Yoshitaka Honma1, Takashi Terauchi2, Ukihide Tateishi3, Daisuke Kano3,4, Kengo Nagashima5, Hirokazu Shoji1, Satoru Iwasa1, Atsuo Takashima1, Ken Kato1, Tetsuya Hamaguchi1, Narikazu Boku1, Yasuhiro Shimada1,6, Yasuhide Yamada1,7,8. 1. 1 Gastrointestinal Medical Oncology Division, National Cancer Center Hospital , Tokyo , Japan. 2. 2 Department of Nuclear Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo , Japan. 3. 3 Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University Graduate School of Medicine , Tokyo , Japan. 4. 4 Department of Pharmacy, National Cancer Center Hospital East , Kashiwa , Japan. 5. 5 Department of Global Clinical Research, Graduate School of Medicine, Chiba University , Chiba , Japan. 6. 6 Department of Medical Oncology, Kochi Health Sciences Center , Kouchi , Japan. 7. 7 Department of Clinical Oncology, Hamamatsu University School of Medicine , Hamamatsu , Japan. 8. 8 Department of Oncology, National Center for Global Health and Medicine , Toyama , Japan.
Abstract
OBJECTIVE: Peritoneal metastasis (PM) is the most frequent form of metastasis in gastric cancer (GC). The sensitivity of detecting PM by pre-operative imaging modalities is low. Utility of positron emission tomography (PET) with 18F-fluodeoxyglucose (FDG) for GC is limited, because diffuse-type tumors are not FDG-avid. 18F-fluothymidine ([F-18]FLT) is a radiotracer that reflects cellular proliferation and the utility of [F-18]FLT-PET in GC has been reported. In this proof-of-concept study, we explored the ability of [F-18]FLT-PET/CT to detect PM of GC previously identified by other imaging modalities. METHODS: The key eligibility criteria were as follows; (i) histologically proven gastric adenocarcinoma; (ii) evident PM detected by CT performed within 4 weeks prior to registration; (iii) no prior treatment of PM within 4 weeks before registration. [F-18]FLT-PET/CT was performed at National Cancer Center Hospital, and [F-18]FLT-PET/CT images were evaluated independently by two radiologists. Safety assessments were carried out before and after [F-18]FLT-PET/CT. The primary end point was the detection sensitivity of PM. RESULTS: A total of 19 eligible patients were analyzed, of which 15 (78.9%) had diffuse-type histology. Detection sensitivity of PM, primary lesion, and lymph node metastasis were 73.7% [maximum standardized uptake value (SUVmax): 1.697-13.21], 100% (SUVmax: 2.71-22.01), and 72.7% (SUVmax: 2.079-12.61), respectively. No patients experienced adverse events during or after [F-18]FLT-PET/CT. CONCLUSION: This proof-of-concept study shows that [F-18]FLT-PET/CT is a sensitive method for detecting PM in GC, and paves the way for future studies investigating the clinical utility of this approach for the detection of clinically non-evident PM in GC. Advances in knowledge: This proof-of-concept study found that [F-18]FLT-PET/CT is a sensitive method for detecting peritoneal metastases in GC.
OBJECTIVE: Peritoneal metastasis (PM) is the most frequent form of metastasis in gastric cancer (GC). The sensitivity of detecting PM by pre-operative imaging modalities is low. Utility of positron emission tomography (PET) with 18F-fluodeoxyglucose (FDG) for GC is limited, because diffuse-type tumors are not FDG-avid. 18F-fluothymidine ([F-18]FLT) is a radiotracer that reflects cellular proliferation and the utility of [F-18]FLT-PET in GC has been reported. In this proof-of-concept study, we explored the ability of [F-18]FLT-PET/CT to detect PM of GC previously identified by other imaging modalities. METHODS: The key eligibility criteria were as follows; (i) histologically proven gastric adenocarcinoma; (ii) evident PM detected by CT performed within 4 weeks prior to registration; (iii) no prior treatment of PM within 4 weeks before registration. [F-18]FLT-PET/CT was performed at National Cancer Center Hospital, and [F-18]FLT-PET/CT images were evaluated independently by two radiologists. Safety assessments were carried out before and after [F-18]FLT-PET/CT. The primary end point was the detection sensitivity of PM. RESULTS: A total of 19 eligible patients were analyzed, of which 15 (78.9%) had diffuse-type histology. Detection sensitivity of PM, primary lesion, and lymph node metastasis were 73.7% [maximum standardized uptake value (SUVmax): 1.697-13.21], 100% (SUVmax: 2.71-22.01), and 72.7% (SUVmax: 2.079-12.61), respectively. No patients experienced adverse events during or after [F-18]FLT-PET/CT. CONCLUSION: This proof-of-concept study shows that [F-18]FLT-PET/CT is a sensitive method for detecting PM in GC, and paves the way for future studies investigating the clinical utility of this approach for the detection of clinically non-evident PM in GC. Advances in knowledge: This proof-of-concept study found that [F-18]FLT-PET/CT is a sensitive method for detecting peritoneal metastases in GC.
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