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Journal of Nuclear Medicine Vol. 48 No. 3 367-372
© 2007 by Society of Nuclear Medicine

Clinical Investigation

18F-Fluorodeoxythymidine PET for Evaluating the Response to Hyperthermic Isolated Limb Perfusion for Locally Advanced Soft-Tissue Sarcomas

Lukas B. Been1,2, Albert J.H. Suurmeijer3, Philip H. Elsinga1, Pieter L. Jager1, Robert J. van Ginkel2 and Harald J. Hoekstra2

1 Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; 2 Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and 3 Department of Pathology and Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

Correspondence: For correspondence contact: Harald J. Hoekstra, MD, PhD, Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, Groningen, The Netherlands. E-mail: h.j.hoekstra{at}chir.umcg.nl

Locally advanced soft-tissue sarcomas of an extremity can be treated either by amputation of the limb or by hyperthermic isolated limb perfusion (HILP) followed by resection of the tumor. In this study, the response to HILP was measured by PET with 18F-fluorodeoxythymidine (18F-FLT). Methods: Ten patients with primary nonresectable soft-tissue sarcomas of an extremity underwent HILP with tumor necrosis factor-{alpha} and melphalan. Before and after HILP, all patients underwent PET with 18F-FLT for response evaluation. Results: Before HILP, all tumors were clearly visible on 18F-FLT PET; for the maximum standardized uptake value (SUVmax), the mean was 3.5 (range, 1.0–6.7), and for the mean standardized uptake value (SUVmean), the mean was 1.9 (range, 0.7–2.7). After HILP, all but 1 tumor showed necrosis ranging from 10% to 95%. 18F-FLT PET after HILP revealed significantly decreased uptake of the tracer. The mean SUVmax decreased to 1.7 (P = 0.008), and the mean SUVmean decreased to 0.8 (P = 0.002). One small axillary lymph node metastasis was not visible on 18F-FLT PET. Conclusion: 18F-FLT PET revealed high uptake in soft-tissue sarcomas. 18F-FLT uptake was correlated with the mitotic index of the tumors (r = 0.82 and P = 0.004 for SUVmax; r = 0.87 and P = 0.001 for SUVmean). After HILP, the uptake of 18F-FLT decreased significantly (P = 0.008 and P = 0.002 for SUVmax and SUVmean, respectively). Tumors with initially high 18F-FLT uptake showed a better response to HILP (r = 0.64, P < 0.05). Software fusion of PET images with images from conventional imaging modalities revealed the heterogeneity of the tumors before and after HILP. Such data can help a surgeon in planning the resection of a tumor.

Key Words: 18F-FLT PET • soft-tissue sarcomas • hyperthermic isolated limb perfusion

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.


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