18F-FDG-PET/CT to Select Patients with Peritoneal Carcinomatosis for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
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Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with significantly longer survival in patients with peritoneal carcinomatosis (PC). So far, no morphological imaging method has proven to accurately assess the intra-abdominal tumor spread. This study was designed to predict tumor load in patients with PC using dual-modality 18FDG-PET/CT and to compare the results with those of PET and CT alone by correlating imaging findings with intraoperative staging.
Twenty-two patients with PC from gastrointestinal (n = 13), ovarian cancer (n = 8), and mesothelioma (n = 1) underwent contrast-enhanced 18FDG-PET/CT before surgery and HIPEC. In a retrospective analysis PET, CT, and fused PET/CT were separately and blindly reviewed for the extent of peritoneal involvement using the Peritoneal Cancer Index (PCI). Imaging results were correlated with the intraoperative PCI using Pearson’s correlation coefficient and linear regression analysis.
There was a strong correlation between the PCI obtained with PET/CT and the surgical PCI with respect to the total score (r = 0.951) as well as in the regional analysis (small bowel, r = 0.838; other, r = 0.703). The correlation was slightly lower for CT alone (total score, r = 0.919; small bowel, r = 0.754; other, r = 0.666) and significantly lower (p = 0.002) for PET alone (total score, r = 0.793; small bowel, r = 0.553, other, 0.507).
Contrast-enhanced CT is superior compared with PET alone to predict the extent of PC. In our patient group, the combination of both modalities (contrast enhanced PET/CT) yielded the best results and proved to be a useful tool for selecting candidates for peritonectomy and HIPEC.
KeywordsPositron Emission Tomography Positive Predictive Value Peritoneal Carcinomatosis Tumor Load Peritoneal Cancer Index
The authors thank their technicians, Henriette Heners, Agnetha Bürklin, Sylvia Stotz, Tina Brutschy, and Diana Feil, for helpful assistance in the acquisition of PET/CT data, and gratefully acknowledge the continuing support of their colleagues from the Radiopharmacy Department.
- 3.Verwaal VJ, van Ruth S, de Bree E, van Slooten GW, van Tintere H, Boot H, Zoetmulder FA. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21:3737–43.PubMedCrossRefGoogle Scholar
- 7.Yan TD, Haveric N, Carmignani CP, Chang D, Sugarbaker PH. Abdominal computed tomography scans in the selection of patients with malignant peritoneal mesothelioma for comprehensive treatment with cytoreductive surgery and perioperative intraperitoneal chemotherapy. Cancer. 2005;103:839–49.PubMedCrossRefGoogle Scholar
- 11.Antoch G, Saoudi N, Kuehl H, Dahmen G, Mueller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol. 2004;22:4357–68.PubMedCrossRefGoogle Scholar
- 14.Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat. 1979;6:65–70.Google Scholar
- 15.R Development Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2007.Google Scholar
- 24.Baski M, Marin D, Catalano C, et al. Diagnostic accuracy of 64-slice CT with isotropic multiplanar reconstructions (MPRs) in the pre-operative diagnosis of peritoneal carcinomatosis: correlation with intraoperative and histopathologic findings. Eur Radiol. 2008;18:145.Google Scholar
- 32.Berger KL, Nicholson SA, Dehdashti F, Siegel BA. FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features. Am J Roentgenol. 2000;174:1005–8.Google Scholar