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Calvo Manuel FÁ, Serrano J, Solé C, Cambeiro M, Palma J, Aristu J, Garcia-Sabrido JL, Cuesta MA, Del Valle E, Lapuente F, Miñana B, Morcillo MÁ, Asencio JM, Pascau J. Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development. Clin Transl Oncol 2023; 25:429-439. [PMID: 36169803 PMCID: PMC9873754 DOI: 10.1007/s12094-022-02955-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/14/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Local cancer therapy by combining real-time surgical exploration and resection with delivery of a single dose of high-energy electron irradiation entails a very precise and effective local therapeutic approach. Integrating the benefits from minimally invasive surgical techniques with the very precise delivery of intraoperative electron irradiation results in an efficient combined modality therapy. METHODS Patients with locally advanced disease, who are candidates for laparoscopic and/or thoracoscopic surgery, received an integrated multimodal management. Preoperative treatment included induction chemotherapy and/or chemoradiation, followed by laparoscopic surgery and intraoperative electron radiation therapy. RESULTS In a period of 5 consecutive years, 125 rectal cancer patients were treated, of which 35% underwent a laparoscopic approach. We found no differences in cancer outcomes and tolerance between the open and laparoscopic groups. Two esophageal cancer patients were treated with IOeRT during thoracoscopic resection, with the resection specimens showing intense downstaging effects. Two oligo-recurrent prostatic cancer patients (isolated nodal progression) had a robotic-assisted surgical resection and post-lymphadenectomy electron boost on the vascular and lateral pelvic wall. CONCLUSIONS Minimally invasive and robotic-assisted surgery is feasible to combine with intraoperative electron radiation therapy and offers a new model explored with electron-FLASH beams.
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Affiliation(s)
| | - Javier Serrano
- Department of Oncology, Clinica Universidad de Navarra, Madrid-Pamplona, Spain
| | - Claudio Solé
- Instituto RadioMedicina, Santiago del Chile, Chile
| | - Mauricio Cambeiro
- Department of Oncology, Clinica Universidad de Navarra, Madrid-Pamplona, Spain
| | - Jacobo Palma
- Department of Oncology, Clinica Universidad de Navarra, Madrid-Pamplona, Spain
| | - Javier Aristu
- Department of Oncology, Clinica Universidad de Navarra, Madrid-Pamplona, Spain
| | | | | | | | - Fernando Lapuente
- Department of Surgery, Clinica Universidad de Navarra, Madrid, Spain
| | - Bernardino Miñana
- Department of Urology, Clinica Universidad de Navarra, Madrid, Spain
| | | | | | - Javier Pascau
- Department of Bioengineering and Aerospace Engineering, Universidad Carlos III de Madrid, Getafe, Spain
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Abstract
[(18)F]Fluorodeoxyglucose (FDG) PET is a functional imaging tool that provides metabolic information, which has the potential to detect a lesion before it becomes anatomically apparent. This ability constitutes a strong argument for using FDG-PET/computed tomography (CT) in the management of oncology patients. Many studies have investigated the accuracy of FDG-PET or FDG-PET/CT for these purposes, but with small sample sizes based on retrospective cohorts. This article provides an overview of the role of FDG-PET or FDG-PET/CT in patients with liver malignancies treated by means of surgical resection, ablative therapy, chemoembolization, radioembolization, and brachytherapy, all being liver-directed oncologic interventions.
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Domachevsky L, Jacene HA, Sakellis CG, Kim CK. Postradiation changes in tissues: evaluation by imaging studies with emphasis on fluorodeoxyglucose-PET/computed tomography and correlation with histopathologic findings. PET Clin 2014; 9:217-35. [PMID: 25030284 DOI: 10.1016/j.cpet.2013.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Efforts have been made to minimize the damage to adjacent normal tissues during radiotherapy, primarily by shifting from the use of conventional radiotherapy to more advanced techniques. Reviewing the overall pattern on combined anatomic and functional imaging can enhance diagnostic accuracy. Several radiotracers can be used; [(18)F]fluorodeoxyglucose is the most common. Familiarity with the type and timing of previous radiation therapy, the spectrum of imaging findings after radiation injury, and the appropriate use of the different radiotracers can be crucial. This article summarizes postradiation histologic findings and multimodality imaging findings, with emphasis on PET/computed tomography.
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Affiliation(s)
- Liran Domachevsky
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Christopher G Sakellis
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Chun K Kim
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Chen C, Yan LM, Guo KY, Wang YJ, Zou F, Gu WW, Tang H, Li YL, Wu SJ. The diagnostic value of 18F-FDG-PET/CT in hematopoietic radiation toxicity: a Tibet minipig model. JOURNAL OF RADIATION RESEARCH 2012; 53:537-544. [PMID: 22843618 PMCID: PMC3393352 DOI: 10.1093/jrr/rrs006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 03/03/2012] [Accepted: 03/06/2012] [Indexed: 06/01/2023]
Abstract
This study was undertaken to assess the diagnostic value of 2-[(18)F]-fluoro-2-deoxy-D-glucose positron emission tomography with computed tomography ([(18)F]-FDG-PET/CT) in the detection of radiation toxicity in normal bone marrow using Tibet minipigs as a model. Eighteen Tibet minipigs were caged in aseptic rooms and randomly divided into six groups. Five groups (n = 3/group) were irradiated with single doses of 2, 5, 8, 11 and 14 Gy of total body irradiation (TBI) using an 8-MV X-ray linear accelerator. These pigs were evaluated with [(18)F]-FDG-PET/CT, and their marrow nucleated cells were counted. The data were initially collected at 6, 24 and 72 h after treatment and were then collected on Days 5-60 post-TBI at 5-day intervals. At 24 and 72 h post-TBI, marrow standardized uptake value (SUV) data showed a dose-dependent decrease in the radiation dose range from 2-8 Gy. Upon long-term observation, SUV and marrow nucleated cell number in the 11-Gy and 14-Gy groups showed a continuous and marked reduction throughout the entire time course, while Kaplan-Meier curves of survival showed low survival. In contrast, the SUVs in the 2-, 5- and 8-Gy groups showed early transient increases followed by a decline from approximately 72 h through Days 5-15 and then normalized or maintained low levels through the endpoint; marrow nucleated cell number and survival curves showed approximately the same trend and higher survival, respectively. Our findings suggest that [(18)F]-FDG-PET/CT may be helpful in quickly assessing the absorbed doses and predicting the prognosis in patients.
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Affiliation(s)
- Chi Chen
- Department of Hematology, Zhujiang Hospital, Southern Medical University, 253# Industry Road, 510282, Guangzhou, Guangdong, China
| | - Li-Meng Yan
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, 253# Industry Road, 510282, Guangzhou, Guangdong, China
| | - Kun-Yuan Guo
- Department of Hematology, Zhujiang Hospital, Southern Medical University, 253# Industry Road, 510282, Guangzhou, Guangdong, China
| | - Yu-Jue Wang
- Department of Laboratory Animal Center, Southern Medical University, 1838# Guangzhou North Road, 510282, Guangzhou, Guangdong, China
| | - Fei Zou
- School of Hygiene and Tropical Medicine, Southern Medical University, 1838# Guangzhou North Road, 510282, Guangzhou, Guangdong, China
| | - Wei-Wang Gu
- Department of Laboratory Animal Center, Southern Medical University, 1838# Guangzhou North Road, 510282, Guangzhou, Guangdong, China
| | - Hua Tang
- Department of Laboratory Animal Center, Southern Medical University, 1838# Guangzhou North Road, 510282, Guangzhou, Guangdong, China
| | - Yan-Ling Li
- Center of Laboratory Medicine, Affiliated Hospital of The Medical College of Guiyang, 2# Beijing Road, 550001, Guiyang, Guizhou, China
| | - Shao-Jie Wu
- Department of Hematology, Zhujiang Hospital, Southern Medical University, 253# Industry Road, 510282, Guangzhou, Guangdong, China
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Wang TJ, Liu ZS, Zeng ZC, Du SS, Qiang M, Jiang W, Zhou LY, Ding WJ, Zeng HY. Caffeine does not enhance radiosensitivity of normal liver tissue in vivo. Mol Biol Rep 2010; 38:4359-67. [PMID: 21116849 DOI: 10.1007/s11033-010-0563-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 11/17/2010] [Indexed: 11/30/2022]
Abstract
The aim of this study was to determine whether caffeine enhanced radiosensitivity of normal liver tissue in a rat radiation-induced liver disease model. Buffalo rat McA-RH7777 hepatocellular cancer cells and BRL3A normal liver cells were irradiated, and cell cycle distribution and apoptosis rates were analyzed. A rat model of radiation-induced liver disease was established, rats were randomized into four groups: control; caffeine alone; irradiation (IR) alone; and caffeine plus IR (Caff + IR) group. Apoptosis rates in normal rat liver tissue after IR were evaluated by TUNEL staining and caspase-3 Western blot. Transaminase activity was measured and histopathological examination was done after IR. Caffeine abrogated IR-induced G2 phase arrest (Caff + IR vs. IR: 40.9 ± 4.0 vs. 60.7 ± 5.5%, at 12 h after IR) and increased apoptosis rates (Caff + IR vs. IR: 56.1 ± 6.8 vs. 35.5 ± 4.0%, at 72 h after IR) in McA-RH7777 cells, but did not affect IR-induced G2 phase arrest and apoptosis rates at any time point after IR in BRL3A cells. Caffeine did not enhance apoptosis, transaminase activity, or histopathological injury of normal rat liver tissue at any time points after IR. This study suggests that caffeine might not enhance radiosensitivity of normal liver tissue in vivo. In an earlier study, we reported that caffeine enhanced radiosensitivity of human hepatocellular cancer in a nude mice model. Together, these results offer feasibility of clinical application.
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Affiliation(s)
- Tie-Jun Wang
- Department of Radiation Oncology, Second Affiliated Hospital, Jilin University, Changchun 100021, China
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Wang TJ, Liu ZS, Zeng ZC, Du SS, Qiang M, Zhang SM, Zhang ZY, Tang ZY, Wu WZ, Zeng HY. Caffeine enhances radiosensitization to orthotopic transplant LM3 hepatocellular carcinoma in vivo. Cancer Sci 2010; 101:1440-6. [PMID: 20384627 PMCID: PMC11158075 DOI: 10.1111/j.1349-7006.2010.01564.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 02/23/2010] [Accepted: 03/04/2010] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to determine whether caffeine enhanced radiosensitization in an orthotopic transplant of LM3 human hepatocellular cancer in nude mice. LM3 hepatocellular carcinoma cells were infected with red fluorescent protein and irradiated, and cell cycle distribution and survival fraction were detected. A nude mouse model of orthotopic transplant of red fluorescent protein-expressing LM3 hepatocellular cancer was established. Nude mice were divided into four groups: control (NS); caffeine (Caff) alone; irradiation (IR) alone; and caffeine + IR (Caff + IR). Tumor growth curves were described. Expression of cyclin and apoptosis were evaluated by analysis of phosphorylated cyclin dependent kinase 1 (CDC2) Tyr15 (CDC2-Tyr15-P), cyclinB1, TUNEL staining, and caspase-3. Caffeine abrogated IR-induced G(2) phase arrest and decreased survival of irradiated LM3 cells. Caffeine enhanced radiosensitivity of LM3 hepatocellular cancer in vivo. Tumor growth delay time in the Caff + IR group was 14.3 days compared with the NS group, 14.1 days compared with the Caff alone group, and 7.2 days compared with the IR alone group. At 15 Gy, expression of CDC2-Tyr15-P in the Caff + IR group (26.0 +/- 8.9%) was significantly lower than in the IR alone group (68.4 +/- 10.6%), expression of cyclinB1 and proportion of TUNEL-positive cells in the Caff + IR group (30.4 +/- 8.7% and 59.2 +/- 9.5%, respectively) was significantly higher than in the IR alone group (7.0 +/- 3.7% and 24.2 +/- 7.2%, respectively), expression of caspase-3 was consistent with the TUNEL staining results. This study suggested that caffeine might enhance the radiosensitivity of LM3 hepatocellular cancer in vivo, and may be feasible for further clinical applications.
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Affiliation(s)
- Tie-Jun Wang
- Department of Radiation Oncology, the Second Affiliated Hospital of Jilin University, Changchun, China
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Gastrointestinal 18F-FDG accumulation on PET without a corresponding CT abnormality is not an early indicator of cancer development. Eur Radiol 2009; 19:2171-9. [PMID: 19415294 DOI: 10.1007/s00330-009-1405-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Accepted: 02/21/2009] [Indexed: 12/22/2022]
Abstract
Focal gastrointestinal 2-deoxy-2-[(18)F]-fluoro-D: -glucose (FDG) uptake can frequently be found on FDG-PET/CT even in patients without known gastrointestinal malignancy. The aim of this study was to evaluate whether increased gastrointestinal FDG uptake without CT correlate is an early indicator of patients developing gastrointestinal malignancies. A total of 1,006 patients without esophagogastric or anorectal malignancies underwent FDG-PET/CT. The esophagogastric junction, the stomach and the anorectum were evaluated for increased FDG uptake. Patients without elevated uptake were assigned to group A, patients with elevated uptake were allocated to group B. The SUVmax values of both groups were tested for significant differences using the U test. A follow-up of longer than 1 year (mean 853 +/- 414 days) served as gold standard. A total of 460 patients had to be excluded based on insufficient follow-up data. For the remaining 546 patients the mean SUVmax was as follows: (a) esophagogastric junction, group A 3.1 +/- 0.66, group B 4.0 +/- 1.11, p < 0.01; (b) stomach, group A 2.8 +/- 0.77, group B 4.1 +/- 1.33, p < 0.01; (c) rectal ampulla, group A 2.8 +/- 0.83, group B 3.9 +/- 1.49, p < 0.01; (d) anal canal, group A 2.7 +/- 0.55, group B 3.9 +/- 1.59, p < 0.01. Only one patient developed gastric cancer. In the case of an unremarkable CT, elevated esophagogastric or anorectal FDG uptake does not predict cancer development and does not have to be investigated further.
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Iyer RB, Balachandran A, Bruzzi JF, Johnson V, Macapinlac HA, Munden RF. PET/CT and hepatic radiation injury in esophageal cancer patients. Cancer Imaging 2007; 7:189-94. [PMID: 18055293 PMCID: PMC2151325 DOI: 10.1102/1470-7330.2007.0027] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper evaluates the imaging appearance of radiation injury in the liver on positron emission tomography (PET)/computed tomography (CT) in patients with distal esophageal cancer who underwent pre-operative chemoradiation therapy. Twenty-six patients with distal esophageal cancer who received chemoradiotherapy before esophagectomy were included. All patients had baseline and follow-up PET/CT. Fluorodeoxyglucose (FDG) uptake in both left and right lobes of the liver was evaluated. CT findings suggesting radiation damage were documented. Abnormal FDG uptake in the liver was observed in 5 (19%) patients after therapy. These abnormalities were in the left lobe (12%) and right lobe (12%) of the liver. In the irradiated left lobe, FDG uptake increased focally greater than 50% over baseline in two patients (54% and 133%); in one of these patients, biopsy confirmed radiation injury. In the non-irradiated right lobe, standard uptake values (SUV) increased diffusely in two different patients. In one patient, SUV decreased by at least 50% in both the right and left lobes. In the remaining patients, there were no significant changes in FDG uptake. Atrophy and attenuation changes of irradiated liver on CT were found in 15 (58%) patients. In patients receiving chemoradiotherapy, PET/CT may identify metabolic abnormalities in irradiated liver. Such abnormalities should be correlated with other imaging, clinical and laboratory findings to avoid confusion with hepatic metastases.
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Affiliation(s)
- Revathy B Iyer
- Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Christiansen H, Sheikh N, Saile B, Reuter F, Rave-Fränk M, Hermann RM, Dudas J, Hille A, Hess CF, Ramadori G. x-Irradiation in Rat Liver: Consequent Upregulation of Hepcidin and Downregulation of Hemojuvelin and Ferroportin-1 Gene Expression. Radiology 2007; 242:189-97. [PMID: 17090718 DOI: 10.1148/radiol.2421060083] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To prospectively analyze hepcidin, hemojuvelin, and ferroportin-1 expression after x-irradiation of rat liver and isolated rat hepatocytes. MATERIALS AND METHODS The treatment of the rats and this study were approved by the local committee and the public authority on animal welfare. Rat livers in vivo and isolated rat hepatocytes in vitro were irradiated. The total number of rats in this study was 43. RNA extracted from livers (1, 3, 6, 12, 24, and 48 hours after irradiation) and from hepatocytes (1, 3, 6, 12, and 24 hours after irradiation) was analyzed with real-time polymerase chain reaction and Northern blot. Cytokines and prohepcidin in serum of irradiated rats were quantitatively detected with enzyme-linked immunosorbent assay. Sham-irradiated animals served as controls in all experiments. Differences between sham-irradiated and irradiated data groups were tested with analysis of variance and Dunnett post hoc test. RESULTS In vivo, a significant radiation-induced increase of hepcidin (P=.034), interleukin (IL) 1beta (P=.008), IL-6 (P<.011), and tumor necrosis factor alpha (TNF-alpha) (P=.047) expression could be detected within the first 48 hours after irradiation. Expression of hemojuvelin (P=.008) and ferroportin-1 (P=.002) was significantly decreased. Serum iron levels were decreased because of irradiation (P<.058); prohepcidin serum levels were increased (P=.05). In rat hepatocytes in vitro, hepcidin RNA levels were significantly downregulated after irradiation (P<.001). Incubation of irradiated hepatocytes with IL-1beta, IL-6, or TNF-alpha led to upregulation of hepcidin expression in vitro up to 6 hours after irradiation, with subsequent significant downregulation for incubation with IL-1beta (P<.001). Hemojuvelin expression behaved in a way opposite to that of hepcidin. CONCLUSION x-Irradiation of the liver induced changes of hepcidin gene expression that are probably induced by acute phase mediators produced within the liver itself.
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Affiliation(s)
- Hans Christiansen
- Department of Radiation Oncology, Section of Gastroenterology and Endocrinology, University Hospital Goettingen, Robert-Koch-Strasse 40, 37075 Goettingen, Germany.
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Chin BB, Chang PPL. Gastrointestinal malignancies evaluated with (18)F-fluoro-2-deoxyglucose positron emission tomography. Best Pract Res Clin Gastroenterol 2006; 20:3-21. [PMID: 16473798 DOI: 10.1016/j.bpg.2005.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
(18)F-fluoro-2-deoxyglucose positron emission tomography has demonstrated high accuracy in the staging and evaluation of colorectal and esophageal carcinomas. FDG PET is demonstrating increasing utility in a number of other gastrointestinal tumours and clinical scenarios. The established clinical indications for its use, the diagnostic accuracy, and limitations will be reviewed. Data on the emerging indications and limitations for pancreatic, hepatocellular, and gastric carcinomas, as well as gastrointestinal stromal tumours, cholangiocarcinoma, and carcinoma of unknown primary will also be briefly discussed. The use of combined PET-CT is demonstrating further improvements in diagnostic accuracy.
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Affiliation(s)
- Bennett B Chin
- Division of Nuclear Medicine, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
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Gutzeit A, Antoch G, Kühl H, Egelhof T, Fischer M, Hauth E, Goehde S, Bockisch A, Debatin J, Freudenberg L. Unknown primary tumors: detection with dual-modality PET/CT--initial experience. Radiology 2004; 234:227-34. [PMID: 15564390 DOI: 10.1148/radiol.2341031554] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To retrospectively evaluate fused positron emission tomography (PET)/computed tomography (CT) in depicting the primary lesion in cancer of an unknown primary tumor, compared with PET, CT, and PET and CT side-by-side evaluation. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. Forty-five patients (26 men and 19 women) with metastatic cervical adenopathy (n = 18) or extracervical metastases (n = 27) of unknown primary tumor were included. The mean age of the patients was 57 years (range, 29-95 years). PET/CT imaging was performed in all patients 1 hour after administration of 350 MBq of fluorodeoxyglucose with a whole-body field of view. Contrast agents were administered orally and intravenously in all patients to ensure diagnostic CT data. PET/CT data sets were evaluated for the primary tumor, and imaging results were compared with those of CT, PET, and PET and CT side-by-side evaluation. Differences in diagnostic performance were assessed by using the McNemar test with Bonferroni correction, which accounts for multiple comparisons. RESULTS PET/CT depicted the primary tumor in 15 (33%) of 45 patients. In 30 (67%) patients, the primary tumor site remained occult (P > .05). PET and CT side-by-side evaluation depicted 13 (29%) of 45 tumors (P > .05). PET alone revealed the primary tumor in 11 (24%) of 45 patients (P > .05), while CT alone helped in the correct diagnosis in eight (18%) of 45 patients (P > .05). There were no significant differences between the diagnostic accuracies of PET/CT and the other imaging modalities. CONCLUSION PET/CT was able to depict more primary tumors, though not significantly, than either of the other imaging modalities, but larger patient cohorts are required to finally judge its value for revealing the primary tumor site.
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Affiliation(s)
- Andreas Gutzeit
- Department of Diagnostic and Interventional Radiology, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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