Localised disease in cancer of unknown primary (CUP): the value of positron emission tomography (PET) for individual therapeutic management.
BACKGROUND
Two to four percent of cancer patients present with CUP syndrome. Median survival for localised disease is 20 and for disseminated disease, seven months. For localised disease, curative treatment is more likely and individual therapeutic strategies become more important. After conservative diagnostic procedures including MRI, the primary is detected in less than 25%. The diagnostic value of PET and its influence on therapeutic strategies was evaluated.


METHODS
Forty-two patients with localised CUP were investigated from 5 of 98 to 10 of 2000. The presenting site was lymph node metastasis in 34 and visceral metastasis in 8 patients. After a median of 7 (3-11) diagnostic procedures without detection of the primary, but evidence of localised disease, PET was performed with fluorine-18-fluorodeoxyglucose.


RESULTS
In 26 of 42 patients (62%), a primary was suggested by PET and confirmed in 18 (43%). In 5 of 18 patients beyond localised disease, additional dissemination, not detected by previous diagnostic measures, was diagnosed by PET. Overall, dissemination was only detected only by PET in 16 of 42 patients (38%). In29 of 42 patients (69%), the PET result influenced selection of the definitive treatment.


CONCLUSIONS
In CUP patients, PET has a certain impact on detection of the primary as well as of the disseminated disease. and may also have a certain impact on therapeutic management.
Rades
D
D
Department of Radiation Oncology, Hannover Medical College, Germany. Rades.Dirk@gmx.net
Kühnel
G
G
Wildfang
I
I
Börner
A R
AR
Schmoll
H J
HJ
Knapp
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004724:Endoscopy; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000000981:diagnostic imaging* / Q000628:therapy; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18