Mesothelioma Patients Benefit From CT-PET Scan by yaofenjin


									Mesothelioma Patients Benefit From CT-PET Scan

A combination computed tomography-positron emission tomography (CT-PET)
scan is more accurate than either CT scan or magnetic resonance imaging (MRI)
at staging mesothelioma, preventing many patients with late-stage cancer from
having to undergo invasive surgery, according to a recent study in Clinical Lung

A common mesothelioma treatment for earlier stage disease combines
chemotherapy, radiation, and extrapleural pneumonectomy (EPP)—a surgery
that removes the entire lung, heart lining (pericardium), and diaphragm. Though it
is effective at removing cancer cells, EPP is major surgery. Approximately 5% of
patients die from the surgery, and many more develop serious complications
such as bleeding, respiratory failure, and blood clots. Because of these risks, it is
important to determine which patients are the most appropriate candidates
before putting them through an EPP procedure. Anyone whose cancer has
spread to stage four is not likely to be cured by surgery.

CT and MRI scans are used to stage mesothelioma patients, but research shows
they are not very accurate at determining how far mesothelioma has spread. As
a result, 25% of patients undergo invasive surgery for cancer that cannot be
removed surgically.

A few studies have suggested that the combination CT-PET scan is a more
accurate way to stage mesothelioma than either CT or MRI. To evaluate whether
this test is of value to patients who are deciding whether to undergo EPP,
researchers at the Mayo Clinic retrospectively reviewed the cases of 35
mesothelioma patients who were staged with CT-PET scans. The patients were
divided into two groups: those who underwent EPP, and those who were
excluded from surgery based on CT-PET scan results.

When the researchers evaluated the scan results, the CT scans showed that four
out of 35 patients were at an advanced stage. Yet the CT-PET scan results
demonstrated that 16 out of the 35 patients had an advanced stage of cancer.
“The CT-PET scan automatically moved a third of patients into a higher stage of
disease,” says study author James R. Jett, MD, Professor of Medicine and
Consultant in Pulmonary Medicine and Medical Oncology at the Mayo Clinic. As
a result of the CT-PET test results, an additional 11 patients were ruled out for
consideration of EPP. “CT-PET saves those people the risk of surgery, the

               Generated on 7/21/2011 12:20:01 PM, by iNews Publisher,
morbidity [complications] of surgery, and the cost,” he says.

Dr. Jett and his colleagues discovered that excluding patients from surgery
based on their CT-PET scan results did not impact their survival odds. In the
group that had surgery, mortality was 80%, compared to 79% in the group that
was excluded from surgery.

Additional, larger studies are needed to confirm the role of CT-PET scans in
staging mesothelioma.  However, this test has quickly become the
standard pre-surgical diagnostic and staging technique at large cancer centers
around the country. “In my opinion, I don’t think a patient should undergo surgery
without a PET-CT,” Dr. Jett says. “I think it’s going to mean that a lot of folks are
saved the operation, because the operation doesn’t have the chance to cure
them if they’re found to have a higher stage. It’s also likely to improve the
outcome for those who do have surgery, because you’re more sure of their stage
of disease.”


Source:Wilcox BE, Subramaniam RM, Peller PJ, Aughenbaugh GL, Nichols FC,
Aubry MC, Jett Jr. Utility of integrated computed tomography-positron emission
tomography for selection of operable malignant pleural mesothelioma. Clinical
Lung Cancer. 2009;10:244-248.

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