CME Sessions at EANM’06

EANM’06 – CME Session XII

Oncology
October 4, 2006, 08:00 – 09:30
Value of nuclear medicine modalities in detecting cancer of unknown origin (CUP)

Moderator: E. Bombardieri (Milano)
Co-Moderator: G. Bisi (Torino)


Speakers:
extended
abstract
E. Bombardieri (Milano):
The clinical problem of cancer of unknown origin
G. Bisi (Torino):
Does PET/CT change the approaches and decline the frequency of CUP?
S. Fanti (Bologna):
Detection of cancer of unknown origin by means of SPECT and PET tracers


Educational objectives:

Metastatic cancer of unknown primary origin is a clinical entity that oncologists have to face, since it accounts for 2-3% of all malignant neoplasms. CUP represents a heterogeneous group of malignancies that share a unique clinical behaviour. The detection of the primary and its histological diagnosis is essential for a successful therapy and this heavily affects the prognosis and the management of the patients. The diagnostic problem involves the oncologists, the pathologists, the specialists in diagnostic imaging. Extensive work-up with specific pathology investigations and modern imaging technology have resulted in some improvements in the diagnosis. At present nuclear medicine plays a relevant role in this disease, especially positron emission tomography (PET) scanning is being increasingly used for the localization of CUP, particularly when other imaging modalities have failed, although its precise role remains to be defined.

The goals of this session are:

  • to define the clinical aspects of CUP by describing the biology, the most frequent tumour types, the epidemiology, the current diagnostic approaches, the strategies of treatment and the prognostic and predictive factors;
  • to learn the therapeutic strategies for CUP patients;
  • to examine the most relevant diagnostic imaging tools for studying CUP comparing the advantages and disadvantages of nuclear medicine modalities versus non nuclear medicine modalities;
  • to stress the role of PET and PET/CT in evaluating patients with CUP, with particular attention to those patients with head and neck localizations, brain metastases, lung metastases, involvement of lymphatic system, etc.;
  • to discuss the diagnostic specificity of PET and SPECT radiopharmaceuticals according to their ability to provide information about tumour type and characteristics;
  • to try to define the position of nuclear medicine modalities in presence of a CUP.


References:

Pavlidis N, Briasoulis E., Hinsworth J, Greco F.A. Diagnostic and therapeutic management of cancer of an unknown primary Eur J Cancer, 2003; 39: 1990-2005
Levi F. Te VC, Erler G, Randibimbison L., la Vecchia C. Epidemiology of unknown primary tumors Eur J Cancer, 2002; 38: 1810-1812
Bohuslavizki KH, Klutmann S. Kroger S FDG PET detection of unknown primary tumours J Nucl Med, 2000; 41: 816-822
Lonneaux M, Reffad A, Metastases from unknown primary tumor. PET-FDG as initial diagnostic provcedure ? Clin Positron Imag 2000; 3: 137-141
Lenzi R, Kim EE, Raber MN, Abbruzzese JL Detection of primary breast cancer presenting as metastatic carcinoma of unknown primary origin by 111In-pentetreotide scan Ann Oncol 1998; 9: 213-216
Rusthoven KE, Koshy M, Paulino AC, The role of FDG-PET in cervical lymph node metastases from an unknowm primary tumor, Cancer 2004; 101:2641-2649
Jeong H.H., Chung JK, Kim YK, Kim CY, Kim Dg, Jeong JM, Lee DS, Jung HW, Lee MC Usefulness of WB 18F-FDG PET in Patients with suspected metastatic brain tumors J Nucl Med 2002; 42: 1432-1437

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