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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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 18FDG-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 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.

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.

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Acknowledgments

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.

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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, University of Tuebingen, Tübingen, Germany

    Ingmar Königsrainer MD, Derek Zieker MD, Stefan Beckert MD, Jörg Glatzle MD, Björn L. Brücher MD & Alfred Königsrainer MD

  2. Department of Radiology and Nuclear Medicine, University of Tuebingen, Tübingen, Germany

    Christina Pfannenberg MD, Philip Aschoff MD, Mehmet Ö. Öksüz MD & Claus D. Claussen MD

  3. Center for Bioinformatics Tuebingen, University of Tuebingen, Tübingen, Germany

    Stephan Symons & Kay Nieselt PhD

  4. Department of Pathology, University of Tuebingen, Tübingen, Germany

    Claus V. Weyhern MD

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  1. Christina Pfannenberg MD
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  2. Ingmar Königsrainer MD
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Correspondence to Alfred Königsrainer MD.

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Christina Pfannenberg and Ingmar Königsrainer equally contributing authors.

Statement: This manuscript contains original material that has not been previously published or submitted to another journal.

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Pfannenberg, C., Königsrainer, I., Aschoff, P. et al. 18F-FDG-PET/CT to Select Patients with Peritoneal Carcinomatosis for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 16, 1295–1303 (2009). https://doi.org/10.1245/s10434-009-0387-7

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