Patterns of disease progression on 18F-fluorodeoxyglucose positron emission tomography-computed tomography in patients with malignant pleural mesothelioma undergoing multimodality therapy with pleurectomy/ decortication

Andrea Bille, Sugama Chicklore, Lawrence Okiror, Gary J R Cook, James Spicer, David Landau, Loic Lang-Lazdunski

Research output: Contribution to journalArticle

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Abstract

INTRODUCTION: The aim of this study was to evaluate the patterns of disease progression in patients treated with pleurectomy/decortication (P/D), hyperthermic pleural lavage with povidone-iodine, prophylactic radiotherapy and adjuvant chemotherapy, using F-fluorodeoxyglucose (F-FDG) PET/computed tomography (PET/CT). MATERIALS AND METHODS: This was a retrospective study of 65 patients treated with a multimodality therapy including P/D between October 2004 and March 2012. Thirty-two patients underwent F-FDG PET/CT within 6 weeks of completion of adjuvant chemotherapy and 6-monthly thereafter at our institution. The first site of relapse on F-FDG PET/CT was recorded, and all scans were reviewed by an independent observer. RESULTS: Thirty-two patients (27 male, median age 61 years, range 45-73) underwent their F-FDG PET/CT scans at our institution. Eighteen of the 32 patients were alive at last follow-up (median follow-up 42 months, range 16-76). Nine patients were alive with disease recurrence. Fourteen patients died of disease progression (median survival 24.7 months, range 15-38). The median maximum standardized uptake value (SUVmax) in relapsing mesothelioma was 10.9 (range 4.9-27.3). There was a statistically significant correlation between the SUVmax and tumour lesion glycolysis of recurrent mesothelioma and overall survival (P=0.05). The site of disease recurrence was the pleura in the majority of the alive patients and was extrapleural in the dead patients. There was a statistically significant correlation between disease-free survival and complete macroscopic resection (P=0.02). CONCLUSION: After P/D with hyperthermic pleural lavage with povidone-iodine, prophylactic radiotherapy and adjuvant chemotherapy, the most frequent site of recurrence is the pleural cavity. Peritoneal seeding is rare. The tumour SUVmax and tumour lesion glycolysis correlate significantly with overall survival.

Original languageEnglish
Pages (from-to)1075-1083
Number of pages9
JournalNuclear Medicine Communications
Volume34
Issue number11
DOIs
Publication statusPublished - Nov 2013

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Fluorodeoxyglucose F18
Disease Progression
Adjuvant Chemotherapy
Tomography
Povidone-Iodine
Recurrence
Therapeutics
Therapeutic Irrigation
Mesothelioma
Glycolysis
Survival
Radiotherapy
Positron Emission Tomography Computed Tomography
Malignant Mesothelioma
Pleural Cavity
Neoplasms
Pleura
Disease-Free Survival
Retrospective Studies

Keywords

  • F-FDG positron emission tomography/computed tomography
  • malignant pleural mesothelioma
  • recurrence

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Patterns of disease progression on 18F-fluorodeoxyglucose positron emission tomography-computed tomography in patients with malignant pleural mesothelioma undergoing multimodality therapy with pleurectomy/ decortication. / Bille, Andrea; Chicklore, Sugama; Okiror, Lawrence; Cook, Gary J R; Spicer, James; Landau, David; Lang-Lazdunski, Loic.

In: Nuclear Medicine Communications, Vol. 34, No. 11, 11.2013, p. 1075-1083.

Research output: Contribution to journalArticle

Bille, Andrea ; Chicklore, Sugama ; Okiror, Lawrence ; Cook, Gary J R ; Spicer, James ; Landau, David ; Lang-Lazdunski, Loic. / Patterns of disease progression on 18F-fluorodeoxyglucose positron emission tomography-computed tomography in patients with malignant pleural mesothelioma undergoing multimodality therapy with pleurectomy/ decortication. In: Nuclear Medicine Communications. 2013 ; Vol. 34, No. 11. pp. 1075-1083.
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AU - Okiror, Lawrence

AU - Cook, Gary J R

AU - Spicer, James

AU - Landau, David

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N2 - INTRODUCTION: The aim of this study was to evaluate the patterns of disease progression in patients treated with pleurectomy/decortication (P/D), hyperthermic pleural lavage with povidone-iodine, prophylactic radiotherapy and adjuvant chemotherapy, using F-fluorodeoxyglucose (F-FDG) PET/computed tomography (PET/CT). MATERIALS AND METHODS: This was a retrospective study of 65 patients treated with a multimodality therapy including P/D between October 2004 and March 2012. Thirty-two patients underwent F-FDG PET/CT within 6 weeks of completion of adjuvant chemotherapy and 6-monthly thereafter at our institution. The first site of relapse on F-FDG PET/CT was recorded, and all scans were reviewed by an independent observer. RESULTS: Thirty-two patients (27 male, median age 61 years, range 45-73) underwent their F-FDG PET/CT scans at our institution. Eighteen of the 32 patients were alive at last follow-up (median follow-up 42 months, range 16-76). Nine patients were alive with disease recurrence. Fourteen patients died of disease progression (median survival 24.7 months, range 15-38). The median maximum standardized uptake value (SUVmax) in relapsing mesothelioma was 10.9 (range 4.9-27.3). There was a statistically significant correlation between the SUVmax and tumour lesion glycolysis of recurrent mesothelioma and overall survival (P=0.05). The site of disease recurrence was the pleura in the majority of the alive patients and was extrapleural in the dead patients. There was a statistically significant correlation between disease-free survival and complete macroscopic resection (P=0.02). CONCLUSION: After P/D with hyperthermic pleural lavage with povidone-iodine, prophylactic radiotherapy and adjuvant chemotherapy, the most frequent site of recurrence is the pleural cavity. Peritoneal seeding is rare. The tumour SUVmax and tumour lesion glycolysis correlate significantly with overall survival.

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