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Results: SLN negative patients were found in 67.6% (277/410) of those breast cancer patients undergoing
BM aspirations simultaneously. Their BMM status was negative in 75.8% (210/277), whereas in
24.2% (67/277) BM micrometastases were identified. The median follow-up was 60 months for both
groups. The 5-year overall survival was 92.7% for the BMM negative and 92.5% for the BMM positive
group (p=0.85). The 5-year disease-free survival reached 93.6% in the BMM negative group versus
92.2% in the BMM positive group (p=0.50).
Conclusion: This is the first prospective study to examine the long-term disease-free and overall survival
in SLN negative patients in correlation to their BMM status. Although BMM are identified in one of four
SLN negative patients, they are not a prognostic factor regarding disease-free and overall survival in
SLN negative breast cancer patients.
36.2
PET-CT improves staging in patients with adenocarcinoma of the stomach and cardia
K. Lehmann, M. Schiesser, P. Bauerfeind, A. Rickenbacher, D. Schmid, A. Weber, T. Frauenfelder, T.
Hany, P.-M. Schneider (Zurich)
Objective: To prospectively assess the accuracy of PET-CT, EUS and CT in staging patients with adenocarcinoma
of the stomach and cardia. The accuracy of preoperative staging in patients with adenocarcinoma
of the stomach or esophagogastric junction (AEG) Siewert type II/III is low despite endoscopic
ultrasound (EUS) and multislice CT. PET-CT is a novel imaging modality that could improve these results.
Therefore, we prospectively assessed the accuracy of PET-CT, EUS and CT.
Methods: Fifty-two consecutive patients with adenocarcinoma of the stomach (n=30) or AEG type II/
III (n=22) were prospectively evaluated. Systematic D2-lymphadenectomy (median: 31 nodes) was
performed with individual histopathologic assessment of lymph node stations 1-12 (Japanese Gastric
Cancer Association), and additionally lymph nodes of the lower mediastinum for AEG type II/III. Preoperative
staging results from EUS, CT and PET-CT were correlated to histopathological results.
Results: PET-CT demonstrated a high specificity with a resulting positive predictive value of 100%, but
a low sensitivity for the detection of loco-regional lymph nodes (sensitivity: 37%, specificity: 100%, accuracy:
66%). Sensitivity was higher if the tumor was PET-positive (47%), and for nodes located in
compartment D2 compared to D1 (40% vs. 21%). In comparison, EUS was more sensitive (sensitivity:
80%, specificity: 63%, accuracy: 70%), and CT alone displayed similar results (sensitivity: 53%, specificity:
69%, accuracy: 60%). PET-CT however, displayed a higher accuracy for the detection of extraregional
lymph node metastases (M1LYM) and organ metastases (sensitivity: 77%, specificity: 100%,
accuracy: 94%) compared to CT alone (sensitivity: 38%, specificity: 97%, accuracy: 83%).
Conclusion: PET-CT enhances the specificity and positive predictive value for the staging of loco-regional
lymph nodes compared to EUS and CT, and is more accurate in the detection of extra-regional lymph
nodes and systemic metastases compared to CT alone. We therefore recommend the use of PET-CT for
preoperative staging of adenocarcinoma of the stomach and cardia.
36.3
Management of peritoneal carcinomatosis by hyperthermic intraperitoneal chemotherapy a 13 years
experience
F. Ris, G. Herren, Ph. Morel, F. Volonte, A. Roth, O. Huber (Geneva)
Objective: Peritoneal carcinomatosis (PC) is a common manifestation of advanced malignancies, associated
to bad prognosis. There is presently increasing interest in hyperthermic intraperitoneal chemotherapy
(HIPEC) combined with surgical cytoreduction (SC). We report here our 13 years experience
for the management of peritoneal carcinomatosis.
Methods: Retrospective study of all operative management of PC by SC-HIPEC from 1996 to 2009.
Results: During this period, 53 surgical explorations for PC were performed. Complete cytoreduction
was judged impossible in 7. Median age of the 46 resected patients (31 F, 15 M), was 52 (17-65).
Primary cancers were 32% pseudomyxomas, 24% colorectal, 22% ovarian, 17% gastric and 4% mesotheliomas.
Overall morbidity (grade I-IV) was 71%; severe morbidity (grade III-IV) 39%; reoperation
was warranted in 20% (3 anastomotic leaks, 4 perforations); perioperative mortality (D60) was 2%
(n=1); median hospital stay was 23 days (12-84). Median follow-up was 13.5 months (1-196), with
an overall survival rate of 80%. 8 patients died of disease; 37 patients are alive, from which 86.6%
(32/37) are presently without signs of recurrence.
Conclusion: these results show that, in very selected patients, SC-HIPEC has a profound impact on the
prognosis PC; in this context, the high observed morbidity appears easily acceptable; SC-HIPEC has a
very promising future in specialized centers.
36.4
Impact of 18F-FDG-PET on re-staging and prediction of tumor response of patients with locally advanced
rectal cancer
B. Kern, F. Jüngling, A. Staehelin, K. Baumann, M. O. Guenin, R. Peterli, C. Ackermann, M. von Flüe
(Basel)
Objective: Neoadjuvant chemoradiotherapy (CRT) has become a standard practice for locally advanced
rectal cancer. Complete pathologic response can be achieved in up to 20% and discussions
about a “watch-and-wait” strategy in these patients are going on. Reliable methods to detect patients
with a complete pathological response after CRT are not known. One possible method may be the 18F-
FDG-PET. The aim of this study was to evaluate the change in tumor maximum standardized uptake
value (SUVmax) before and after CRT and to correlate the change with the pathologic response.
Methods: Between 7/2005 and 11/2009 104 patients (36 females, 68 males) with locally advanced
rectal cancer were treated by preoperative CRT in a prospective study. A18F-FDG-PET scan was performed
in 97 patients before and in 99 patients 4 weeks after CRT. For each scan SUVmax was measured
in the tumor. The percentage of SUVmax decrease from starting scan to presurgical scan was
correlated with pathologic response and tumor regression grade. Surgical approach was a sphincter
saving total mesorectal excision or an abdominoperineal amputation 6 weeks after CRT.
Results: Mean tumor uptake was 11.9 ± 0.7 before and 3.6 ± 0.4 after CRT (p