC was underestimated by PET/CT and even more by CT alone (p?

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18F-FDG-PET/CT to Select Patients with Peritoneal Carcinomatosis for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Abstract: Contrast-enhanced CT is superior compared with PET alone to predict the extent of PC. In our patient group, the combination of both modalities (contrast enhanced PET/CT) yielded the best results and proved to be a useful tool for selecting candidates for peritonectomy and HIPEC.

Cited by 134 publications

References 25 publications

Diagnostic accuracy of (18) F-FDG PET/CT for the detection of peritoneal carcinomatosis of colorectal origins

Diagnostic accuracy of (18) F-FDG PET/CT for the detection of peritoneal carcinomatosis of colorectal origins

1^stEvidence-based Italian Consensus Conference on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinosis from Ovarian Cancer

Assessment of Relapse in Patients with Peritoneal Carcinomatosis after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy using F-18-FDG-PET/CT

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18F-FDG-PET/CT to Select Patients with Peritoneal Carcinomatosis for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Abstract: Contrast-enhanced CT is superior compared with PET alone to predict the extent of PC. In our patient group, the combination of both modalities (contrast enhanced PET/CT) yielded the best results and proved to be a useful tool for selecting candidates for peritonectomy and HIPEC.

Cited by 134 publications

References 25 publications

Diagnostic accuracy of (18) F-FDG PET/CT for the detection of peritoneal carcinomatosis of colorectal origins

Diagnostic accuracy of (18) F-FDG PET/CT for the detection of peritoneal carcinomatosis of colorectal origins

1stEvidence-based Italian Consensus Conference on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinosis from Ovarian Cancer

Assessment of Relapse in Patients with Peritoneal Carcinomatosis after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy using F-18-FDG-PET/CT

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Product

Resources

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1^stEvidence-based Italian Consensus Conference on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinosis from Ovarian Cancer