J Cancer 2012; 3:241-245. doi:10.7150/jca.2586

Short Research Communication

FDG PET/CT Response Evaluation in Malignant Pleural Mesothelioma Patients Treated with Talc Pleurodesis and Chemotherapy

Giovenzio Genestreti1✉, Andrea Moretti2, Sara Piciucchi3, Noemi Giovannini1, Riccardo Galassi2, Emanuela Scarpi4, Marco Angelo Burgio1, Dino Amadori1, Stefano Sanna5, Venerino Poletti6, Federica Matteucci2, Giampaolo Gavelli7

1. Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy;
2. Department of Nuclear Medicine, Morgagni-Pierantoni Hospital, Forlì, Italy;
3. Department of Radiology, Morgagni Pierantoni Hospital; Forlì, Italy;
4. Unit of Biostatistics and Clinical Trials, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy;
5. Department of Thoracic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy;
6. Department of Pneumology, Morgagni-Pierantoni Hospital, Forlì, Italy;
7. Department of Radiology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy;

Abstract

Purpose: Talc pleurodesis (TP) is employed worldwide for the management of persistent pneumothorax or pleural effusion, particularly of malignant origin. However, there are very little available data on 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F FDG PET/CT) response evaluation in malignant pleural mesothelioma (MPM) patients treated with TP and chemotherapy.

Methods: Patients with histologically confirmed MPM underwent TP and FDG PET/CT staging and restaging after 3-4 courses of chemotherapy. All patients fasted and received a dose of 5.18 MBq 18F-FDG per kilogram of body weight. Whole-body emission scans were acquired with and without Ordered Subset Expectation Maximization (OSEM) iterative reconstruction algorithm.

Results: From January 2004 to March 2010, 8 patients with biopsy confirmed MPM (7 epithelial, 1 biphasic), with a median age of 65 years (range: 54-77), were evaluated. Median follow-up was 31 months (range: 4-44). After TP treatment, there was a mean interval of 14 days (range: 9-22) and 125 days (range: 76-162) between FDG PET/CT staging and restaging. According to modified RECIST and EORTC criteria, there was a concordance between the radiologic and metabolic SUVmean and SUVmax responses in 6 (75%) and 3 (37.5%) patients, respectively.

Conclusion: TP produces an increased FDG PET uptake which may interfere with the post-chemotherapy disease evaluation. In our case series, the metabolic response measured by SUVmean seems to be in better agreement with the radiologic response compared to the SUVmax.

Keywords: 18F-FDG PET-CT scan, fluorodeoxyglucose, SUV, talc pleurodesis, malignant pleural mesothelioma.

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How to cite this article:
Genestreti G, Moretti A, Piciucchi S, Giovannini N, Galassi R, Scarpi E, Burgio MA, Amadori D, Sanna S, Poletti V, Matteucci F, Gavelli G. FDG PET/CT Response Evaluation in Malignant Pleural Mesothelioma Patients Treated with Talc Pleurodesis and Chemotherapy. J Cancer 2012; 3:241-245. doi:10.7150/jca.2586. Available from http://www.jcancer.org/v03p0241.htm