F-18 FDG PET/CT Demonstration of an Adrenal Metastasis in a Patient With Anaplastic Thyroid Cancer

Stanford University, Palo Alto, California, United States
Clinical Nuclear Medicine (Impact Factor: 3.93). 02/2007; 32(1):13-5. DOI: 10.1097/01.rlu.0000249591.51354.3e
Source: PubMed


An adrenal metastasis was identified on an F-18 FDG PET/CT scan in a patient with anaplastic thyroid cancer. There are very few reports of thyroid cancer, even anaplastic thyroid cancer, metastasizing to the adrenal.

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    ABSTRACT: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive solid tumors in humans. The use of positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) in ATC has not been studied, and only a few case reports have been published. The objective of this study was to investigate the potential contribution of 18F-FDG PET to the clinical management of patients with ATC. All patients with ATC studied with 18F-FDG PET from August 2001 through March 2007 were included. The PET results were correlated with computed tomography, ultrasound, magnetic resonance imaging, bone scan, histology, and clinical follow-up. The FDG uptake was semiquantified as maximum standard uptake value. Any change in the treatment plan as a direct result of the PET findings as documented in the clinical notes was recorded. Sixteen patients were included. True-positive PET findings were seen for all primary tumors, in all nine patients with lymph node metastases, in five out of eight patients with lung metastases, and in two patients with distant metastases other than lung metastases. In 8 of the 16 patients, the medical records reported a direct impact of the PET findings on the clinical management. ATC demonstrates intense uptake on 18F-FDG PET images. In 8 of the 16 patients (50%), the medical records reported a direct impact of the PET findings on the management of the patient. PET may improve disease detection and have an impact on the management of patients with ATC relative to other imaging modalities.
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    ABSTRACT: Our aim was to evaluate in anaplastic thyroid carcinoma (ATC) patients the value of 18F-FDG PET/CT compared with total body computed tomography (CT) using intravenous contrast material for initial staging, prognostic assessment, therapeutic monitoring and follow-up. Twenty consecutive ATC patients underwent PET/CT for initial staging. PET/CT was performed again during follow-up. The gold standard was progression on imaging follow-up (CT or PET/CT) or confirmation with another imaging modality. A total of 265 lesions in 63 organs were depicted in 18 patients. Thirty-five per cent of involved organs were demonstrated only with PET/CT and one involved organ only with CT. In three patients, the extent of disease was significantly changed with PET/CT that demonstrated unknown metastases. Initial treatment modalities were modified by PET/CT findings in 25% of cases. The volume of FDG uptake (≥300 ml) and the intensity of FDG uptake (SUVmax≥18) were significant prognostic factors for survival. PET/CT permitted an earlier assessment of tumour response to treatment than CT in 4 of the 11 patients in whom both examinations were performed. After treatment with combined radiotherapy and chemotherapy, only the two patients with a negative control PET/CT had a confirmed complete remission at 14 and 38 months; all eight patients who had persistent FDG uptake during treatment had a clinical recurrence and died. FDG PET/CT appears to be the reference imaging modality for ATC at initial staging and seems promising in the early evaluation of treatment response and follow-up.
    European Journal of Nuclear Medicine 12/2010; 37(12):2277-85. DOI:10.1007/s00259-010-1570-6 · 5.38 Impact Factor
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    ABSTRACT: Adrenal metastasis is common in oncology but patients with this diagnosis are usually asymptomatic. The diagnosis can be challenging and delayed. Incidence, presenting symptoms and diagnostic modalities are reviewed. Various treatment options are also discussed, including open and laparoscopic surgery, local ablation (radiofrequency ablation, cryoablation, microwave thermal ablation, and chemical ablation) as well as radiation therapy. These treatment modalities were compared and contrasted in regards to their invasiveness, risks, side effects, outcomes, and patients’ tolerance. Radiotherapy including stereotactic body radiation therapy (SBRT) is the only non-invasive approach, which is important as majority of the patients with adrenal metastases also receive systemic therapy, e.g., chemotherapy. The initial goal of conventional radiotherapy for metastatic adrenal lesion is for palliation which has been shown to be effective. With the advent of technological advances in radiation oncology, e.g., image-guidance during radiation delivery, patient immobilization and patient re-positioning, tumor motion management, sophisticated treatment planning allowing rapid dose fall-off, accurate QA, etc., the clinical implementation of SBRT has been very successful. SBRT is defined as a “treatment method to deliver high dose of radiation to the target, utilizing either a single dose or a small number of fractions with a high degree of precision within the body”. Adrenal metastasis, an example of oligometastases even from radioresistant primary, could be successfully treated with SBRT without significant toxicity as evidenced by various recently reported clinical trials. An additional advantage could be adrenal function preservation when compared to surgical intervention. The optimal total dose and fractionation scheme are yet to be determined. SBRT is an emerging non-invasive, safe, and effective treatment modality, and further research is warranted to define its role in the management of adrenal metastasis.
    03/2012; 1(1). DOI:10.1007/s13566-012-0012-4
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