The%20clinical%20role%20of%20PET%20scanning%20in%20a%20consecutive%20series%20of%20GIST%20patients - PowerPoint PPT Presentation

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The%20clinical%20role%20of%20PET%20scanning%20in%20a%20consecutive%20series%20of%20GIST%20patients

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The clinical role of PET scanning in a consecutive series of GIST patients Frits van Coevorden & Lester van Ravenswade Department of Surgery Netherlands Cancer ... – PowerPoint PPT presentation

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Title: The%20clinical%20role%20of%20PET%20scanning%20in%20a%20consecutive%20series%20of%20GIST%20patients


1
The clinical role of PET scanning in a
consecutive series of GIST patients
Frits van Coevorden Lester van Ravenswade
Department of Surgery Netherlands Cancer
Institute - Antoni van Leeuwenhoek ziekenhuis
Amsterdam The Netherlands
2
  • The metabolic activity in GastroIntestinal
    Stromal Tumors has become of interest in this
    era of targeted therapy
  • Positron Emission Tomography is the imaging
    modality to assess metabolic activity in tumors

3
  • The metabolic activity in GastroIntestinal
    Stromal Tumors has become of interest in this
    new Imatinib era
  • Positron Emission Tomography is the imaging
    modality to assess metabolic activity in tumors
  • PET imaging may reveal the metastatic character
    of tumors
  • Comparing PET activity before and after the start
    of TKIs may provide useful information in
    assessing the response to drug treatment

4
  • In a consecutive series of 98 evaluable patients
    seen in the Netherlands Cancer Institute between
    2000 2007 our GIST database was reviewed with
    focus on the use of PET scanning
  • The indication for PET imaging was classified as
  • Diagnostic to evaluate the primary tumor
  • Diagnostic to evaluate metastatic disease

5
  • In a consecutive series of 98 evaluable patients
    seen in the Netherlands Cancer Institute between
    2000 2007 our GIST database was reviewed with
    focus on the use of PET scanning
  • The indication for PET imaging was classified as
  • Diagnostic to evaluate a primary tumor
  • Diagnostic to evaluate metastatic disease
  • Diagnostic tool to prove or exclude recurrent or
    residual disease after previous surgery
  • Response assessment of drug treatment

6
  • Methods
  • We reviewed all files and PET -CT studies
  • Classified PET imaging as
  • diagnostic only
  • diagnostic and used for response evaluation

7
  • Methods
  • We reviewed all files and PET -CT studies
  • Classified PET imaging as
  • diagnostic only
  • diagnostic and used for response evaluation
  • Correlated the outcome to the associated CT scan
  • Classified the comparison results as
  • Conformal or Discrepant

8
  • Methods
  • We reviewed all files and PET -CT studies
  • Classified PET imaging as
  • diagnostic only
  • diagnostic and used for response evaluation
  • Correlated the outcome to the associated CT scan
  • Classified the comparison results as
  • Conformal or Discrepant
  • Correlated the results to the clinical course of
    the patient with follow up

9
  • Results (1)
  • the data here presented are an update of those in
    abstract 934
  • 98 evaluable patients
  • 45 patients had one or more PET scans
  • 4 scans as tool to search for residual or
    possible recurrent disease after surgery
  • All were negative, as was the clinical and CT
    correlate
  • In 41 patients PET was supposed to show activity

10
  • Results (2)
  • PET was false negative in 9 /45 patients (20 )
  • 3 in active primary or local recurrent disease
  • 6 in metastatic hepatic or peritoneal disease

11
  • Results (2)
  • PET was false negative in 9 /45 patients (20 )
  • 3 in active primary or local recurrent disease
  • 45 yr female 6 cm bilobar endogastric Gist

12
  • Results (2)
  • PET was false negative in 9 /45 patients (20)
  • 3 in active primary or local recurrent disease
  • 51 yr male 10 cm small curvature gastric Gist

50 vital after 1 yr Imatinib
13
  • Results (3)
  • PET was false negative in 9 /45 patients (20 )
  • PET was true negative in 4 patients (post surgery
    controls)
  • PET was true positive in 32 patients
  • . so 80 correlation to CT
    scan and Clinic !!

14
  • Results (3)
  • PET was false negative in 9 /45 patients (20 )
  • PET was true negative in 4 patients (post surgery
    controls)
  • PET was true positive in 32 patients
  • Repeat PET used for response assessment in 23
    patients

15
  • Results (4)
  • Repeat PET for response assessment in 23 patients
  • 19 patients PET confirmed good response
  • 3 unchanged PET activity confirmed active SD
    on CT
  • . so if 1st PET shows disease
    activity
  • 95 correlation to CT scan and Clinic !!

16
  • Results (4)
  • Repeat PET for response assessment in 23 patients
  • 19 patients confirmed good response
  • 3 unchanged PET activity confirmed active SD
    on CT
  • 1 discrepancy

17
  • Case presented at CTOS 2006 in Venice
  • 33 yr male
  • dec 2005 resection of high grade small bowel GIST
  • randomized in 62024 to control group

18
  • Case presented at CTOS 2006 in Venice
  • 33 yr male
  • dec 2005 resection of high grade small bowel GIST
  • randomized in 62024 to control group
  • aug 2006 peritoneal recurrence
  • Start Imatinib 400 mg

19
Case presented at CTOS 2006 in Venice
20
August 2006 Start (neoadjuvant)Imatinib 400
mg October 2006 effect ???
Before Glivec
Progression ?
Or response ?
So he went for surgery
21
Bad message At pathology the PET negative tumor
more than 90 vital GIST
Before Glivec
22
Bad message At pathology the PET negative tumor
more than 90 vital GIST
Good message Exon 9 mutation Now 1 year later
on 800 mg Imatinib NO ACTIVE DISEASE
So maybe PET did predict a favourable outcome
very early ??
23
Survival related to PET scanning
PET positive initial scan False PET negative scan True PET negative scan ALL 45 pat
NED 12 5 4 21
Alive with inactive disease 9 2 11
Alive with active disease 3 1 4
Dead of disease 8 1 9
24
PET response correlated to outcome at FU
Beneficial PET response No change or progressive disease at PET ALL
NED or inactive disease 13 13
Alive with active disease 5 5
Dead of disease 3 2 5

25
  • Conclusions
  • PET had a 80 correlation to active GIST
  • but PET was false negative in 20
  • If PET is positive 95 correct response
    correlation
  • No change or PD at response assessment
    predicts a poor outcome

26
Thank you
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