Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

Open Access 01-02-2005 | Original Article

The value of PET, CT and in-line PET/CT in patients with gastrointestinal stromal tumours: long-term outcome of treatment with imatinib mesylate

Authors: G. W. Goerres, R. Stupp, G. Barghouth, T. F. Hany, B. Pestalozzi, E. Dizendorf, P. Schnyder, F. Luthi, G. K. von Schulthess, S. Leyvraz

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 2/2005

Abstract

Purpose

Gastrointestinal stromal tumours (GIST) are mesenchymal neoplasms of the gastrointestinal tract that are unresponsive to standard sarcoma chemotherapy. Imaging of GIST patients is done with structural and functional methods such as contrast-enhanced helical computed tomography (ceCT) and positron emission tomography (PET) with ¹⁸F-fluorodeoxyglucose (FDG). The aim of this study was to compare the prognostic power of PET and ceCT and to evaluate the clinical role of PET/CT imaging.

Methods

All patients with GIST undergoing PET or PET/CT examinations were prospectively included in this study, and the median overall survival, time to progression and treatment duration were documented. The prognostic significance of PET and ceCT criteria of treatment response was assessed and PET/CT was compared with PET and ceCT imaging. Data for 34 patients (19 male, 15 female, 21–76 years) undergoing PET or PET/CT for staging or restaging were analysed.

Results

In 28 patients, PET/CT and ceCT were available after introduction of treatment with the tyrosine kinase inhibitor imatinib mesylate (Gleevec; Novartis, Basel, Switzerland). Patients without FDG uptake after the start of treatment had a better prognosis than patients with residual activity. In contrast, ceCT criteria provided insufficient prognostic power. However, more lesions were found on ceCT images than on PET images, and FDG uptake was sometimes very variable. PET/CT delineated active lesions better than did the combination of PET and ceCT imaging.

Conclusion

Both PET and PET/CT provide important prognostic information and have an impact on clinical decision-making in GIST patients. PET/CT precisely delineates lesions and thus allows for the correct planning of surgical interventions.

Miettinen M, Sarlomo-Rikala M, Lasota J. Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol 1999;30:1213–20.CrossRefPubMed

Miettinen M, Lasota J. Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch 2001;438:1–12.CrossRefPubMed

Wang X, Mori I, Tang W, Utsunomiya H, Nakamura M, Nakamura Y, et al. Gastrointestinal stromal tumors: are they of Cajal cell origin? Exp Mol Pathol 2002;72:172–7.CrossRefPubMed

Plaat BE, Hollema H, Molenaar WM, Torn Broers GH, Pijpe J, Mastik MF, et al. Soft tissue leiomyosarcomas and malignant gastrointestinal stromal tumors: differences in clinical outcome and expression of multidrug resistance proteins. J Clin Oncol 2000;18:3211–20.PubMed

Heinrich MC, Rubin BP, Longley BJ, Fletcher JA. Biology and genetic aspects of gastrointestinal stromal tumors: KIT activation and cytogenetic alterations. Hum Pathol 2002;33:484–95.CrossRefPubMed

Burkill GJ, Badran M, Al-Muderis O, Meirion Thomas J, Judson IR, Fisher C, Moskovic EC. Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread. Radiology 2003;226:527–32.PubMed

Chen MY, Bechtold RE, Savage PD. Cystic changes in hepatic metastases from gastrointestinal stromal tumors (GISTs) treated with Gleevec (imatinib mesylate). Am J Roentgenol 2002;179:1059–62.

Van den Abbeele AD, Badawi RD. Use of positron emission tomography in oncology and its potential role to assess response to imatinib mesylate therapy in gastrointestinal stromal tumors (GISTs). Eur J Cancer 2002;38(Suppl 5):S60–5.

Gayed I, Vu T, Iyer R, Johnson M, Macapinlac H, Swanston N, Podoloff D. The role of¹⁸F-FDG PET in staging and early prediction of response to therapy of recurrent gastrointestinal stromal tumors. J Nucl Med 2004;45:17–21.

10.

Stroobants S, Goeminne J, Seegers M, Dimitrijevic S, Dupont P, Nuyts J, et al.¹⁸FDG-positron emission tomography for the early prediction of response in advanced soft tissue sarcoma treated with imatinib mesylate (Glivec). Eur J Cancer 2003;39:2012–20.CrossRefPubMed

11.

Goerres GW, Kamel E, Heidelberg TN, Schwitter MR, Burger C, von Schulthess GK. PET-CT image co-registration in the thorax: influence of respiration. Eur J Nucl Med Mol Imaging 2002;29:351–60.CrossRefPubMed

12.

Dizendorf EV, Treyer V, Von Schulthess GK, Hany TF. Application of oral contrast media in coregistered positron emission tomography-CT. Am J Roentgenol 2002;179:477–81.

13.

Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92:205–16.CrossRefPubMed

14.

Young H, Baum R, Cremerius U, Herholz K, Hoekstra O, Lammertsma AA, et al. Measurement of clinical and subclinical tumour response using [¹⁸F]-fluorodeoxyglucose and positron emission tomography: review and EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group. Eur J Cancer 1999;35:1773–82.CrossRefPubMed

15.

Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 2002;33:459–65.CrossRefPubMed

16.

Bos R, van Der Hoeven JJ, van Der Wall E, van Der Groep P, van Diest PJ, Comans EF, et al. Biologic correlates of (18)fluorodeoxyglucose uptake in human breast cancer measured by positron emission tomography. J Clin Oncol 2002;20:379–87.

17.

Kitagawa Y, Sano K, Nishizawa S, Nakamura M, Ogasawara T, Sadato N, Yonekura Y. FDG-PET for prediction of tumour aggressiveness and response to intra-arterial chemotherapy and radiotherapy in head and neck cancer. Eur J Nucl Med Mol Imaging 2003;30:63–71.CrossRefPubMed

18.

Emory TS, O’Leary TJ. Prognosis and surveillance of gastrointestinal stromal/smooth muscle tumors. Ann Chir Gynaecol 1998;87:306–10.PubMed

19.

DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000;231:51–8.CrossRefPubMed

20.

Hohenberger P, Bauer S, Schneider U, Pinlk D, Dirsch O, Schuette J, Reichardt P. Tumor resection following imatinib pretreatment in GI stromal tumors. Proc Am Soc Clin Oncol 2003;22:818 (abstract).

Title: The value of PET, CT and in-line PET/CT in patients with gastrointestinal stromal tumours: long-term outcome of treatment with imatinib mesylate
Authors: G. W. Goerres
R. Stupp
G. Barghouth
T. F. Hany
B. Pestalozzi
E. Dizendorf
P. Schnyder
F. Luthi
G. K. von Schulthess
S. Leyvraz
Publication date: 01-02-2005
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 2/2005
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-004-1633-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The value of PET, CT and in-line PET/CT in patients with gastrointestinal stromal tumours: long-term outcome of treatment with imatinib mesylate

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2005

Left ventricular end-diastolic volume is decreased at maximal exercise in athletes with marked repolarisation abnormalities: a continuous radionuclide monitoring study

Certificate of Fellowship of the European Board of Nuclear Medicine 2005

Precise localisation of a sentinel lymph node in a rare drainage region with SPECT/MRI using interstitial injection of 99mTc-nanocolloid and superparamagnetic iron oxide

Involvement of pulmonary endothelial cell injury in the pathogenesis of pulmonary fibrosis: clinical assessment by 123I-MIBG lung scintigraphy

Discriminating infection from sterile inflammation: can radiolabelled antibiotics solve the problem?

Electrocardiographic-gated dual-isotope simultaneous acquisition SPECT using 18F-FDG and 99mTc-sestamibi to assess myocardial viability and function in a single study