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Bedeutung der PET für die Chirurgie des gastrointestinalen Stromatumors

Importance of PET for surgery of gastrointestinal stromal tumors

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coloproctology Aims and scope

Zusammenfassung

Hintergrund

Gastrointestinale Stromatumoren (GIST) sind die häufigste mesenchymale Neoplasie des Gastrointestinaltraktes. Sie unterscheiden sich hinsichtlich Tumorbiologie, Behandlungsstrategie und insbesondere Indikationsstellung zum chirurgischen Vorgehen in wesentlichen Aspekten von gastrointestinalen Karzinomen. Jeder an der Behandlung von GIST beteiligte Chirurg sollte mit diesen Aspekten vertraut sein.

Ziel der Arbeit

In dieser Arbeit wird der Stellenwert der Positronenemissionstomographie (PET) in der chirurgischen Behandlung von Patienten mit GIST diskutiert und ein Ausblick auf die Entwicklung von auf GIST maßgeschneiderten molekularen Tracern gegeben.

Ergebnisse

In verschiedenen klinischen Szenarien ist die PET eine wertvolle Hilfe für die Therapieplanung und insbesondere chirurgische Indikationsstellung in der multimodalen Behandlung von GIST. Hervorzuheben sind das Primärstaging, das Monitoring unter neoadjuvanter Therapie sowie das Staging und die Verlaufskontrolle in der metastasierten Situation. Der routinemäßig eingesetzte Tracer ist 18F-FDG, der zuverlässig den Metabolismus von GIST-Läsionen abbildet. Verglichen mit Computertomographie/Magnetresonanztomographie erlaubt das 18F-FDG-PET häufig eine frühere und genauere Responsebeurteilung. GIST-spezifische molekulare Tracer, die eine direkte Prognose zum Therapieansprechen und frühzeitige Informationen zur Resistenzentwicklung liefern könnten, befinden sich in der präklinischen Entwicklung. Hier sind aber noch pharmakokinetische und immunologische Hürden zu überwinden. Fernziel ist die Entwicklung von „theranostics“, also Substanzen, die zugleich diagnostische und therapeutische Zwecke erfüllen.

Diskussion

In der multimodalen Therapie von GIST und der Indikationsstellung zum chirurgischen Vorgehen hat die PET einen festen Stellenwert.

Abstract

Background

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the digestive tract. The GIST differ substantially from gastrointestinal carcinomas regarding tumor biology, treatment strategies and indications for surgery. Every surgeon involved in the treatment of GIST should be acquainted with these aspects.

Objectives

The aims of this article are to discuss the value of positron emission tomography (PET) in the surgical treatment of patients with GIST and to provide an outlook on the development of molecular tracers specifically tailored for GIST.

Results

PET is an invaluable decision aid in the multimodal therapy of GIST and particularly for deciding on surgical indications. Specific scenarios in which PET is used are primary staging monitoring during neoadjuvant therapy and staging and response assessment in the metastatic setting. The routinely used tracer is 18F-fluorodeoxyglucose (18F-FDG) and uptake reliably correlates with the metabolism of GIST lesions. Compared to computed tomography and magnetic resonance imaging (CT/MRI), 18F-FDG-PET often allows a more timely and accurate response assessment. GIST-specific molecular tracers, which could provide a direct prognosis regarding response and development of resistance to treatment, are currently in preclinical development. However, pharmacokinetic and immunological issues still need to be resolved. A distant aim is the development of “theranostics”, i.e. substances which serve both diagnostic and therapeutic purposes.

Discussion

PET has an established value in the multimodal treatment of GIST and is particularly useful for deciding on surgical indications.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. U. Ronellenfitsch, B. Wängler, S. Niedermoser, A. Dimitrakopoulou-Strauss, P. Hohenberger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Chirurgische Klinik, Sektion Spezielle Chirurgische Onkologie und Thoraxchirurgie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1–3, 68135, Mannheim, Deutschland

    U. Ronellenfitsch &  P. Hohenberger

  2. Institut für Klinische Radiologie und Nuklearmedizin, Sektion Molekulare Bildgebung und Radiochemie, Universitätsmedizin Mannheim, Mannheim, Deutschland

    B. Wängler & S. Niedermoser

  3. Klinische Kooperationseinheit Nuklearmedizin, Deutsches Krebsforschungszentrum (DKFZ) Heidelberg, Heidelberg, Deutschland

    A. Dimitrakopoulou-Strauss

Authors
  1. U. Ronellenfitsch
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  2. B. Wängler
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  3. S. Niedermoser
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  4. A. Dimitrakopoulou-Strauss
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  5. P. Hohenberger
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Corresponding author

Correspondence to P. Hohenberger.

Additional information

Dieser Beitrag wurde erstpubliziert in Chirurg (2014) 85:493–499.

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Ronellenfitsch, U., Wängler, B., Niedermoser, S. et al. Bedeutung der PET für die Chirurgie des gastrointestinalen Stromatumors. coloproctology 37, 170–176 (2015). https://doi.org/10.1007/s00053-015-0525-6

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  • DOI: https://doi.org/10.1007/s00053-015-0525-6

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