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See detailStaging of primary cervical cancers: the role of nuclear medicine
Belhocine, Tarik; Kridelka, Frédéric ULg; Thille, Alain ULg et al

in Critical Reviews in Oncology/Hematology (2003), 46(3), 275-284

In nuclear medicine, [F-18]-fluorodeoxyglucose positron emission tomography ((18)FDG PET) and lymphatic mapping and sentinel lymphadenectomy (LM/SL) may significantly improve the staging of primary ... [more ▼]

In nuclear medicine, [F-18]-fluorodeoxyglucose positron emission tomography ((18)FDG PET) and lymphatic mapping and sentinel lymphadenectomy (LM/SL) may significantly improve the staging of primary cervical cancers. Indeed, the disease progresses in a 'level by level' fashion to regional nodes through the lymphatic channels, and also to extra-nodal sites via the hematogenous stream. Additionally, the sub-optimal efficacy of routine radiological protocols, while new combined therapies are proving to be more efficient, stresses the need for alternative staging procedures. Current data suggest that LM/SL accurately reflects the regional lymph node status in early stage cervical cancers, and thus could avoid unnecessary complete lymphadenectomies. Also, whole body (18)FDG PET may provide valuable insights on extra-pelvic and distant tumor spreading, with a significant impact on treatment choices. If these promising results are confirmed on large controlled trials, LM/SL and (18)FDG PET imaging could be incorporated in the routine staging work-up of primary cervical cancers. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved. [less ▲]

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See detailWhole-body tumor imaging using PET and 2-18F-fluoro-l-tyrosine: Preliminary evaluation and comparison with 18F-FDG
Hustinx, Roland ULg; Lemaire, Christian ULg; Jerusalem, Guy ULg et al

in Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine (2003), 44(4), 533-539

18F-FDG PET imaging is now established as a valuable tool for evaluating cancer patients. However, a limitation of 18F-FDG is its absence of specificity for tumor. Both protein synthesis and amino acid ... [more ▼]

18F-FDG PET imaging is now established as a valuable tool for evaluating cancer patients. However, a limitation of 18F-FDG is its absence of specificity for tumor. Both protein synthesis and amino acid transport are enhanced in most tumor cells, but their metabolism is less affected in inflammation. We therefore decided to evaluate the ability of PET with 2-18F-fluoro-L-tyrosine (18F-TYR) to visualize cancer lesions in patients compared with 18F-FDG PET. Methods: 18F-FDG PET and 18F-TYR PET were performed on 23 patients with histologically proven malignancies (11 non-small cell lung cancers (NSCLCs), 10 lymphomas, and 2 head and neck carcinomas). Fully corrected, whole-body PET studies were obtained on separate days. 18F-FDG studies were performed after routine clinical fashion. 18F-TYR studies were started 36 ± 6 min after tracer injection and a second scan centered over a reference lesion was acquired after completion of the whole-body survey-on average, 87 min after injection. Standardized uptake values (SUVs) were calculated for all abnormal foci and for various normal structures. Results were compared with pathologic or correlative studies. Results: 18F-FDG PET correctly identified 54 malignant lesions, among which 36 were also visualized with 18F-TYR (67%). 18F-TYR did not detect any additional lesion. Tumor SUVs (SUVbw, 5.2 vs. 2.5), tumor-to-muscle (7.4 vs. 2.7), and tumor-to-mediastinum activity ratios (3 vs. 1.4) were higher with 18F-FDG than with 18F-TYR. Two of 11 NSCLCs and 4 of 10 lymphomas were understaged with 18F-TYR compared with 18F-FDG. Although the NSCLC lesions missed by 18F-TYR PET were small, several large lymphoma lesions did not accumulate the tracer. In 4 patients, 18F-TYR-positive lesions coexisted with 18F-TYR-negative lesions. There was a high physiologic 18F-TYR uptake by the pancreas (average SUVbw, 10.3) and the liver (average SUVbw, 6.3). Muscle and bone marrow uptakes were also higher with 18F-TYR than with 18F-FDG: average SUVbw, 1 versus 0.7 and 2.6 versus 1.8, respectively. There was no change over time in the 18F-TYR uptake by the tumors or the normal structures. Conclusion: 18F-TYR PET is not superior to 18F-FDG PET for staging patients with NSCLC and lymphomas. [less ▲]

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See detailImaging gliomas with positron emission tomography and single-photon emission computed tomography
Bénard, François; Romsa, Jonathan; Hustinx, Roland ULg

in Seminars in Nuclear Medicine (2003), 33(2), 148-162

Over the last two decades the large volume of research involving various brain tracers has shed invaluable light on the pathophysiology of cerebral neoplasms. Yet the question remains as to how best to ... [more ▼]

Over the last two decades the large volume of research involving various brain tracers has shed invaluable light on the pathophysiology of cerebral neoplasms. Yet the question remains as to how best to incorporate this newly acquired insight into the clinical context. Thallium is the most studied radiotracer with the longest track record. Many, but not all studies, show a relationship between Tl-201 uptake and tumor grade. Due to the overlap between tumor uptake and histologic grades, Tl-201 cannot be used as the sole noninvasive diagnostic or prognostic tool in brain tumor patients. However, it may help differentiating a high-grade tumor recurrence from radiation necrosis. MIBI is theoretically a better imaging agent than Tl-201 but it has not convincingly been shown to differentiate tumors according to grade. MDR-1 gene expression as demonstrated by MIBI does not correlate with chemoresistance in high grade gliomas. Currently, MIBI's clinical role in brain tumor imaging has yet to be defined. IMT, a radio-labeled amino acid analog, may be useful for identifying postoperative tumor recurrence and, in this application, appears to be a cheaper, more widely available tool than positron emission tomography (PET). However, its ability to accurately identify tumor grade is limited. 18 F-2-Fluoro-2-deoxy-D-glucose (FDG) PET predicts tumor grade, and the metabolic activity of brain tumors has a prognostic significance. Whether FDG uptake has an independent prognostic value above that of histology remains debated. FDG-PET is effective in differentiating recurrent tumor from radiation necrosis for high-grade tumors, but has limited value in defining the extent of tumor involvement and recurrence of low-grade lesions. Amino-acid tracers, such as MET, perform better for this purpose and thus play a complementary role to FDG. Given the poor prognosis of patients with gliomas, particularly with high-grade lesions, the overall clinical utility of single photon emission computed tomography (SPECT) and PET in characterizing recurrent lesions remains dependent on the availability of effective treatments. These tools are thus mostly suited to the evaluation of treatment response in experimental protocols designed to improve the patients' outcome. (C) 2003 Elsevier Inc. All rights reserved. [less ▲]

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See detailTomographie à émission de positons : vers une approche plus spécifique des pathologies oncologiques
Hustinx, Roland ULg

Thèse d’agrégation de l’enseignement supérieur (2003)

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See detailIntra-patient variability of SUV in normal tissues.
PAQUET, N.; HUSTINX, Roland ULg; FOIDART-WILLEMS, Jacqueline ULg

in European Journal of Nuclear Medicine and Molecular Imaging (2003), 30(SUPPL 2), 327

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See detailValue of 18FDG gamma camera coincidence imaging in the follow-up of head and neck squamous cell carcinoma.
PAQUET, N.; LEFEBVRE, B.; HUSTINX, Roland ULg et al

in European Journal of Nuclear Medicine and Molecular Imaging (2003), 30(SUPPL 2), 278

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See detailAdded value of whole body 18FDG PET imaging in monitoring uterine cancers.
BELHOCINE, T.; THILLE, A.; DE BARSY, C. et al

in European Journal of Nuclear Medicine and Molecular Imaging (2003), 30(SUPPL 2), 269

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See detailWhole-body FDG PET imaging as a method for staging and early assessment of treatment response in pediatric patients with lymphoma.
DE BARSY; DEPAS, G.; DRESSE, MF. et al

in Journal of Nuclear Medicine (The) (2003), 44

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See detailWhole-body FDG PET in the follow-up of pediatric patients with lymphoma.
DE BARSY; DEPAS, G.; DRESSE, MF. et al

in Journal of Nuclear Medicine (The) (2003), 44

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See detailRadiothérapie métabolique des douleurs osseuses métastatiques
Hustinx, Roland ULg; Sautois, Brieuc ULg; Jerusalem, Guy ULg et al

in Médecine et Hygiène (2003), 61

La radiothérapie métabolique des métastases osseuses est un traitement palliatif de la douleur. Cet objectif est rempli dans la grande majorité des cas, sans effets secondaires cliniquement ressentis par ... [more ▼]

La radiothérapie métabolique des métastases osseuses est un traitement palliatif de la douleur. Cet objectif est rempli dans la grande majorité des cas, sans effets secondaires cliniquement ressentis par le patient. Tous les patients en dissémination osseuse ne peuvent cependant bénéficier de cette approche qui, lorsqu'elle est choisie, doit toujours être appliquée dans un cadre multidisciplinaire. Les lésions accessibles à ce traitement doivent avoir démontré leur caractère ostéocondensant en scintigraphie. La fonction rénale et la réserve médullaire sont des paramètres importants, l'élimination des radiopharmaceutiques étant urinaire et leur toxicité, médullaire. Les situations particulières telles que risque fracturaire important ou compression médullaire sont des contre-indications. Le traitement est simple dans son principe et dans sa réalisation. Il permet une amélioration très significative de la qualité de vie, tout en réalisant des économies substantielles en terme de coût de santé publique. [less ▲]

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See detailPET scan imaging in oncology.
Jerusalem, Guy ULg; Hustinx, Roland ULg; Beguin, Yves ULg et al

in European Journal of Cancer (2003), 39(11), 1525-34

With the emergence of positron emission tomography (PET) from research laboratories into routine clinical use, it is important to redefine the most appropriate use of each imaging technique. The aim of ... [more ▼]

With the emergence of positron emission tomography (PET) from research laboratories into routine clinical use, it is important to redefine the most appropriate use of each imaging technique. The aim of this review article is to show the potential of PET in oncology. We discuss the most promising indications and the perspectives for the future. We will also point out the shortcomings and the important questions to be answered before fully considering PET as a necessary tool in the day-to-day practice of oncology. Although many studies have documented the high accuracy of 18F-FDG PET for the detection and staging of malignant tumours and for the monitoring of therapy results in these patients, it is very important to assess the impact of the technique on patient outcome and to show cost-effectiveness from the societal viewpoint. [less ▲]

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See detailEarly detection of relapse by whole-body positron emission tomography in the follow-up of patients with Hodgkin's disease.
Jerusalem, Guy ULg; Beguin, Yves ULg; Fassotte, Marie-France ULg et al

in Annals of Oncology (2003), 14(1), 123-30

BACKGROUND: Relapse after treatment of Hodgkin's disease (HD) is usually identified as a result of the investigation of symptoms. We undertook this study to examine the value of whole-body positron ... [more ▼]

BACKGROUND: Relapse after treatment of Hodgkin's disease (HD) is usually identified as a result of the investigation of symptoms. We undertook this study to examine the value of whole-body positron emission tomography (PET) for the detection of preclinical relapse. PATIENTS AND METHODS: Thirty-six patients underwent 2-[fluorine-18]fluoro-2-deoxy-D-glucose ((18)F-FDG) PET at the end of treatment and than every 4-6 months for 2-3 years after the end of polychemotherapy and/or radiotherapy. In those cases of abnormal (18)F-FDG accumulation a confirmatory study was performed 4-6 weeks later. RESULTS: One patient had residual tumor and four patients relapsed during a follow-up of 5-24 months. All five events were correctly identified early by (18)F-FDG PET. Residual tumor or relapse was never first diagnosed based on clinical examination, laboratory findings or computed tomography (CT) studies. Two patients presented B symptoms and the three others were asymptomatic at the time of residual disease or relapse. Confirmation of residual disease or relapse was obtained by biopsy in four patients 1, 1, 5 and 9 months after PET and by unequivocal clinical symptoms and CT studies in one patient 3 months after PET. False-positive (18)F-FDG PET studies incorrectly suggested possible relapse in six other patients, but the confirmatory PET was always negative. Our study also provides important information about physiological (18)F-FDG uptake in the thymus. CONCLUSIONS: Our data suggest the potential of (18)F-FDG PET to detect preclinical relapse in patients with HD. This could help identify patients requiring salvage chemotherapy at the time of minimal disease rather than at the time of clinically overt relapse. Further studies are warranted to determine the impact of PET on treatment management and outcome. In fact, the aim of follow-up procedures is not only to detect preclinical relapse but mainly to obtain better results by starting salvage treatment earlier. A cost-benefit analysis will also be necessary before (18)F-FDG PET can be used routinely in the follow-up of patients with HD. [less ▲]

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See detailRadiothérapie métabolique des douleurs osseuses d'origine métastatique : nouveaux traitements, nouvelles pratiques
Hustinx, Roland ULg; Paulus, Patrick

in Annales de l'Association Belge de Radioprotection = Annalen van de Belgische Vereniging voor Stralingsbescherming (2003), 28

Le traitement palliatif des douleurs osseuses liées à la dissémination métastatique s'est récemment enrichi d'une molécule, le 153Sm-EDTMP (Quadramet). Le traitement classique faisait appel au Strontium ... [more ▼]

Le traitement palliatif des douleurs osseuses liées à la dissémination métastatique s'est récemment enrichi d'une molécule, le 153Sm-EDTMP (Quadramet). Le traitement classique faisait appel au Strontium-89 (Métastron). Alors que ce dernier est un émetteur bêta pur, de longue demi-vie (50,5 jours), le 153Sm émet également un rayonnement gamma de 103 keV, et sa période physique est de 1,95 jours. Dans cet exposé nous envisagerons, du point de vue de la radioprotectio, les propriétés pharmacocinétiques du radiopharmaceutique et les caractéristiques physiques du 153Sm. Nous relaterons également l'expérience acquise dans notre centre avec le 186Re-HEDP. [less ▲]

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See detailLes lymphomes
Jerusalem, Guy ULg; Hustinx, Roland ULg; Beguin, Yves ULg et al

in Médecine Nucléaire : Imagerie Fonctionnelle et Métabolique (2003), 27(8), 401-410

Actuellement, on arrive à guérir 70-80% des patients atteints de maladie de Hodgkin et 50% des patients atteints de lymphome non-Hodgkinien de malignité intermédiaire ou élevée. Une approche systématique ... [more ▼]

Actuellement, on arrive à guérir 70-80% des patients atteints de maladie de Hodgkin et 50% des patients atteints de lymphome non-Hodgkinien de malignité intermédiaire ou élevée. Une approche systématique concernant le diagnostic, la classification de la maladie et la détermination des facteurs pronostiques permet de choisir la thérapeutique la plus appropriée. Les auteurs passent en revue les examens à réaliser au diagnostic et discutent de la place de la tomographie à émission de positons (TEP) dans cette indication. Ils évoquent ensuite le problème des masses résiduelles. La TEP est maintenant l'examen de choix pour établir le bilan de fin de traitement. Les auteurs discutent également du rôle potentiel de la TEP pour l'évaluation thérapeutique précoce et le suivi régulier des patients après traitement pour lymphome. Enfin, l'aspect particulier des lymphomes de l'enfant est abordé. [less ▲]

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See detailTumor imaging
Hustinx, Roland ULg; Alavi, Abass

in Redvanly, Carol S; Welch, Michael J (Eds.) Handbook of Radiopharmaceuticals. Radiochemistry and Applications. (2003)

Radiopharmaceuticals are used to detect and characterise disease processes, or normal biological function, in living cells, animals or humans. Used as tracer molecules, they map the distribution, uptake ... [more ▼]

Radiopharmaceuticals are used to detect and characterise disease processes, or normal biological function, in living cells, animals or humans. Used as tracer molecules, they map the distribution, uptake and metabolism of the molecule in clinical studies, basic research or applied research. The area of radiopharmaceuticals is expanding rapidly. The number of PET centers in the world is increasing at 20% per year, and many drug companies are utilising PET and other forms of radiopharmaceutical imaging to evaluate products. * Readers will find coverage on a number of important topics such as radionuclide production, PET and drug development, and regulations * Explains how to use radiopharmaceuticals for the diagnosis and therapy of cancer and other diseases [less ▲]

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See detailMalignant melanoma
Paquet, Philippe ULg; Hustinx, Roland ULg; Rigo, Pierre ULg et al

in Oehr, Peter; Biersack, Hans_jürgen; Coleman, Edward R (Eds.) PET and PET-CT in Oncology (2003)

PET and PET-CT in Oncology describes the principles of positron emission tomography and is a useful resource for incorporating the technique in clinical practice. In a clear and straightforward fashion ... [more ▼]

PET and PET-CT in Oncology describes the principles of positron emission tomography and is a useful resource for incorporating the technique in clinical practice. In a clear and straightforward fashion, this heavily-illustrated text offers instructive information and overviews of the basic principles of PET and PET-CT as well as the routine clinical PET scanning procedures for all important oncological indications. It is designed to serve as a reference work for specialists in nuclear medicine and radiology (including therapy planning) and for oncologists. It also provides student and physicians in other medical specialities with a general introduction to the effective integration of this modern technique into routine clinical diagnostics. Above all, this volume illustrates the importance of PET and PET-CT in comparison with other imaging techniques. [less ▲]

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See detailUsefulness of F-18-FDG PET in the post-therapy surveillance of endometrial carcinoma
Belhocine, Tarik; De Barsy, Caroline; Hustinx, Roland ULg et al

in European Journal of Nuclear Medicine and Molecular Imaging (2002), 29(9), 1132-1139

The aim of this study was to assess the usefulness of fluorine-18 tluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) in the post-therapy surveillance of endometrial carcinomas. Forty-one ... [more ▼]

The aim of this study was to assess the usefulness of fluorine-18 tluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) in the post-therapy surveillance of endometrial carcinomas. Forty-one fully corrected whole-body PET studies were performed in 34 women with previously treated endometrial cancers as a part of their follow-up programme. In 28 studies, FDG PET was indicated to localise a recurrence suspected at the control visits on the basis of clinical examination and/or radiological abnormalities (chest X-ray, CT or MRI) and/or elevated tumour marker levels (CA125, CEA). Another 13 studies were performed as a simple surveillance procedure. Overall, in 26 studies PET detected recurrent disease, which was confirmed either by histology (n=7) or by clinical and radiological outcomes (n=19). In 88% of the cases, the PET findings confirmed recurrence suggested by routine follow-up. In the remaining 12% of cases, PET detected asymptomatic recurrences that were unsuspected at the control visits. Whole-body PET accurately localised the site of confirmed recurrences as being above and below the diaphragm in 50%, only below the diaphragm in 35% and only above the diaphragm in 15%. In one patient, however, PET missed microscopic lung metastases shown on thoracic CT, and in three studies, metabolic imaging results were not confirmed. In I I of 12 negative PET studies, no subsequent clinical or radiological recurrences were observed with a median follow-up of 10 months. Overall, the results of PET agreed well with the final diagnosis (Cohen's kappa coefficient =0.78). In 9/26 patients (35%) with confirmed recurrences, the PET findings significantly altered the treatment choice by detecting either clinically or radiologically unsuspected distant metastases. The sensitivity, specificity, diagnostic accuracy and positive and negative predictive values of FDG PET imaging in the post-therapy surveillance of endometrial carcinomas were 96%, 78%, 90%, 89% and 91 %, respectively. Indeed, the high likelihood ratio for a positive test result (4.5) and the low likelihood ratio for a negative test result (0.05) demonstrated the clinical utility of metabolic imaging in "ruling in" disease as well as "ruling out" recurrence. In conclusion, whole-body FDG PET appears useful in the post-therapy surveillance of endometrial cancers, both for the accurate localisation of suspected recurrences and for the detection of asymptomatic recurrent disease. [less ▲]

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See detailIncreased uptake of the apoptosis-imaging agent (99m)Tc recombinant human annexin V in human tumors after one course of chemotherapy as a predictor of tumor response and patient prognosis
Belhocine, Tarik; Steinmetz, Neil; Hustinx, Roland ULg et al

in Clinical Cancer Research : An Official Journal of the American Association for Cancer Research (2002), 8(9), 2766-2774

Purpose: Many anticancer therapies exert their therapeutic effect by inducing apoptosis in target tumors. We evaluated in a Phase I study the safety and the feasibility of Tc-99m-Annexin V for imaging ... [more ▼]

Purpose: Many anticancer therapies exert their therapeutic effect by inducing apoptosis in target tumors. We evaluated in a Phase I study the safety and the feasibility of Tc-99m-Annexin V for imaging chemotherapy-induced apoptosis in human cancers immediately after the first course of chemotherapy. Experimental Design: Fifteen patients presenting with lung cancer (n = 10), lymphoma (n = 3), or breast cancer (n = 2) underwent Tc-99m-Annexin V scintigraphy before and within 3 days after their first course of chemotherapy. Tumor response was evaluated by computed tomography and F-18-fluoro-2-deoxy-D-glucose positron emission tomography scans, 3 months in average after completing the treatment. Median follow-up was 117 days. Results: In all cases, no tracer uptake was observed before treatment. However, 24-48 h after the first course of chemotherapy, 7 patients who showed Tc-99m-Annexin V uptake at tumor sites, suggesting apoptosis, had a complete (n = 4) or a partial response In = 3). Conversely, 6 of the 8 patients who showed no significant posttreatment tumor uptake had a progressive disease. Despite the lack of tracer uptake after treatment, the 2 patients with breast cancer had a partial response. Overall survival and progression-free survival were significantly related to tracer uptake in treated lung cancers and lymphomas (P < 0.05). No serious adverse events were observed. Conclusions: Our preliminary results demonstrated the feasibility and the safety of Tc-99m-Annexin V for imaging apoptosis in human tumors after the first course of chemotherapy. Initial data suggest that early Tc-99m-Annexin V tumor uptake may be a predictor of response to treatment in-patients with late stage lung cancer and lymphoma. [less ▲]

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See detailFluorodeoxyglucose positron emission tomography and somatostatin receptor scintigraphy for diagnosing and staging carcinoid tumours: correlations with the pathological indexes p53 and Ki-67
Belhocine, Tarik; Willems, Jacqueline ULg; Rigo, Pierre ULg et al

in Nuclear Medicine Communications (2002), 23(8), 727-734

We performed this study in order to evaluate the diagnostic accuracy of whole-body fluorodeoxyglucose positron emission tomography (FDG PET) imaging and somatostatin receptor scintigraphy (SRS) for ... [more ▼]

We performed this study in order to evaluate the diagnostic accuracy of whole-body fluorodeoxyglucose positron emission tomography (FDG PET) imaging and somatostatin receptor scintigraphy (SRS) for localizing primary carcinoid tumours and evaluating the extent of the disease. A secondary aim was to correlate those findings with the histological characteristics of the lesions. FDG PET was performed in 17 patients and SRS in 16. All patients had pathologically proven carcinoids. All lesions were verified by histopathological analysis or by follow-up. Ki-67 and p53 expression were assessed as an indicator of the tumours' aggressiveness. FDG PET correctly identified 4/7 primary tumours and 8/11 metastatic spreads, as compared to six and 10 respectively, for SRS. Most tumours were typical carcinoids with low Ki-67 expression. No correlation was found between the histological features and the tracer's uptake. We conclude that SRS remains the modality of choice for evaluating patients with carcinoid tumours, regardless of their proliferative activity. FDG PET should be reserved to patients with negative results on SRS. ((C) 2002 Lippincott Williams Wilkins). [less ▲]

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See detailWhole-body FDG-PET imaging in the management of patients with cancer
Hustinx, Roland ULg; Bénard, François; Alavi, Abass

in Seminars in Nuclear Medicine (2002), 32(1), 35-46

Fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging is increasingly used for the management of patients with cancer. The technique is now well accepted by most physicians as an effective ... [more ▼]

Fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging is increasingly used for the management of patients with cancer. The technique is now well accepted by most physicians as an effective complement to the existing imaging modalities. For many malignancies, PET achieves high sensitivity and specificity. The critical role of this powerful technique is realized increasingly in the day-to-day practice of oncology. This is particularly true for the management of patients with non-small-cell lung cancer (NSCLC). The contribution of PET for the selection of patients eligible for curative treatments in this setting is well established. Convincing data also exist to support the use of PET for evaluating patients with recurrent colorectal carcinoma, for staging and restaging lymphomas, and for diagnosing recurrent thyroid carcinoma in the presence of elevated thyroglobulin and negative I-131 scans. Other indications include staging of various recurrent malignancies, such as breast cancer, melanoma, and head and neck and gynecologic carcinomas. Existing data are limited for the determination of the impact of PET in certain malignancies, and further studies, which should include outcome information, will allow clarification of the role of this modality for such indications. Despite the small number of studies specifically designed to assess changes in management plans for some malignancies after performing PET the overall favorable results are encouraging enough at this time to include this modality as an essential element of the practice of modern oncology. Finally, the evolving role of PET imaging as a predictor of response after local or systemic treatment may add a major dimension to the application of this novel technique. Copyright (C) 2002 by WB. Saunders Company. [less ▲]

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