Metabolic response demonstrated by 18F-FDG-PET/CT in metastatic medullary thyroid carcinoma under sorafenib therapy
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Metabolic response demonstrated by 18F-FDG-PET/CT in metastatic medullary thyroid carcinoma under sorafenib therapy I. Martı´nez-Rodrı´guez • I. Banzo • J. M. Carril
Received: 8 March 2013 / Accepted: 27 March 2013 / Published online: 7 April 2013 Ó Springer Science+Business Media New York 2013
Abstract A 51-year-old woman with a medullary thyroid carcinoma (MTC) presented with a palpable nodule in the right breast. Serum calcitonin was 1,453 pg/ml and carcinoembryonic antigen was 201 ng/ml. Cervical ultrasound and bone scintigraphy were normal. Computed tomography (CT) showed nodules in the right breast and anterior thoracic wall and a hypodense lesion in the right hepatic lobe. Histology of the breast nodule confirmed metastasis from MTC. To evaluate the metabolic activity of these lesions, 18F-fluorodeoxiglucose positron emission tomography-CT (FDG-PET/CT) scan was requested. Axial fused images revealed high FDG uptake by the breast and thoracic wall nodules and the right hepatic lobe. FDG-PET/CT also showed uptake in sacrum and right iliac bone, undetected by CT and bone scintigraphy. After seven cycles of sorafenib PET/CT became negative. Calcitonin decreased to 82.5. A PET/CT performed 6 months later remained negative. This is the first published image of the complete metabolic response of MTC to sorafenib therapy using FDG-PET/CT. Keywords 18F-FDG-PET/CT Medullary thyroid carcinoma Sorafenib Metabolic response Molecular imaging
A 51-year-old woman with a 28-year history of sporadic medullary thyroid carcinoma (MTC) presented with a
I. Martı´nez-Rodrı´guez (&) I. Banzo J. M. Carril Nuclear Medicine Department, Hospital Universitario Marque´s de Valdecilla, Universidad de Cantabria, Avda. Valdecilla, s/n, 39008 Santander, Spain e-mail: [email protected]
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palpable nodule in the right breast. Serum calcitonin was 1,453 pg/ml (normal range, 1–5 pg/ml) and serum carcinoembryonic antigen was 201 ng/ml (normal range, \10 ng/ml). Cervical ultrasound and bone scintigraphy were normal. A contrast-enhanced computed tomography (CT) showed nodules in the right breast and in the anterior thoracic wall and a hypodense lesion poorly defined in the right hepatic lobe. Histological analysis of the breast nodule confirmed metastasis from MTC. To evaluate the metabolic activity of these lesions, 18F-fluorodeoxiglucose positron emission tomography-computed tomography (FDG-PET/CT) scan was requested. Axial fused FDGPET/CT views (Fig. 1a) revealed high FDG uptake by the right breast and thoracic wall nodules (arrows) and the right hepatic lobe. In addition, FDG-PET/CT also showed FDG uptake in the sacrum and right iliac bone, undetected by CT and bone scintigraphy. Surgery was disregarded and treatment with Sorafenib, a new tyrosine kinase inhibitor, was started (400 mg/twice a day p.o.). After seven cycles (8 months), FDG-PET/CT became negative indicating a complete metabolic response (Fig. 1b). Calcitonin level decreased to 82.5 pg/ml. A FDGPET/CT performed 6 months later remained negative.
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