[Is 18F-FDG-PET suitable for therapy monitoring after palliative photodynamic therapy of non-resectable hilar cholangiocarcinoma?].
BACKGROUND
If existing biliary drainage is insufficient, photodynamic therapy (PDT, laser treatment after application of a photosensitizer) is an already established adjunct to palliative therapy for progressing hilar cholangiocarcinoma (Klatskin tumours), since it prolongs survival and improves quality of life. Experimental studies of other tumour entities showed that (18)F-FDG-PET ( (18)F-fluorodeosxyglucose-positron emission tomography) may play a role in monitoring tumour response to PDT. Furthermore, previous studies have revealed a high accuracy of this method for the detection of hilar cholangiocarcinoma. Therefore, the aim of the present study was to investigate the feasibility of (18)F-FDG-PET as a follow-up screening method in patients with hilar cholangiocarcinoma who underwent PDT.


METHODS
10 patients were examined by (18)F-FDG-PET before and 4 - 6 weeks after PDT. The following parameters were evaluated: maximum and mean SUV in the tumour, the ratio of maximum SUV in the tumour and mean SUV in the liver, the vital tumour volume, as well as bilirubin and CA 19 - 9 levels.


RESULTS
All tumours were detected by (18)F-FDG-PET. Within a period of 4 - 6 weeks after PDT the cholestasis parameter bilirubin decreased significantly. However, SUV-associated parameters did not show a significant change after treatment while the estimated vital tumour volume even increased.


CONCLUSIONS
PDT does not effect a relevant reduction of tumour mass in non-resectable hilar cholangiocarcinoma. However, PDT leads to a significant reduction of cholestasis. If (18)F-FDG-PET is suitable for monitoring the effect of new palliative therapeutic approaches, like brachytherapy, the use of modern chemotherapeuticals, COX-2 and receptor-tyrosine kinase inhibitors, perhaps also in combination with PDT, has to be further investigated.
Müller
D
D
Klinik und Poliklinik für Nuklearmedizin, Universität Leipzig.
Wiedmann
M
M
Kluge
R
R
Berr
F
F
Mössner
J
J
Sabri
O
O
Caca
K
K
D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D002780:Cholestasis, Intrahepatic / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006414:Hematoporphyrin Photoradiation; D006500:Hepatic Duct, Common / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D018285:Klatskin Tumor / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary; D008297:Male; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy; D010166:Palliative Care; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy; D049268:Positron-Emission Tomography; D011446:Prospective Studies
D019788:Fluorodeoxyglucose F18