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ABSTRACT: Neben ihrem Stellenwert im initialen Staging (v.a. zum Ausschluss einer Fernmetastasierung) und in der Rezidivdiagnostik
des Ösophaguskarzinoms kann die Positronenemissionstomographie mit Fluordesoxyglucose (FDG-PET) auch zur Kontrolle des Therapieansprechens
verwendet werden. Eine neoadjuvante Chemo-/Radiochemotherapie kann das Überleben von Patienten mit Ösophaguskarzinom signifikant
verbessern, doch profitieren davon nur Patienten mit Ansprechen auf die Induktionstherapie. Die Kontrolle des Therapieansprechens
kann spät, d.h. nach Ende der neoadjuvanten Therapie, sowie früh im Therapieverlauf erfolgen. Als Surrogatparameter zur Vorhersage
des Therapieansprechens und der Prognose für Adenokarzinome des gastroösophagealen Übergangs wurde die FDG-PET bereits in
mehreren Studien evaluiert und validiert. Die unizentrische MUNICON-Studie zeigte, dass eine PET/CT-gesteuerte Therapie beim
Adenokarzinom des Ösophagus möglich ist, was hinsichtlich einer Individualisierung der multimodalen Therapie wichtig ist.
In anderen Studien war die FDG-PET hinsichtlich Ansprechen und Prognose jedoch nicht aussagekräftig. Die Rolle der FDG-PET/CT
in der Therapiekontrolle des Ösophaguskarzinoms wird intensiv diskutiert. Prospektive randomisierte multizentrische Studien
sind noch erforderlich. Außerhalb von Studien sollte die PET/CT-gesteuerte Therapie nicht eingesetzt werden. Zukünftige Forschung
wird sich auch neuen Möglichkeiten der molekularen Bildgebung sowie innovativen Therapieregimes widmen.
Besides its role in staging (especially to rule out distant metastasis) and restaging of patients with esophageal cancer,
PET with the glucose analog (18)F-FDG can be used for assessing response to therapy. Preoperative chemotherapy or chemoradiotherapy
has been shown to improve outcome with respect to survival. Patients who respond to induction therapy have a significantly
improved survival, compared with patients who do not respond to therapy. Therapy response can be assessed with FDG PET/CT
late, that is, after completion of therapy, and early in the course of therapy. In adenocarcinomas of the esophagogastric
junction, (18)F-FDG has been established and validated in several studies as a surrogate marker that allows prediction of
response and prognosis, whereas in other studies FDG PET/CT was not predictive of response and prognosis. The MUNICON study
was an initial unicenter trial showing that a PET-guided treatment algorithm was feasible in patients with adenocarcinomas
of the esophagogastric junction. The results of this study are important regarding individualization of multimodal treatment.
The use of FDG PET/CT for therapy monitoring in esophageal cancer is the subject of an intense debate. At the present time
it should not be used outside clinical trials. In the future, prospective randomized multicenter trials will have to be performed
and research will address new imaging probes and innovative therapy regimens.
SchlüsselwörterÖsophaguskarzinom -18F-FDG-PET/CT-Staging-Response-Prädiktion
KeywordsEsophageal cancer-
18F-Fluorodeoxyglucose-Positron emission tomography-Staging-Response assessment
Der Onkologe 04/2012; 16(5):471-487. · 0.17 Impact Factor
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ABSTRACT: In the past, enormous public and private investments have been made to reduce cancer incidence and mortality. Despite some improvements over the last 10 years, the overall outcome of the "war on cancer" has been disappointing. Among the reasons for this limited success is our inability to determine, whether the therapeutic target is present, and whether the target is reached by the drug. A further important issue is our limited ability to correctly assess response to treatment early after start of therapy which would allow for more individualized treatment approaches. PET and PET/CT with the glucose analogue 2'-[(18)F]-fluoro-2'-deoxy-D-glucose (FDG) are increasingly used to assess response to therapy in patients, and a converging large body of evidence is emerging that suggests that changes in glucose utilization during therapy can be used to predict clinical outcome. In this article we provide an overview of the utility of (18)F-FDG PET/CT imaging for early monitoring of cancer therapy and address current and future challenges for its more widespread adoption. First, we discuss general requirements that any imaging modality must meet to provide valid and valuable treatment response assessment. We will then review the strengths and limitations of CT (RECIST) and PET based response criteria. Finally, we will examine the role of FDG-PET/(CT) imaging for response assessments in solid tumors.
The quarterly journal of nuclear medicine and molecular imaging: official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of... 12/2011; 55(6):620-32.
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Nuklearmedizin 01/2010; 49(4):N20-1. · 1.28 Impact Factor
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ABSTRACT: An increase of the serum PSA-level is a sensitive in vitro marker for recurrent prostate cancer. However, it remains difficult to differentiate between local, regional or distant recurrent disease. The aim of this study was to assess the relationship between the detection rate of [(11)C]Choline-PET/CT and the serum PSA-level in patients with a biochemical recurrence of prostate cancer with the view towards localisation of recurrent disease.
Sixty-three patients (mean age, 68.8 +/- 6.9; range, 45-83 years) with biochemical recurrence after primary therapy for prostate cancer were included in the analysis. Mean PSA-levels were 5.9 +/- 9.7 ng/ml (range, 0.2-39 ng/ml; median, 2.15). Of the 63 patients, 17 were under anti-androgen therapy at the time of [(11)C]Choline PET/CT. Patients underwent a [(11)C]Choline-PET/CT study after injection of 656 +/- 119 MBq [(11)C]Choline on a Sensation 16 Biograph PET/CT scanner.
Of the 63 patients, 35 (56%) showed a pathological [(11)C]Choline uptake. The detection rate of [(11)C]Choline-PET/CT showed a relationship with the serum PSA-level: The detection rate was 36% for a PSA-value <1 ng/ml, 43% for a PSA-value 1-<2 ng/ml, 62% for a PSA-value 2-<3 ng/ml and 73% for a PSA-value >or=3 ng/ml. Anti-androgen therapy did not show a significant effect on the detection rate of [(11)C]Choline-PET/CT (p = 0.374).
As an important result our study shows that even for PSA-values <1.0 ng/ml the detection efficiency of [(11)C]Choline-PET/CT is 36%. Furthermore, the detection rate of [(11)C]Choline-PET/CT shows a positive relationship with serum PSA-levels in patients with biochemical recurrence of prostate cancer after primary therapy. Therefore, in these patients, [(11)C]Choline PET/CT allows not only to diagnose but also to localise recurrent disease with implications on disease management (localised vs systemic therapy).
European Journal of Nuclear Medicine 01/2008; 35(1):18-23. · 4.53 Impact Factor
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ABSTRACT: PET imaging with the glucose analog fluorodeoxyglucose (FDG-PET) has been evaluated in several studies to monitor tumor response in patients undergoing chemo- and radiotherapy. The clinical value of FDG-PET for differentiation of residual tumor and therapy induced fibrosis has been documented for esophageal cancer. Furthermore, there are now several reports suggesting that quantitative assessment of therapy induced changes in tumor FDG-uptake may allow prediction of tumor response and patient outcome very early in the course of therapy. This suggests that FDG-PET may be used to identify non-responders early during neoadjuvant chemoradiotherapy allowing for early modifications of the treatment protocol.
Der Radiologe 03/2007; 47(2):110-4. · 0.61 Impact Factor
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ABSTRACT: This study assessed the value of (18)F-deoxyglucose positron emission tomography (FDG-PET) for visualisation and early metabolic response assessment in metastatic gastro-oesophageal cancer.
Twenty-six patients who were treated for metastatic disease (20 adenocarcinomas, 6 squamous cell cancers) underwent FDG-PET before and two weeks after the onset of palliative chemotherapy with either oxaliplatin + 5-FU/LV or with docetaxel + capecitabine. PET results were validated according to clinical response based on RECIST criteria.
Twenty-four tumours (92%) could be visualised by FDG-PET and were also assessable by a second PET scan at 2 weeks. The 2 tumours that were not detectable by PET were both gastric cancers belonging to the non-intestinal subtype according to Lauren. Median time to progression and overall survival were not significantly different for metabolic responders and non-responders (6.3 vs 5.3 months and 14.1 vs 12.5 months, respectively).
In this heterogeneous study population, FDG-PET had a limited accuracy in predicting clinical response. However, the metabolic response prediction was particularly good in the subgroup of patients with oesophageal squamous cell cancer. Therefore, FDG-PET and assessment of cancer therapy clearly merits further investigation in circumscribed patient populations with metastatic disease.
Nuklearmedizin 02/2007; 46(6):263-70. · 1.28 Impact Factor
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ABSTRACT: Die diagnostische Wertigkeit der Positronenemissionstomographie mit dem Glukoseanalogon [18F]Fluorodeoxyklukose (FDG-PET) wurde in verschiedenen Studien zur Verlaufskontrolle einer neoadjuvanten Therapie beim sophaguskarzinom untersucht. Neben der Differenzierung von Resttumorgewebe nach Therapie und therapieinduzierter Fibrose besteht die Mglichkeit, mit der FDG-PET durch Messung quantitativer nderungen des Glukosemetabolismus frh im Verlauf der Therapie das histopathologische Tumoransprechen sowie die Prognose des Patienten vorherzusagen. Bei Patienten, die nicht auf die Therapie ansprechen, besteht somit die Mglichkeit, im Verlauf einer Therapie das therapeutische Procedere zu ndern und dem Patienten alternative Therapiekonzepte anzubieten.PET imaging with the glucose analog fluorodeoxyglucose (FDG-PET) has been evaluated in several studies to monitor tumor response in patients undergoing chemo- and radiotherapy. The clinical value of FDG-PET for differentiation of residual tumor and therapy induced fibrosis has been documented for esophageal cancer. Furthermore, there are now several reports suggesting that quantitative assessment of therapy induced changes in tumor FDG-uptake may allow prediction of tumor response and patient outcome very early in the course of therapy. This suggests that FDG-PET may be used to identify non-responders early during neoadjuvant chemoradiotherapy allowing for early modifications of the treatment protocol.
Der Radiologe 01/2007; 47(2):110-114. · 0.61 Impact Factor
