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Impact of PET/CT on clinical management in patients with cancer of unknown primary—a PET/CT registry study

  • Molecular Imaging
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the impact of PET/CT on clinical management in patients with cancer of unknown primary (CUP).

Methods

A cohort of patients with CUP undergoing PET/CT was prospectively enrolled in a local PET/CT registry study between April 2013 and June 2018. Questionnaire data from referring physicians on intended patient management prior and after PET/CT were recorded including items on the intended treatment concept and intended additional diagnostics. Changes in management after PET/CT were recorded. Patient outcome of different cohorts was analyzed for overall survival drawn from patient records.

Results

One hundred fifty-five patients (53 female; 63.4 ± 12.1 years) were included. Intended therapeutic management was revised in 45.8% of patients after PET/CT, including major changes affecting the intended treatment goal in 26.5% of patients and minor changes (therapy adjustments) in 19.3% of patients. Invasive and additional diagnostic procedures were intended in 25.8% and 63.2% prior PET/CT and 13.5% and 6.5% after PET/CT. PET/CT-based curative therapy concepts were associated with significantly longer patient survival (4.7 ± 0.3 years) than palliative therapy concepts (1.8 ± 0.5 years, p = .0001). Patients with cervical CUP showed a significantly longer survival (4.3 ± 0.3 years) than patients with extracervical CUP (3.5 ± 0.5 years, p = .01). The identification of the primary did not significantly affect survival.

Conclusion

This registry study confirms previous studies reporting that PET/CT significantly influences clinical management in patients with CUP, helping physicians to select a more individualized treatment and to avoid additional diagnostics. Furthermore, we could confirm that tumor localization and extent as shown by PET/CT have a significant impact on patient prognosis.

Key Points

• PET/CT significantly influences intended clinical management in patients with CUP, helping physicians to select a more individualized treatment and to avoid additional diagnostics.

• Tumor localization and extent as shown by PET/CT have a significant impact on patient prognosis.

• The identification of the primary tumor has no significant impact on overall patient survival.

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Abbreviations

18F-FDG:

18F-fluoro-2-deoxyglucose

68Ga:

68Gallium

CT:

Computed tomography

CUP:

Cancer of unknown primary

MBq:

Megabecquerel

MRI:

Magnetic resonance imaging

NOPR:

National Oncologic PET Registry

PET:

Positron emission tomography

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str.3, 72076, Tuebingen, Germany

    Christian Philipp Reinert, Julia Sekler, Christina Pfannenberg & Sergios Gatidis

  2. Department of Radiology, Nuclear Medicine, University Hospital Tuebingen, Hoppe-Seyler-Str.3, 72076, Tuebingen, Germany

    Christian la Fougère

Authors
  1. Christian Philipp Reinert
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  2. Julia Sekler
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  3. Christian la Fougère
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  4. Christina Pfannenberg
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  5. Sergios Gatidis
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Correspondence to Christian Philipp Reinert.

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Guarantor

The scientific guarantor of this publication is Dr. Christian Philipp Reinert.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• Prospective

• Diagnostic or prognostic study

• Performed at one institution

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Reinert, C.P., Sekler, J., la Fougère, C. et al. Impact of PET/CT on clinical management in patients with cancer of unknown primary—a PET/CT registry study. Eur Radiol 30, 1325–1333 (2020). https://doi.org/10.1007/s00330-019-06518-9

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  • DOI: https://doi.org/10.1007/s00330-019-06518-9

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