PET-TC nei GEP NET: indicazioni e limiti · Roma, 7-9 novembre 2014 Characterization of the disease...

Roma, 7-9 novembre 2014

PET-TC nei GEP NET: indicazioni e limiti

Nicola Fazio, MD, PhD


GEP NEN: characterization of disease �

� Neuroendocrinology�(DOI:10.1159/000367850)� ©�2014�S.�Karger�AG,�Basel 27��

�

Figure 1. Venn diagram of modalities involved in identification of a NET.

Dow

nloa

ded

by:

213.

203.

147.

37 -

11/9

/201

4 6:

09:1

5 AM

Bodei et al., Neuroendocrinology Sep 2014


Characterization of the disease

SSTR

68Ga –DOTA PET-CT Octreoscan®

FDG

PET-TC FDG

Radiological evolution Triphasic CT

Ki-67 / MI MIB-‐1

Tumor grade

Syndrome


68Ga 18F-FDG

18F-DOPA

PET in GEP NENs: available tracers in clinical practice


G3

G1 (Ki-67 ≤ 2% and/or MI < 2)

G2 (Ki-67 3-20% and/or MI 2-20)

WHO 2010 Classification

G3 G3 (Ki-67 > 20% and/or MI > 20)

68Ga

FDG

68Ga FDG

PET in GEP NENs: which tracer in which tumor?


Liver mets from tail PNET: discrepancy between FDG and Ga68 PET-CT

! !

!

68Ga-PET-CT

FDG-PET-CT


Bodei et al., Neuroendocrinology Sep 2014

FDG-PET in GEP NET: when?

“La PET FDG può essere considerata per i NET G2 con Ki67 > 15-20% per i quali octreoscan e PET Gallio potrebbero essere inattendibili”

“La PET FDG è generalmente raccomandata per i NET G3”


FDG PET

FDG PET

SRS SRS Pancreatic; Ki67 < 2% Ileal; Ki67 < 2%

Ki-67 is not enough


Liver metastases: functional characterization related to the

supposed therapy and treatment goal

!


Fax +41 61 306 12 34E-Mail [email protected]

Clinical Images

Dig Surg 2008;25:330 DOI: 10.1159/000158907

Miliary Hepatic Metastases from Neuroendocrine Carcinoma

Nicola Fazio Giovanni Di Meglio Katia Lorizzo Filippo de Brand

European Institute of Oncology, Milan , Italy

A 57-year-old man with a bronchial carcinoid, meta-static from 1999, underwent cholecystectomy in 2004, due to lithiasis, probably caused by long-lasting therapy with somatostatin analogs.

Liver metastases had been known since 2002 on the basis of a previous computed tomography (CT) and so-matostatin receptor scintigraphy (SRS). Intraoperatively a miliariform hepatic dissemination was evident ( fig. 1 ), and was much more extended than previously seen on CT and SRS.

The liver is often involved in the metastatic spread of neuroendocrine carcinomas (NECs). The morphological heterogeneity of these neoplasms takes into account the varying accuracy of instrumental examinations. Mag-netic resonance imaging was superior to CT and SRS in the detection of hepatic metastases from NECs. However, none of these examinations was able to detect the mili-ariform dissemination in the liver, and therefore the tu-mor burden was underestimated. This could be of crucial importance for clinicians when deciding on the thera-peutic strategy, i.e. the indication for resection.

Published online: October 1, 2008

Nicola Fazio European Institute of Oncology Via Ripamonti 435 IT–20141 Milan (Italy) Tel. +39 025 7489 599, Fax +39 025 7489 457, E-Mail [email protected]

© 2008 S. Karger AG, Basel0253–4886/08/0255–0330$24.50/0

Accessible online at:www.karger.com/dsu

Fig. 1. Miliary hepatic metastases from a neuroendocrine carci-noma.

68Ga PET: risk of false negative due to the size of lesions


Extra-hepatic staging: bone

!

Liver and bone mets from PNET

68Ga-PET-TC


68Ga FDG F-DOPA

Prognosis yes yes no

Staging yes yes yes

Prediction of response

to PRRT

Yes (positive)

Yes (negative) no

PET in GEP NENs: function


Da un mese iporessia, astenia G1, dispepsia G1

52 aa, maschio Nessuna comorbilità

Sport a livello agonistico

!

TC tor-add: neoformazione corpo-coda pancreas + met. fegato

AST/ALT 2 volte UNL GGT/ALP 5-6 volte

Bil norm

P.S. 1 Calo ponderale 5%,

epatomegalia

Tumore neuroendocrino Ki-67 18%

PNET metastatico non funzionante: caso clinico


!

Supporto 3-4 sett. ! profilo umorale epatico e clinica stabili

PET-Gallio PET-FDG



PET-Gallio PET-FDG Tumore

primitivo ++ ++

Metastasi epatiche ++ -

Osso multifocale ++ +



•  SSA

•  Everolimus +/- SSA

•  Chemioterapia

•  PRRT (trial)

•  Chir. Primitivo +/- mets.

•  TAE

•  Sunitinib (trial fase 4)

TC PET-Gallio

PET-FDG

T (Pancreas) + + +

Fegato + + -

Osso - + +



PNET metastatico non funzionante: come valutare la risposta

•  Sintomi, P.S., profilo umorale epatico

•  Marcatori circolanti

•  TC

•  PET-Gallio

•  PET-FDG



1° linea: TMZ/CAP + SSA

•  TC a due mesi


Valutazione:



Dopo 2 mesi di TMZ/CAP + SSA passa a PRRT + SSA + CAP

•  Scintigrafia al momento della PRRT


Valutazione:


10 Novembre 2014 • Bologna STARHOTELS EXCELSIOR

V.le Pietramellara, 51

TUMORI NEUROENDOCRINI: INCONTRO DEDICATO AI PAZIENTI E AI LORO FAMILIARI in occasione di NET CANCER DAY 2014

Affrontare malattie rare come i tumori neuroendocrini significa, per il paziente e i suoi familiari, avere molte domande e cercare delle risposte. Grazie all’impegno di Medici Specialisti e dell’Associazione Pazienti nasce questo importante momento d’incontro “ConNET” per favorire un dialogo sempre aperto tra il paziente stesso e le figure professionali che lo circondano.

In collaborazione con

Iniziativa realizzata da

PET-TC nei GEP NET: indicazioni e limiti · Roma, 7-9 novembre 2014 Characterization of the disease...

Documents

Transcript of PET-TC nei GEP NET: indicazioni e limiti · Roma, 7-9 novembre 2014 Characterization of the disease...