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Imaging peritoneal metastasis of gastric cancer with PET/CT and the radiotracer 18F-fluorothymidine (18F-FLT):Proof-of-concept study.

Abstract

11013
Background: Peritoneal metastasis (PM) is the most frequent form of metastasis in gastric cancer (GC), especially in diffuse type adenocarcinoma (DTAC). Microscopic PM can be identified accurately only in laparoscopic staging. The utility of metabolic imaging for GC is limited because DTAC are not 18F-fluorodeoxiglucose (FDG) avid, and the sensitivity of detecting PM by FDG/PET is known to be low in GC.18F-fluorothymidine (18F-FLT) was developed for imaging cellular proliferation, and its physiological accumulation to the intestinal tract is known to be less than FDG. In previous reports, 18F-FLT-PET had higher sensitivity than FDG and could visualize primary lesion or lymph node metastasis of GC with sufficient contrast, even in DTAC. In this proof-of-concept study, we explored the capability of 18F-FLT PET/CT for detecting macroscopic PM of GC. Methods: The key eligibility criteria were: (i) histologically proven gastric adenocarcinoma; (ii) PM detected by CT imaging; (iii) PS: 0-2; and (iv) sufficient organ function. 18F-FLT PET/CT was performed at the National Cancer Center Hospital, and the PET/CTs were interpreted by two independent radiologists who were not informed of the patient background. Detection sensitivity (DS) was defined as proportion of patients for whom 18F-FLT PET/CT noted at least one of the lesions detected in CT. Results: Twenty patients were enrolled in this study. One patient was diagnosed as gastric lymphoma by pathological review, who was excluded from the analysis. Fifteen of 19 patients (78.9%) had DTAC. PM was detected by 18F-FLT PET/CT in 14 of 19 patients (SUVmax: 1.697-13.21, DS = 73.7%). Classifying the patterns of PM into omental-cake-type (oPM) and nodule-type (nPM), seven of 19 patients (36.8%) had oPM, all of which were detected by 18F-FLT PET/CT (SUVmax: 1.771-13.21, DS = 100%). Meanwhile, in a total of 42 nodules detected by CT in the 12 patients with nPM, 20 nodules were detected by 18F-FLT PET/CT (SUVmax for positive cases: 1.697-6.524, DS = 47.6%). Conclusions: This proof-of-concept study clear the criteria of DS by 18F-FLT PET/CT for proceeding to the future study investigating clinical utility of 18F-FLT PET/CT for PM of GC. Clinical trial information: UMIN000009329.

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Journal of Clinical Oncology
Pages: 11013

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Published online: May 20, 2015
Published in print: May 20, 2015

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Yoshitaka Honma
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
Takashi Terauchi
Cancer Screening Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
Ukihide Tateishi
Department of Radiology, Yokohama City University Hospital, Kanagawa, Japan
Daisuke Kano
National Cancer Center Hospital EAST, Kashiwa, Chiba, Japan
Kengo Nagashima
Clinical Research Center, Chiba University Hospital, Chiba, Japan
Natsuko T. Okita
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
Atsuo Takashima
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
Satoru Iwasa
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
Ken Kato
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
Tetsuya Hamaguchi
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
Yasuhiro Shimada
National Cancer Center Hospital, Tokyo, Japan
Narikazu Boku
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
Yasuhide Yamada
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan; Department of Radiology, Yokohama City University Hospital, Kanagawa, Japan; National Cancer Center Hospital EAST, Kashiwa, Chiba, Japan; Clinical Research Center, Chiba University Hospital, Chiba, Japan; National Cancer Center Hospital, Tokyo, Japan

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Yoshitaka Honma, Takashi Terauchi, Ukihide Tateishi, Daisuke Kano, Kengo Nagashima, Natsuko T. Okita, Atsuo Takashima, Satoru Iwasa, Ken Kato, Tetsuya Hamaguchi, Yasuhiro Shimada, Narikazu Boku, Yasuhide Yamada
Journal of Clinical Oncology 2015 33:15_suppl, 11013-11013

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