18F-FDG-PET/CT to Select Patients with Peritoneal Carcinomatosis for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

• Published in: Annals of surgical oncology 2009-05, Vol.16 (5), p.1295-1303
• Main Authors: Pfannenberg, Christina, Königsrainer, Ingmar, Aschoff, Philip, Öksüz, Mehmet Ö., Zieker, Derek, Beckert, Stefan, Symons, Stephan, Nieselt, Kay, Glatzle, Jörg, Weyhern, Claus V., Brücher, Björn L., Claussen, Claus D., Königsrainer, Alfred
• Format: Article
• Language: English
• Subjects: Gastrointestinal Oncology; Medicine; Medicine & Public Health; Oncology; Surgery; Surgical Oncology
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-009-0387-7

Background 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 18 FDG-PET/CT and to compare the results with those of PET and CT alone by correlating imaging findings with intraoperative staging. Methods Twenty-two patients with PC from gastrointestinal (n = 13), ovarian cancer (n = 8), and mesothelioma (n = 1) underwent contrast-enhanced 18 FDG-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. Results 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). Conclusions 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.