Şeyda TÜRKÖLMEZ, Nilüfer Yıldırım POYRAZ, Didem Şener DEDE, Zuhal KANDEMİR, Mutlay KESKİN, Elif ÖZDEMİR

Kutanoz malign melanomda hastalığın yaygınlığını belirlemede ve tedavi seciminde 18-F FDG PET/BT'nin katkısı

Amaç: Kutanoz malign melanom (KMM) beklenmedik yerlere metastaz yapabilen, mortalite oranı yüksek bir deri kanseridir. Hastalığın yaygınlığının doğru şekilde belirlenmesi tedavi seçimini etkiler. Bu retrospektif çalışmada orta- yüksek riskli KMMli hastalarda hastalığın yaygınlığını belirlemede ve tedavi seçiminde 18F-florodeoksiglukoz pozitron emisyon tomografisi/bilgisayarlı tomografi (18-F FDG PET/BT)nin geleneksel tanısal yöntemlere katkısını araştırdık. Yöntemler: Bu amaçla orta-yüksek riskli olan (evre II, III), klinik/radyolojik olarak metastaz şüphesi bulunan 41 KMMli hastanın (23 E, 18K, ortalama yaş: 52) gerçek tüm vücut (verteksten topuğa kadar) PET/BT taraması sonuçları diğer tanısal yöntemler ile karşılaştırıldı ve tedavi secimi takip edildi. tüm hastalara eksizyonel biyopsi yapılmış, histopatolojik olarak KMM tanısı konulmuş ve hastaların primer lezyonu çıkarılmıştı. Bulgular: Yedi hastada PET/BT taraması ile uzak metastaz ekarte edildi. Yirmi beş hastada diğer görüntüleme yöntemlerinde saptanmayan ek lezyonlar PET/BT ile saptandı, 9 hastada ise diğer görüntüleme yöntemleri ile saptanan lezyonlar dışında ek bulgu gözlenmedi. Böylece toplam 32 hastada (%78) hastalığın yaygınlığını belirlemede, 24 hastada (%59) tedavi seçiminde -7 hastanın ek tedaviye ihtiyaç duymadan takip edilmesi, 4 hastaya ek cerrahi operasyon planlanması, 2 hastada ek cerrahi sonrasında kemoterapi (KT) planlanması ve 11 hastada cerrahi iptal edilerek KT/radyoterapi (RT) uygulanması- PET/BTnin diğer tanısal yöntemlere katkısı olduğu saptandı. Sonuç: FDG PET-BT KMM hastalarında evreleme ve tedavi seçiminde değerli bir metoddur. (Gazi Med J 2012; 23: 62-5)

The contribution of 18-F FDG PET /CT in assessment of the extent of disease and management strategy in cutaneous malignant melanoma

Objective: Cutaneous malignant melanoma (CMM) is a skin cancer with high mortality and can metatasize to unexpected sites. Accurate assessment of the extent of metastatic disease affects the management strategy. In this retrospective study, we investigated the contribution of PET /CT to conventional diagnostic studies in assessment of the extent of disease and management strategy in intermediate-high risk CMM patients. Methods: We compared true whole body (from vertex to feet) PET/CT scanning results of 41 CMM patients (23 M, 18 F, mean age: 52 years) with the results of other diagnostic studies . All of the patients had intermediate-high risk (stage II,III) CMM with clinical-radiological suspicion of metastasis. In all patients, the histopathological CMM diagnosis was confirmed by excisional biopsy, and the primary lesions were removed. Results: In 7 of the patients, distant metastases were ruled out by PET/CT scanning. In 25 patients, additional lesions which could not be detected by other imaging techniques were reported by PET/CT. In 9 patients, PET/CT results correlated with the findings in previous imaging studies in respect to the metastatic sites. In a total of 32 patients (78%) PET/CT contributed to staging and led to treatment changes in 24 patients (59%); in 11 patients the planned operative procedure was cancelled and chemotherapy/radiation therapy was planned, in 4 patients an additional operation was performed, chemotherapy after surgery was planned in 2 patients and followed-up without any therapy in 7 patients. Conclusion: It was concluded that FDG PET/CT is a valuable tool in staging and therapeutic management of CMM patients. (Gazi Med J 2012; 23: 62-5)

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