Utilidad de la PET con FDG en el estudio de estadificación inicial, recurrencia y respuesta al tratamiento con imatinib (Glivec) en pacientes diagnosticados de un tumor del estroma gastrointestinal

Abstract

Gastrointestinal stromal tumors (GISTs) account for almost 4 % of all gastrointestinal neoplasms. Recently, a new type of tyrosine kinase inhibitor (Glivec), has been successfully used in patients with metastasic or unresectable disease. The aim of the study is to show the utility of PET in the staging, recurrence and treatment response to Glivec in GIST tumors. 48 whole body FDG-PET studies in 27 patients with GIST (19 men/mean age = 56 y) were evaluated for initial staging (n = 13), recurrence (n = 15) or treatment response to Glivec (n = 20). Images were acquired in a whole body 2D mode using attenuation correction on an Advance Nxi G.E.MS camera and were evaluated visually and quantatively using SUV analysis. Results were compared with radiological findings, hystological confirmation or follow-up. In the initial staging evaluation, FDG-PET shows a more extensive disease than suspected in 3/10 patients. In other 3 patients PET ruled out mesenteric or peritoneal disease. In the evaluation of treatment response to Glivec, FDG-PET showed a good response in eleven patients (complete response in seven and partial response in four). In this group a sixty percent decrease of the SUV max was assessed. Two patients showed no response to Glivec at doses of 400 mg or 800 mg, showing a stable SUV value and/or increased in some abdominal lesions. PET detected recurrence in one patient. This study show how FDG-PET is accurate in the early treatment response to Glivec. PET could be helpful in the staging and recurrence of GIST tumors.