Does positron emission tomography offer prognostic information in malignant pleural mesothelioma?

Abstract

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether positron emission tomography is useful in the diagnosis and prognosis of malignant pleural mesothelioma (MPM). Altogether 136 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that fluorodeoxyglucose-positron emission tomography (FDG-PET) accurately differentiates benign from malignant pleural disease, helps detect recurrence and provides prognostic information in terms of staging, survival and mortality. Eleven studies evaluated the role of FDG-PET in the diagnosis and prognosis of MPM. Malignant disease had a higher standardised uptake value (SUV) (6.5 ± 3.4 vs. 0.8 ± 0.6; P < 0.001) than benign pleural disease. Shorter median survival (9.7 vs. 21 months; P = 0.02) was associated with high SUV (>10) than low SUV (<10). PET accurately upstaged 13% and downstaged 27% of cases initially staged with computed tomography (CT). In patients undergoing chemotherapy, higher total glycolytic volume led to a lower median survival (4.9 vs. 11.5 months; P = 0.09), while a decline in FDG uptake was associated with a longer time to tumour progression (14 vs. 7 months; P = 0.02). Four studies observed the role of FDG-PET-CT in the diagnosis and prognosis of MPM. SUV was found to be higher in MPM compared to benign pleural disease (6.5 vs. 0.8; P < 0.001). A higher SUV(max) was observed in primary pleural lesions of metastatic (7.1 vs. 4.7; P = 0.003) compared to non-metastatic disease. Patients who underwent surgery had equivalent survival to those excluded based on scan results (20 vs. 12 months; P = 0.3813). One study compared the utility of PET and PET-CT in the diagnosis and prognosis of mesothelioma. PET-CT was found to be more accurate than PET in terms of staging (P < 0.05) disease. Overall, PET accurately diagnoses MPM, predicts survival and disease recurrence. It can guide further management by predicting the response to chemotherapy and excluding surgery in patients with extrathoracic disease. Combined PET-CT has additional benefits in accurately staging disease.

Tomotherapy PET-guided dose escalation

“…DVHs were used to evaluate the PTV and OAR dose distributions both for the standard treatment and for the dose escalation plans. In order to evaluate the feasibility of the dose escalation, OAR NTCP calcula- into account functional volume show significant correlation with survival in MPM patients [10,11,23]. This approach is expected to reduce the dose to critical organs compared with the whole-organ dose escalation approach.…”

“…The use of RT alone with curative intent for unresected disease is not recommended with traditional techniques, since target volumes typically exceed normal tissue tolerance limits; a therapeutic dose of 60 Gy to the pleura, delivered with a standard three-dimensional conformal RT (3DCRT) technique, would expose more than 50 % of the ipsilateral lung volume to doses of > 20 Gy [9]. Recent studies have shown that 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) may help differentiate benign from malignant pleural disease and provide prognostic information in terms of survival and mortality [10]. Klabatsa et al [11] reported that 18 F-FDG PET/CT parameters that take into account functional volume were significantly associated with survival in patients with MPM before adjusting for histological subtype.…”

Diagnóstico y tratamiento del mesotelioma pleural maligno

“…No obstante, la TC es poco sensible para valorar una posible afectación ganglionar mediastínica o la existencia de afectación pleural contralateral o peritoneal. Para investigar estos aspectos, y la presencia de posibles metástasis a distancia, es mucho más útil la tomografía de emisión de positrones (positron emission tomography [PET]), especialmente si se combina con TC (PET-TC) 12 . La PET-TC desempeña un papel relevante en la estadificación preoperatoria del mesotelioma pleural maligno, en la valoración de la respuesta al tratamiento y para detectar la posible aparición de recidivas 13 .…”

Orthotopic Pleural Mesothelioma in Mice: SPECT/CT and MR Imaging with HER1- and HER2-targeted Radiolabeled Antibodies

“…MR imaging may be helpful in selected patients with potentially resectable disease to determine the local extent of tumor. Positron emission tomography (PET) with fluorine 18 fluorodeoxyglucose (FDG) has gained popularity for imaging MPM because of its superior specificity for tumors (5,6). These imaging modalities help in triaging patients to the most appropriate treatment options.…”