Tumor Relapse after Pancreatic Cancer Resection is Detected Earlier by 18-FDG PET than by CT

  • Cosimo Sperti
  • Claudio Pasquali
  • Sergio Bissoli
  • Franca Chierichetti
  • Guido Liessi
  • Sergio Pedrazzoli
Original Article

Abstract

Introduction

Pancreatic cancer recurrence is often difficult to detect by conventional imaging. Our aim was to evaluate the impact of fluorodeoxyglucose-positron emission tomography (FDG-PET) in the diagnosis of recurrent pancreatic cancer.

Methods

One-hundred thirty-eight patients were followed after resection for pancreatic cancer. Sixty-six underwent only CT and were excluded. Seventy-two patients also had FDG-PET. Recurrent patients were divided in two groups: group-1, CT positive and group 2, CT non diagnostic, FDG-PET positive. Characteristics and survival curves of the two groups were compared. Significance was set at p < 0.05.

Results

Overall, tumors recurred in 63 of 72 (87.5%) patients; two patients had a second cancer resected, thanks to FDG-PET. Tumor relapse was detected by CT in 35 patients and by FDG-PET in 61. Prognostic factors were similar in groups 1 and 2. Five out of 35 group 1 patients underwent surgery (two R0, two bypass, and one exploratory). Ten out of 28 group 2 patients underwent surgery (four R0, two R2, two bypass, and two exploratory). FDG-PET influenced treatment strategies in 32 of 72 patients (44.4%). Group 2 patients survived longer (P = 0.09), but the difference was not significant. Disease-free survival was similar in groups 1 and 2.

Conclusion

Tumor relapse is detected earlier by FDG-PET than by CT. FDG-PET can help select the best candidates for surgical exploration, although the real benefit is still to be defined. It influences treatment strategies in a significant percentage of patients. An earlier diagnosis did not influence survival due to the lack of effective therapies.

Keywords

Pancreas Pancreatic cancer Tumor relapse PET scan Follow-up 

Notes

Acknowledgement

The authors gratefully acknowledge Mario Gruppo for the statistical analysis, Tania Lazzarin for helping with the manuscript, and Simona Callegari for helping with data collection. This study was supported in part by grants from the Italian Ministry for the University, Scientific and Technological Research (MURST), project 2005060715_001.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Cosimo Sperti
    • 1
  • Claudio Pasquali
    • 1
  • Sergio Bissoli
    • 2
  • Franca Chierichetti
    • 2
  • Guido Liessi
    • 3
  • Sergio Pedrazzoli
    • 1
    • 4
  1. 1.Department of Medical and Surgical Sciences, IV Surgery ClinicUniversity of PadovaPadovaItaly
  2. 2.Department of Nuclear MedicineCastelfranco Veneto HospitalTrevisoItaly
  3. 3.Department of RadiologyCastelfranco Veneto HospitalTrevisoItaly
  4. 4.Clinica Chirurgica IVOspedale GiustinianeoPadovaItaly

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