Detection of unknown occult primary tumors using positron emission tomography

Kole, AC; Nieweg, Omgo E.; Pruim, Jan; Hoekstra, Harald J.; Koops, Heimen Schraffordt; Roodenburg, Jan; Vaalburg, W; Vermey, A

doi:10.1002/(sici)1097-0142(19980315)82:6<1160::aid-cncr22>3.0.co;2-3

Cited by 214 publications

(116 citation statements)

References 16 publications

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“…Newer imaging techniques (Tilanus-Linthorst et al, 1997; Kole et al, 1998;Lenzi et al, 1998;Schorn et al, 1999;Stevens et al, 1999), such as breast MRI, positron emission tomography and other nuclear medicine techniques, that can give clues as to the site of the primary, presently remain of limited help.…”

Section: Discussionmentioning

confidence: 99%

Carboplatin, doxorubicin and etoposide in the treatment of tumours of unknown primary site

et al. 2004

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The aim of this study was to assess the activity and toxicity of a platinum-based treatment on a group of patients with unknown primary tumours (UPTs). Patients with a diagnosis of UPT underwent a standard diagnostic procedure. Treatment was started within 2 weeks from diagnosis and consisted of carboplatin 400 mg m À2 day 1, doxorubicin 50 mg m À2 day 1, etoposide 100 mg m À2 days 1 -3, every 21 days. Response was evaluated after three courses and treatment continued in case of objective response (OR) or symptom control. A total of 102 patients were eligible. The median age was 59 years, sex male/female 54/48, histology was mainly adenocarcinoma or poorly differentiated carcinoma. Nodes, bone, liver and lung were the most frequently involved sites. In all, 79 patients received at least three courses of treatment; 26 patients received six courses or more. Six complete responses and 21 partial responses were observed, for a total of 27 of 102 ORs or 26.5% (95% confidence interval 18.2 -36.1%). The median survival was 9 months and median progression-free survival was 4 months. Toxicity was moderate to severe, with 57.8% of patients experiencing grade III -IV haematological toxicity, mainly leucopenia. The regimen employed has shown activity in tumours of unknown primary site, but was associated with significant toxicity. Such toxicity may be considered unjustified, given the large proportion of patients with tumours not likely to respond. Efforts should therefore be addressed to identify predictors of response to chemotherapy, thus limiting aggressive treatment to those patients who could benefit from it.

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Section: Discussionmentioning

confidence: 99%

Carboplatin, doxorubicin and etoposide in the treatment of tumours of unknown primary site

et al. 2004

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“…FDG-PET has proved to be a complementary study for patients with unknown primary tumor of the head and neck when conventional evaluation fails (Fig 2). [11][12][13][14][15][16][17][18] A review of 16 studies published between 1994 and 2003 evaluating the utility of FDG-PET in identifying unknown primary carcinomas af- PET/CT showed a 1.0 ϫ 1.2 cm hypermetabolic (gold arrow) and enhancing (red arrow) lesion at the right base of the tongue, large nodes in the right levels II/III, an 8-mm node at level IV, and no left-sided nodes or distant metastases. Direct laryngoscopy with biopsy and cervical esophagoscopy showed no lesions, but palpation showed a 1-cm firm right base of tongue lesion not crossing the midline, which was pathologically proved to be SCC.…”

Section: Detection Of Unknown Primary Tumormentioning

confidence: 99%

Fluorodeoxyglucose–Positron-Emission Tomography Imaging of Head and Neck Squamous Cell Cancer

Subramaniam

Truong

Peller

et al. 2009

AJNR Am J Neuroradiol

107

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SUMMARY:The hybrid technique of PET/CT has significantly impacted the imaging and management of HNSCC since its introduction in 2001 and has become the technique of choice for imaging of this cancer. Diagnostic FDG-PET/CT is useful for identification of an unknown primary tumor, delineation of extent of primary tumor, detection of regional lymph node involvement even in a normal-sized node, detection of distant metastases and occasional synchronous primary tumor, assessment of therapy response, and long-term surveillance for recurrence and metastases. The role of PET/CT is evolving in radiation therapy planning. Combined diagnostic PET/CT provides the best anatomic and metabolic in vivo information for the comprehensive management of HNSCC.ABBREVIATIONS: CR ϭ complete response; DCT ϭ contrast enhanced diagnostic CT;18 F ϭ fluorine-18; FDG ϭ fluorodeoxyglucose; FDG-PET ϭ fluorodeoxyglucose-positron-emission tomography; FNA ϭ fine-needle aspiration; GTV ϭ gross tumor volume; HNSCC ϭ head and neck squamous cell carcinomas; IMRT ϭ intensity modulated radiation therapy; M ϭ metastasis; N ϭ node; PET ϭ positron-emission tomography; PTV ϭ planning target volume; RD ϭ residual disease; SCC ϭ squamous cell carcinoma; SUV ϭ standard uptake value; SUV max ϭ maximum SUV; T ϭ tumor M ore than 40,000 people are diagnosed with head and neck cancer each year in the United States.1 The overall annual mortality rate for this cancer in the United States is 23%, and the 5-year survival rate is 56%.1-3 More than 80% of early-stage tumors are cured, but nearly one-half of patients have evidence of advanced local disease or lymph node metastases at the time of diagnosis. Surgery and radiation therapy, either alone or in combination with chemotherapy, are used for definitive locoregional treatment of head and neck cancers. For patients with advancedstage and high-risk features, postoperative chemoradiation improves locoregional control and overall survival. 4,5 Cross-sectional imaging with CT and MR imaging is commonly used for tumor staging and may allow detection of subcentimeter lesions. Locoregional lymph node metastases have a major impact on survival. Patients with lymph-node involvement have a worse prognosis (approximately 30%) than patients without lymph node involvement (Ͼ50% 5-year survival). 6,7 PET using the radiotracer 18 F FDG is widely used to evaluate patients with HNSCC. The hybrid technique, PET/CT, provides anatomic and functional information and can be performed as PET and DCT with intravenous contrast-enhancement (PET/ DCT) or PET and noncontrast CT (PET/CT) for attenuation correction and anatomic localization. PET/CT is useful for identification of an unknown primary tumor, delineation of the extent of regional lymph node involvement, detection of distant metastases and occasional synchronous primary tumor, radiation-therapy planning, assessing therapy response, and long-term surveillance for recurrence and metastases.PET/CT Protocols PET/CT imaging was developed to improve PET imaging by expediting attenuation c...

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“…The reduced signal-to-noise ratio may be a reason. The detection of tumors with PET/CT depends on the difference between the intensity of the signal from the tumor and that of the background [10]. Another explanation is that the primary lesion has involuted and is not detectable when the metastasis becomes evident [22,23].…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that positron emission tomography/ computed tomography (PET/CT) utilizing 18 F-Fluorodeoxyglucose (FDG) is a valuable tool in patients with CUP, but with large difference between studies from 24 to 80 percent of detection rates [8][9][10][11][12].…”

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confidence: 99%

Clinical implication of 18F-FDG PET/CT in carcinoma of unknown primary

Sj²,

Ij³

et al. 2011

neo

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The value of 18 F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in the detection of carcinoma of unknown primary (CUP) differs among the studies. This study aimed to evaluate the role of 18 F-FDG PET/CT in CUP.Fifty-one patients (19 women, 32 men) with metastasis confirmed by histopathology from an unknown primary tumor were included in this study. Patients received 370 MBq of 18 F-FDG intravenously, and PET/CT was performed at 60 minutes after injection.Primary tumor sites were detected in 5 of 51 patients (9.6%): in 2 patients with carcinoma of the lung, in 1 patient with carcinoma of the gallbladder, in 1 patient with carcinoma of the esophagus, and in 1 patient with carcinoma of the stomach. No primary tumor was discovered in the remaining 46 patients (90.4%) during the follow-up. The sensitivity, specificity, and accuracy of 18 F-FDG PET/CT were 100%, 80.4%, and 82.4%. The positive and negative predictive values were 35.7 and 100%, respectively.Based on the data presented, 18F-FDG PET/CT has a clinical implicative value in detecting the primary tumor of CUP. PET/CT can be useful to rule out the possibility of detecting the primary tumor during the follow-up.

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Detection of unknown occult primary tumors using positron emission tomography

Abstract: A previously unknown primary tumor was able to be identified with FDG-PET in 7 of 29 patients after an unsuccessful conventional diagnostic workup. However, the clinical relevance of PET information in this setting is limited.

Cited by 214 publications

References 16 publications

Carboplatin, doxorubicin and etoposide in the treatment of tumours of unknown primary site

Carboplatin, doxorubicin and etoposide in the treatment of tumours of unknown primary site

Fluorodeoxyglucose–Positron-Emission Tomography Imaging of Head and Neck Squamous Cell Cancer

Clinical implication of 18F-FDG PET/CT in carcinoma of unknown primary

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