(18)F-FDG-PET/CT to Select Patients With Peritoneal Carcinomatosis for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Ann Surg Oncol. 2009 May;16(5):1295-303. doi: 10.1245/s10434-009-0387-7. Epub 2009 Feb 28.


Background: Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with significantly longer survival in patients with peritoneal carcinomatosis (PC). So far, no morphological imaging method has proven to accurately assess the intra-abdominal tumor spread. This study was designed to predict tumor load in patients with PC using dual-modality (18)FDG-PET/CT and to compare the results with those of PET and CT alone by correlating imaging findings with intraoperative staging.

Methods: Twenty-two patients with PC from gastrointestinal (n = 13), ovarian cancer (n = 8), and mesothelioma (n = 1) underwent contrast-enhanced (18)FDG-PET/CT before surgery and HIPEC. In a retrospective analysis PET, CT, and fused PET/CT were separately and blindly reviewed for the extent of peritoneal involvement using the Peritoneal Cancer Index (PCI). Imaging results were correlated with the intraoperative PCI using Pearson's correlation coefficient and linear regression analysis.

Results: There was a strong correlation between the PCI obtained with PET/CT and the surgical PCI with respect to the total score (r = 0.951) as well as in the regional analysis (small bowel, r = 0.838; other, r = 0.703). The correlation was slightly lower for CT alone (total score, r = 0.919; small bowel, r = 0.754; other, r = 0.666) and significantly lower (p = 0.002) for PET alone (total score, r = 0.793; small bowel, r = 0.553, other, 0.507).

Conclusions: Contrast-enhanced CT is superior compared with PET alone to predict the extent of PC. In our patient group, the combination of both modalities (contrast enhanced PET/CT) yielded the best results and proved to be a useful tool for selecting candidates for peritonectomy and HIPEC.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / administration & dosage*
  • Chemotherapy, Cancer, Regional Perfusion
  • Combined Modality Therapy
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Hyperthermia, Induced
  • Infusions, Parenteral
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Patient Selection
  • Peritoneal Neoplasms / diagnostic imaging*
  • Peritoneal Neoplasms / pathology
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Positron-Emission Tomography*
  • Predictive Value of Tests
  • Radiopharmaceuticals
  • Surgical Procedures, Operative
  • Tomography, X-Ray Computed*
  • Tumor Burden


  • Antineoplastic Agents
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18