1 / 30

Positron emission tomography in oncology

Positron emission tomography in oncology. Prof. Dr. Alex Maes AZ Groeninge Kortrijk KUL Campus Kortrijk. RIZIV-terugbetaalde indicaties van PET-onderzoeken. Geïsoleerde longnodule van onbekende aard Vermoeden recidief of residuele massa ter hoogte van hersenen, mond of farynx

max
Download Presentation

Positron emission tomography in oncology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Positron emission tomography in oncology Prof. Dr. Alex Maes AZ Groeninge Kortrijk KUL Campus Kortrijk

  2. RIZIV-terugbetaalde indicaties van PET-onderzoeken • Geïsoleerde longnodule van onbekende aard • Vermoeden recidief of residuele massa ter hoogte van hersenen, mond of farynx • Opstellen staging bij • Longgezwel (niet kleincellig) • Slokdarmgezwel • Pancreasgezwel • Maligne melanoom vanaf stadium IIc (AJCC-classificatie) • Lymfoom van intermediaire of hoge grading

  3. RIZIV-terugbetaalde indicaties van PET-onderzoeken • Vermoeden recidief of residuele massa bij • Maligne melanoom • Longtumor (niet kleincellig) • Colorectale tumor • Pancreastumor • Ovariumtumor • Lymfoma • Evaluatie myocard viabiliteit • Localisatie van epileptogene haard met oog op heelkunde

  4. Sensitivity of imaging modalities Structural sensitivity RX / CT millimeter MRI US 10 -1 PET centimeter SPECT

  5. Sensitivity of imaging modalities Biological Sensitivity RX / CT MRI millimolar 10 - 6 US nanomolar SPECT PET picomolar

  6. Most used tracer ? Fluor-18 – deoxyglucose = FDG Half-life-time: 110 minutes, iv injection

  7. Imaging and measurement of glucose up-take Into normal tissue Brain, heart, liver and other organs In cancer tissue Brochial, skin, colon, liver, lymph node, esophagus, larynx-cancer in inflammation What is PET able to do with FDG ?

  8. Visualisation of normal tissue Vessels, intestine, bone, muscle Changes in morphology anatomic variants organ-enlargement pathological changes BUT: Is not able to distinguish distinctly between malignant and benign changes What is CT able to give us ?

  9. Combination of function PET – positron emission tomography and morphology CT – computed tomography PET/CT

  10. Combination: Functional information from PET morphological information from CT Time saving: Reduced data acquisition time of PET/CT compared to PET alone 55 minutes vs. 20-24 minutes PET/CT: PET and CT in a single machine

  11. FDG-PET in Oncology Diagnosis Staging Prognosis Therapy Monitoring Metabolic characterization of structural lesions Correlation with response rate and survival Responders versus Non-responders Whole-body screening

  12. PET and lung cancer: mediastinal staging • early stage tumors • stage I (T1-2, N0) • stage II (T1-2, N1) • locally advanced tumors • stage IIIa (T1-3, N2) • stage IIIb (T1-4, N3) surgical treatment marginal resectability induction treatment non-surgical combined treatment Importance of an accurate mediastinal staging

  13. Detection of lymph node metastases Lymph nodes pos.CTPET Sensitivity57-70 %85-92 % Specificity80-94 %90-98 % PPV76-84 %90-96 % NPV84-90 %95-98 %

  14. T staging in NSCL with PET/CT vs. PET+CT Lardinois, Weder, Hany et al. et al., N Engl J Med 2003;348:2500-7 50 patients prospectively evaluated PET/CT additional information in 41% over PET + CT T stagePaired Sign Test P-value PET/CT vs. CT 0.001* PET/CT vs. PET <0.001* PET/CT vs. PET+CT 0.013* N stagePaired Sign Test P-Value PET/CT vs. CT 0.12 PET/CT vs. PET 0.013* ___________ PET/CT vs. PET+CT 0.021 *significant after Bonferroni correction

  15. 1 ,8 ,6 ,4 ,2 PET log-rank P = 0.008 0 0 12 24 36 48 60 Follow-up (months) = overall response = no overall response PET and lung cancer: therapy evaluation • Prognosis according to overall response 1 ,8 Cumulative survival ,6 ,4 ,2 CT log-rank P = 0.10 0 0 12 24 36 48 60 Follow-up (months)

  16. Colon cancer - colonoscopy

  17. Tumor markers in the blood FDG-PET to predict those patients who benefit from laparotomy Libutti SK et al. Ann Surg Oncol. 2001 Dec;8(10):779-86. What does PET/CT for recurrent disease? Recurrent disease PET

  18. Liver metastases (sensitivity) ceCT 95%, PET/CT 91% Intra-hepatic recurrence after liver surgery (specificity) ceCT 50%, PET/CT 100% Local recurrence (sensitivity) ceCT 53 %, PET/CT 93 % Extra-hepatic disease (sensitivity) ceCT 64 %, PET/CT 89 % Additional findings in PET/CT changed management in 21% of cases PET/CT vs. ceCTSelzner M, Hany TF et al. Ann Surg Dec 2004

  19. Hodgkin's disease (HD) less than 1% of all cancers 70% can be cured with combination chemotherapy and/or radiation therapy Non- Hodgkin's lymphoma (NHL)5% of all cancers less predictable than HD and has a greaterpredilection to disseminate to extra nodal sites 2 prognostic groups: low-grade NHL and aggressive NHL overall survival at 5 years is approximately 50% to 60% Lymphoma: epidemiology

  20. Hodgkins lymphoma: FDG-PET staging • CT PET • sensitivity 79% 84% • Specificity 100% 100 % • Jerusalem et al. 2001 • Najjar et al. 2001 • Weihrauch et al. 2002

  21. lymph node involvement sensitivity of PET/CT and ceCT was 93% and 87% specificity was 100% and 85% organ involvement sensitivity of PET/CT and ceCT was 87% and 50% specificity was 100% and 90% PET/CT lymphoma staging/restaging

  22. HD and NHL: up to 60% with residual mass in computed tomography postive PET scan -> high probability of relaps in HD: inflammation or thymus uptake negative scan: does not exclude disease but longer DFS De Wit M et al. Ann Oncol 2001; 12:29-37 Spaepen K et al. Br J Haematol 2001; 115:272-278 Spaepen K et al. J Clin Oncol 2001; 19:414-29 Residual mass after treatment

  23. Evaluation after first-line therapy • Time-point of re-evaluation: • after full scale chemo-therapy • Prognostic role: • significant difference: • positive predictive value for PET compared to CT regarding progression free survival (PFS) and overall survival (OS) • progression free survival (PFS) shorter for persistent uptake • Earlier evaluation? • Jerusalem G. Blood. 1999 Jul 15;94(2):429-33. 8 cycles CHOP

  24. Time-point of re-evaluation: after 2-4 cycles of chemo-therapy Prognostic role: significant difference in PPV for PET compared to CT regarding progression PFS and OS progression free survival (PFS) shorter for persistent uptake Jerusalem G.Ann Oncol. 2003Jan;14(1):123-30. Short term follow-up: Lymphoma 4 cycles CHOP

  25. Staging: PET/CT in 3 (15.7%) patients, ceCT in 1 patient (5.2%) Restaging: PET/CT 6 patients (14.6%), ceCT 1 patient (2.4%) Suggestion: ceCT not anymore necessary, PET/CT sufficient PET/CT findings changed treatmentSchaefer N, Hany TF Taverna et al. Radiology 2004

  26. Prostate cancer

  27. (PSA 82 ng/ml) Re-staging 18F-Cholin

  28. PSA 2.1 ng/ml 10 d after surgery: 0.12 ng/ml Actually after 1 year: 0.00ng/ml Biochemical recurrence of prostate cancerSchmid DT, Hany TF. (2005) Radiology. May;235(2):623-8.

  29. PET/CT 13NH Perfusion and CT

  30. Alzheimer FDG PET

More Related