Clapper, Patti, Schweizer and Mason

Malignant Pleural Mesothelioma (MPM) is notoriously difficult to treat—usually requiring radical surgery, extensive chemotherapy, and radiation treatments.  However, even these cannot stop the disease.  Mesothelioma is invariably fatal and all doctors and patients can hope for is to delay the progress of the cancer for as long as possible while maintaining as high quality a life as possible. 

PET-CT scans have been invaluable in spotting mesothelioma tumors during diagnosis and according to the results of 2008 study from the Departments of Thoracic Surgery, Radiology, Oncology, and Pathology, at both Guys and St Thomas' Hospital in London, they remain invaluable during and after mesothelioma treatments. 

The researchers began by noting that “Integrated 18-FDG-PET-CT combines anatomic and metabolic information in a single imaging procedure and has been shown to be a reliable tool in the staging and assessment of patients with MPM who are candidates for radical treatment.”

The researchers examined data collected from patients who underwent some form of multimodal treatment for mesothelioma—either P/D (Pleurectomy/Decortication) or EPP(Extra Pleural Pneumonectomy) treatments.  Specifically, the subjects either underwent chemotherapy in conjunction with extrapleural pneumonectomy(a radical form of surgery during which the entire lung is removed along with portions of the diaphragm and possibly some membrane around the heart) or radiation therapy in combination with pleurectomy/decortication (a less-invasive form of surgery where the membrane surrounding the lung is removed but the organ is left intact).

They followed the results of these patients after surgery and discovered that 18-fluorodeoxyglucose positron emission tomography-computed tomography (18-FDG-PET-CT) testing spotted disease recurrence after surgery more often than not.  In fact, the scans even spotted mesothelioma tumors in patients whom doctors had not suspected were once more in danger. 

Of the 44 patients the study examined, 21 underwent EEP while 23 underwent P/D treatments.  Twenty-five of these patients had PET-CT scans performed after their multimodality therapy.  Of that group of 25, only 11 were suspected as having recurrences of mesothelioma tumors at the time.  The PET-CT scan correctly identified recurrence in 8 patients and missed microscopic reappearance in 1.

In addition, Surveillance PET-CT scans were given to the remaining 14 patients 11 months on average after treatment.  None of these patients were suspected of carrying mesothelioma tumors at the time they underwent the scans.  However, analysis of the results caught previously unsuspected and undiagnosed mesothelioma recurrence in 4 of those patients.

While the PET-CT scans were not perfect, the errors in diagnosis may be attributable to the individual scan reader’s inability to spot the recurrence rather than a failure in the test. 

Regardless the specific results, it’s clear that PET-CT scans remain tremendously helpful in the fight against mesothelioma both in the diagnosis stage and in post-surgical follow-ups. 

Other more recent research shows that PET and CT scans along with laparoscopic exploration can be invaluable in planning a course of treatment for mesothelioma patients.  By knowing the exact extent and location of the disease, doctors can then discuss the various treatment options with the patient and find the best method for each individual mesothelioma victim.

Source:

http://journals.lww.com/jto/Fulltext/2010/03000/Role_of_Integrated_18_Fluorodeoxyglucose_Position.18.aspx