The therapeutic impact of ¹⁸F-FDG whole body PET

Summary

Aims: An explorative analysis of the diagnostic as well as therapeutic impact of ¹⁸F-FDG whole body PET on patients with various tumours in the setting of an university hospital radiation therapy was performed. Patients and methods: 222 FDG PET investigations (148 initial stagings, 74 restagings) in 176 patients with diverse tumour entities (37 lung carcinoma, 15 gastrointestinal tumours, 38 head and neck cancer, 30 lymphoma, 37 breast cancer, 19 sarcoma and 16 other carcinomas) were done. All PET scans were evaluated in an interdisciplinary approach and consecutively confirmed by other imaging modalities or biopsy. Unconfirmed PET findings were ignored. Proportions of verified PET findings, additional diagnostic information (diagnostic impact) and changes of the therapeutic concept intended and documented before PET with special emphasis on radiooncological decisions (therapeutic impact) were analysed. Results: 195/222 (88%) FDG-PET findings were verified, 104/222 (47%) FDG-PET scans yielded additional diagnostic information (38 distant, 30 additional metastasis, 11 local recurrencies, 10 primary tumours and 15 residual tumours after chemoptherapy). The results of 75/222 (34%) scans induced changes in cancer therapy and those of 58/222 (26%) scans induced modifications of radiotherapeutic treatment plan (esp. target volumes). Conclusion: ¹⁸F-FDG whole body PET is a valuable diagnostic tool for therapy planning in radiooncology with a high impact on therapeutic decisions in initial staging as well as in restaging. Especially in a curative setting it should be used for definition of target volumes.

Zusammenfassung

Ziele: Explorative Analyse des Einflusses der ¹⁸F-FDGPET auf das therapeutische Management von Patienten mit unterschiedlichen Tumorentitäten im Rahmen einer universitären Strahlentherapie. Patienten und Methoden: Insgesamt wurden bei 176 Patienten 222 FDGPET-Untersuchungen (148 primäres Staging, 74 Restaging) mit der Diagnose Bronchialkarzinom (n = 37), gastrointestinaler Tumor (n = 15), HNO-Tumor (n = 38), Lymphom (n = 30), Mammakarzinom (n = 67), Sarkom (n = 19) und sonstiges Malignom (n = 16) vorgenommen und interdisziplinär synoptisch befundet. Alle Befunde wurden einer Verifikation durch komplementäre Verfahren unterworfen. Ausgewertet wurden der Anteil bestätigter PET-Befunde, der Anteil der Untersuchungen, die eine neue diagnostische Information erbrachten (diagnostischer Impact), sowie der Anteil der Untersuchungen, die eine Änderung des ursprünglichen Therapiekonzeptes bzw. des Strahlentherapieplanes zur Folge hatte (therapeutischer Impact). Ergebnisse: 195/222 (88%) FDG-PET-Befunde konnten verifiziert werden, 104/222 (47%) FDG-PET-Untersuchungen erbrachten eine zusätzliche Informationen (38 Fernmetastasen, 30 zusätzliche Metastasen, 11 Lokalrezidive, 10 Primärtumore und 15 Residualbefunde nach Chemotherapie). 75/222 (34%) Befunden hatten Konsequenzen auf die onkologische Therapie, 58/222 (26%) erforderten eine Änderung der radiotherapeutischen Dosis (insbesondere der Zielvolumina). Schlussfolgerung: Die FDG-PET stellt sowohl im Rahmen des Primär- als auch des Restagings ein wertvolles diagnostisches Instrument in der Planung onkologischer Therapien, v. a. der Radiotherapie dar und sollte insbesondere bei kurativer Therapieintention zur Zielvolumendefinition herangezogen werden.

Keywords

FDG PET - radiation oncology - radiation therapy - patient management

Schlüsselwörter

FDG-PET - Strahlentherapie - Patientenmanagement - Radionkologie

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