18FDG PET Is Very Useful in the Follow-up after Resection of Pancreatic and Periampullary Tumours
Sperti C1, Pasquali C1, Bissoli S2, Fiore V2, Scelzi E3, Mion M3, Lessi G4, Pedrazzoli S1
1Department of Medical and Surgical Sciences, Surgical Clinic IV, University of Padua. Padua, Italy. 2PET Center, Nuclear Medicine, 3Department of Oncology, and 4Department of Radiology, Castelfranco Veneto Hospital. Castelfranco Veneto (TV), Italy
ABSTRACT
Background Surveillance after resection of pancreatic and periampullary malignancies generally include abdominal ultrasonography (US) and/or computer tomography (CT), and CA 19-9 serum determinations. Unfortunately, the detection of tumor recurrence is often difficult because of post-therapy anatomic alteration and recurrent disease, when detected, is practically incurable.
Aim In this study we determined the accuracy and contribution to surgical decision making of FDG PET in recurrent pancreatic and periampullary malignancies.
Methods From January 1998 to December 2003, 45 patients underwent whole-body 18-FDG-PET during follow-up after resection for pancreatic (n=31) and periampullary (n=14) cancers. All patients also underwent ultrasound and helical computer tomography, chest X-ray, and serum tumor markers (CEA and CA 19-9). Median follow-up period was 21 months (range 12-84 months).
Results A total of 28 patients experienced tumor’s recurrence; serum CA 19-9 levels were high in 22 of them (79%). Sensitivity of 18-FDG-PET and CT scan in detecting tumor’s relapse was 96% (27/28) and 57% (16/28), respectively. Twelve recurrences were detected only by PET (CT false negative); 9 out of 12 patients were asymptomatic. Six patients underwent surgical resection (three para-aortic lymph nodes, two liver and one colonic metastasis), 5 chemotherapy, and one radiotherapy. In three recurrence-free patients PET only showed a second primary tumor that was successfully resected (one carcinoma of the lung and two colon cancers). A liver metastasis was detected only by CT scan (PET false negative); a single PET false positive result was explained by a local colonic inflammation. Fourteen patients are recurrence free. PET was negative in all; while three had transient elevation of CA 19-9 levels and three had CT findings equivocal for relapse. Overall, 18-FDG-PET modified the treatment in 9/45 patients (20%), and allowed a wait and see policy, confirmed by further follow-up, in 6 patients (13%).
Conclusions 18-FDG-PET is very sensitive in detecting recurrent pancreatic and periampullary carcinoma even in asymptomatic patients. 18-FDG-PET allowed us to perform potentially radical surgery in several selected patients with localized, resectable recurrence or second cancer.
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