Cancer Treatment Today » Neuroendocrine Cancer

FDG PET for neuroendocrine cancer

M Levin, MD — Thu, 20 Sep 2012 14:31:45 +0000

PET that uses FDG (a type of tagged sugar) is not all that sensitive in neuroendocrine cancers(NET). This means that it may not pick up some neuroendocrine cancers. Specificity means that what it does pick up is really cancer and not some other false positive. However, other imaging modalities also had disadvantages as well as advantages. One study revealed that for neuroendocrine tumors, PET that used 18F-FDOPA was more accurate (sensitivity, 100%; specificity, 91%) in the detection of skeletal lesions than octreotide scintigraphy or CAT scan but was insensitive (sensitivity, 20%; specificity, 94%) in the lung, ostensibly because respiratory motion during image acquisition degrade the accuracy of PET. Octreotide scintigraphy yielded its best results in the liver (sensitivity, 75%; specificity, 100%); however, it was less accurate than PET in all organs. However, 18F-FDOPA PET is less sensitive than FDG PET and standard imaging procedures for the staging of small cell lung cancer. Popperl et al recommends that 18F-FDG should be preserved for less differentiated tumors, while amine precursors and somatostatin analogs contrast should be implemented in the diagnostic process of well-differentiated NET. NCCN on p. MS-12 does not recommend FDG PET for neuroendocrine cancer.

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Liver transplantation for neuroendocrine cancer

M Levin, MD — Fri, 24 Aug 2012 16:57:03 +0000

Liver transplantation can theoretically cure cancers which are slow growing and may be restricted to the liver at the time of transplantation. It can cure, for example, some hepatocellular carcinomas. Liver transplantation for the treatment of metastatic neuroendocrine tumors (NETs) has a several decade history and also results in an occasional cure. The reported experience with transplantation for NETs is limited to about 150 cases with widely varying results and few 5-year disease-free survivors. According to a 2010 Consensus recommendation, “liver transplantation can be considered in young patients (below 50 years of age) when the primary tumour originates in the gastrointestinal tract, is drained by the venous portal system, and has been previously removed with curative intent, and when disease progression is controlled for at least 6 months before transplantation.” NCCN does not list liver transplantation as an appropriate option in its 2012 guideline.

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PET for neuroendocrine cancer

M Levin, MD — Fri, 24 Aug 2012 13:35:26 +0000

FDG PET is not all that sensitive in neuroendocrine cancers(NET). This may relate to how neuroendocrine cancer takes up FDG in comparison to other radio-labels used for PET scanning. One study revealed that for neuroendocrine tumors, 18F-FDOPA scanning was more sensitive and accurate (sensitivity, 100%; specificity, 91%) in the detection of skeletal lesions than octreotide scintigraphy or CT but was not sensitive (sensitivity, 20%; specificity, 94%) in the lung, ostensibly because of respiratory motion during image acquisition. Octreotide scintigraphy yielded its best results in the liver (sensitivity, 75%; specificity, 100%); however, it was less accurate than FDOPA PET in all organs. However, 18F-FDOPA PET is less sensitive than FDG PET and standard imaging procedures for the staging of small cell lung cancer. Popperl et al recommends that 18F-FDG should be preserved for less differentiated tumors, while amine precursors and somatostatin analogs should be used for PET scanning in the diagnostic process of well-differentiated NET. NCCN on p. MS-12 does not recommend FDG PET.

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TACE for Liver Metastases from Ovarian Cancer

M Levin, MD — Wed, 20 Jun 2012 17:40:13 +0000

Transcatheter arterial chemoembolization (TACE) of the liver is an alternative to conventional systemic or intra-arterial chemotherapy, and to various nonsurgical tumor-killing techniques. It is meant to treat resectable and non-resectable tumors. The rationale for TACE is that infusions of viscous material containing one or more chemo drugs may have synergy: chemotherapy killing cancer cells that are already weakened from a lack of oxygen in the area. Synergy can be further potentiated by attaching radioactive isotopes for localized radiotherapy. The liver is especially amenable to such an approach, given its unusual anatomy, the fact that it is fed by two main and independent blood sources, and the ability of healthy hepatic tissue to recover from chemotherapy and re-grow damaged cells and thus compensate for cells lost during chemoembolization, whereas the cancer cannot do so. Another rationale is that TACE delivers effective local doses, while minimizing systemic toxicities that can be caused by oral or intravenous chemotherapy.

Trans Arterial Chemoembolization is often used for hepatocellular carcinoma and neuroendocrine cancers of the liver. However for other types of cancer, less information is available. The safety and effectiveness of chemoembolization for breast cancer metastases is unknown as only case reports and series have so far been reported. The largest series reported in a 2008 abstract was of 217 patients but this was not a prospective study.

The Society of Interventional Radiology (SIR, 2009) stated that chemoembolization has shown promising early results with some types of metastatic tumors but that the evidence in the current medical literature is insufficient to demonstrate the efficacy of TACE for the treatment of liver metastases from other primary tumors, including but not limited to breast cancer, colorectal cancer, and other tumors of unknown primary sites, from ovarian cancer. Metastatic disease to the liver from tumors other than primary neuroendocrine tumors is generally treated with surgery, chemotherapy, or both.

Metastatic disease to the liver from ovarian cancer is somewhat less frequent than from breast cancer. A recent report from Vogl at al found that it is TACE is an effective palliative treatment in achieving local control in selected patients with liver metastases from ovarian cancer. It is the only study on this topic. This is similar to outcomes for the metastatic disease to the liver treated with TACE. Generally such results have not been thought to be adequate to recommend TACE of ovarian cancer because overall survival has not been increased.

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