indications de la tep au 18f-fdg en oncologie

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INDICATIONS DE LA TEP AU 18F-FDG EN ONCOLOGIE:
MISE À JOUR 2015 SELON LES RECOMMANDATIONS DE PRISE EN CHARGE EUROPEENNES
(ESMO) ET AMERICAINES (NCCN) PAR TYPE DE CANCER.
EVALUATION D’UNE SERIE CONSECUTIVE DES INDICATIONS DE 400 EXAMENS TEP À
L’INSTITUT BERGONIE, CENTRE DE LUTTE CONTRE LE CANCER D’AQUITAINE.
Mémoire de DES de médecine Nucléaire septembre 2015
Isabelle GALINIER
Directrice du mémoire Dr Anne-laure Cazeau
Interne de Médecine Nucléaire Région Aquitaine

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TABLE DES MATIERES
I. INTRODUCTION ........................................................................................................................................................... 7
II. MATERIELS ET METHODES ...................................................................................................................................... 8
R EALISATION DES RECOMMANDATIONS ESMO ........................................................................................................................ 8 A.
R EALISATION DES RECOMMANDATIONS NCCN ........................................................................................................................ 9 B.
III. REVUE DES INDICATIONS DE LA TEP-FDG EN ONCOLOGIE ....................................................................... 10
H EMATOLOGIE .............................................................................................................................................................................. 10 A.
1. Maladie de Hodgkin ................................................................................................................................................................. 10
a) Indications ESMO 2014 ............................................................................................................................................................................. 10
b) Indications NCCN 2015 ............................................................................................................................................................................. 10
c) Remarques ....................................................................................................................................................................................................... 11
2. Lymphomes non hodgkiniens .............................................................................................................................................. 11
a) Lymphomes B ................................................................................................................................................................................................. 12
(i) Lymphome B diffus à grandes cellules (LBDGC) .................................................................................................................... 12
(a) Indications ESMO 2015 ........................................................................................................................................................... 12
(b) Indications NCCN 2015 ........................................................................................................................................................... 12
(c) Remarques .................................................................................................................................................................................... 13
(ii) Lymphome folliculaire ....................................................................................................................................................................... 13
(a) Indications ESMO 2014 ........................................................................................................................................................... 13
(b) Indications NCCN 2015 ........................................................................................................................................................... 14
(c) Remarques .................................................................................................................................................................................... 14
(iii) Leucémie lymphoïde chronique................................................................................................................................................... 14
(a) Indications ESMO 2015 ........................................................................................................................................................... 14
(b) Indications NCCN 2015 ........................................................................................................................................................... 14
(iv) Lymphome de la zone marginale dont le lymphome de type MALT .......................................................................... 14
(a) Indications ESMO 2013 ........................................................................................................................................................... 14
(b) Indications NCCN 2015 ........................................................................................................................................................... 14
(c) Remarques .................................................................................................................................................................................... 14
(v) Lymphome du manteau ..................................................................................................................................................................... 15
(a) Indications ESMO 2014 ........................................................................................................................................................... 15
(b) Indications NCCN 2015 ........................................................................................................................................................... 15
(c) Remarques .................................................................................................................................................................................... 15
(vi) Maladie de Waldenström ................................................................................................................................................................. 15
Indications ESMO 2013........................................................................................................................................................................ 15
(vii) Lymphome de Burkitt ...................................................................................................................................................................... 15
Indications NCCN 2015 .................................................................................................................................................................. 15
b) Lymphomes T ................................................................................................................................................................................................ 15
(i) Formes leucémiques ............................................................................................................................................................................. 15
(a) Lymphome/leucémie à cellule T de l’adulte ................................................................................................................. 15
Indications NCCN 2015 .................................................................................................................................................................. 15
(b) Leucémie prolymphocytaire à cellules T ........................................................................................................................ 15
Indications NCCN 2015 .................................................................................................................................................................. 15
(ii) Formes ganglionnaires et formes extra-ganglionnaires .................................................................................................... 16
(a) Lymphome T périphérique ................................................................................................................................................... 16
(i) Indications ESMO 2015 ...................................................................................................................................................... 16
(ii) Indications NCCN 2015 ..................................................................................................................................................... 16
(iii) Remarques ............................................................................................................................................................................. 16
c) Désordres lymphoprolifératifs post-transplantation ................................................................................................................. 16
Indications NCCN 2015 ............................................................................................................................................................................. 16
d) Maladie de Castelman ................................................................................................................................................................................ 16
Indications NCCN 2015 ............................................................................................................................................................................. 16
e) Lymphome cutané primitif ...................................................................................................................................................................... 16
(i) Indications ESMO 2013 ....................................................................................................................................................................... 16
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 17
(iii) Remarques .............................................................................................................................................................................................. 17
3. Myélome ....................................................................................................................................................................................... 17
Indications NCCN 2015 ................................................................................................................................................................................... 17
C ANCERS SOLIDES ......................................................................................................................................................................... 17 B.
1. Thorax ........................................................................................................................................................................................... 17
a) Poumon ............................................................................................................................................................................................................. 17
(i) Nodule pulmonaire ............................................................................................................................................................................... 17
(a) Indications ESMO 2014/2015 ............................................................................................................................................. 17
(b) Indications NCCN 2015 ........................................................................................................................................................... 17

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(c) Remarques .................................................................................................................................................................................... 18
(ii) Cancer du poumon non à petites cellules CPNPC ................................................................................................................. 18
(a) Indications ESMO 2014/2015 ............................................................................................................................................. 18
(b) Indications NCCN 2015 ........................................................................................................................................................... 18
(c) Remarques .................................................................................................................................................................................... 19
(iii) Cancer pulmonaire à petites cellules CPPC ............................................................................................................................ 19
(a) Indications ESMO 2013 ........................................................................................................................................................... 19
(b) Indications NCCN 2015 ........................................................................................................................................................... 19
(c) Remarques .................................................................................................................................................................................... 19
(iv) Tumeurs neuroendocrines ............................................................................................................................................................. 19
(a) Indications ESMO 2012 ........................................................................................................................................................... 19
(b) Indications NCCN 2015 ........................................................................................................................................................... 19
b) Mésothéliome ................................................................................................................................................................................................. 20
(i) Indications ESMO 2015 ....................................................................................................................................................................... 20
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 20
(iii) Remarques .............................................................................................................................................................................................. 20
c) Thymus .............................................................................................................................................................................................................. 20
(i) Indications ESMO 2015 ....................................................................................................................................................................... 20
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 20
2. Digestif .......................................................................................................................................................................................... 20
a) Côlon ................................................................................................................................................................................................................... 20
(i) Indications ESMO 2012 et 2013-2014........................................................................................................................................ 20
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 21
(iii) Remarques .............................................................................................................................................................................................. 21
b) Rectum .............................................................................................................................................................................................................. 21
(i) Indications ESMO 2012 et 2013 ..................................................................................................................................................... 21
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 21
(iii) Remarques .............................................................................................................................................................................................. 21
c) Œsophage ......................................................................................................................................................................................................... 22
(i) Indications ESMO 2013 ....................................................................................................................................................................... 22
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 22
(iii) Remarques .............................................................................................................................................................................................. 22
d) Estomac ............................................................................................................................................................................................................. 22
(i) Indications ESMO 2013 ....................................................................................................................................................................... 22
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 22
(iii) Remarques .............................................................................................................................................................................................. 23
e) GIST ..................................................................................................................................................................................................................... 23
(i) Indications ESMO 2014 ....................................................................................................................................................................... 23
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 23
(iii) Remarques .............................................................................................................................................................................................. 23
f) Voies biliaires .................................................................................................................................................................................................. 23
(i) Indications ESMO 2011 ....................................................................................................................................................................... 23
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 23
(iii) Remarques .............................................................................................................................................................................................. 23
g) Pancréas ............................................................................................................................................................................................................ 24
(i) Indications ESMO 2015 ....................................................................................................................................................................... 24
(ii) Indications NCCN 2015 : Adénocarcinome du pancréas ................................................................................................... 24
(iii) Remarques .............................................................................................................................................................................................. 24
h) Anus .................................................................................................................................................................................................................... 24
(i) Indications ESMO 2014 ....................................................................................................................................................................... 24
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 24
(iii) Remarques .............................................................................................................................................................................................. 24
3. Gynécologie ................................................................................................................................................................................. 24
a) Ovaire ................................................................................................................................................................................................................. 24
(i) Indications ESMO 2013 ....................................................................................................................................................................... 24
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 25
(iii) Remarques .............................................................................................................................................................................................. 25
b) Col de l’utérus ................................................................................................................................................................................................ 25
(i) Indications ESMO 2012 ....................................................................................................................................................................... 25
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 25
(iii) Remarques .............................................................................................................................................................................................. 25
c) Endomètre ....................................................................................................................................................................................................... 25
(i) Indications ESMO 2013 ....................................................................................................................................................................... 25
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 25
(iii) Remarques .............................................................................................................................................................................................. 26
d) Maladie trophoblastique gestationnelle ........................................................................................................................................... 26

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Indications ESMO 2013 ............................................................................................................................................................................. 26
4. Cancers oto-rhino-laryngologiques ................................................................................................................................... 26
a) Indications ESMO 2010 ............................................................................................................................................................................. 26
b) Indications NCCN 2015 ............................................................................................................................................................................. 26
c) Remarques ....................................................................................................................................................................................................... 27
5. Sein ................................................................................................................................................................................................. 27
a) Indications ESMO 2014/2015 ................................................................................................................................................................ 27
b) Indications NCCN 2015 ............................................................................................................................................................................. 27
c) Remarques ....................................................................................................................................................................................................... 28
6. Endocrinologie .......................................................................................................................................................................... 28
a) Cancer de la thyroïde .................................................................................................................................................................................. 28
(i) Indications ESMO 2012 ....................................................................................................................................................................... 28
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 28
(iii) Remarques .............................................................................................................................................................................................. 28
b) Tumeurs neuroendocrines (TNE) ........................................................................................................................................................ 29
(i) Indications ESMO 2012 ....................................................................................................................................................................... 29
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 29
(iii) Remarques .............................................................................................................................................................................................. 29
c) Cancers de la surrénale et paragangliomes ..................................................................................................................................... 29
(i) Indications ESMO 2012 ....................................................................................................................................................................... 29
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 29
(iii) Remarques .............................................................................................................................................................................................. 30
7. Sarcomes ...................................................................................................................................................................................... 30
a) Sarcomes osseux ........................................................................................................................................................................................... 30
(i) Indications ESMO 2014 ....................................................................................................................................................................... 30
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 30
(iii) Remarques .............................................................................................................................................................................................. 30
b) Sarcomes des tissus mous et viscéraux ............................................................................................................................................. 30
(i) Indications ESMO 2014 ....................................................................................................................................................................... 30
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 30
(iii) Remarques .............................................................................................................................................................................................. 30
8. Primitif inconnu ........................................................................................................................................................................ 31
a) Indications ESMO 2015 ............................................................................................................................................................................. 31
b) Indications NCCN 2015 ............................................................................................................................................................................. 31
9. Cutané ........................................................................................................................................................................................... 31
a) Carcinome à cellules de Merkel ............................................................................................................................................................. 31
Indications NCCN 2015 ............................................................................................................................................................................. 31
b) Mélanome ........................................................................................................................................................................................................ 31
(i) Indications ESMO 2015 ....................................................................................................................................................................... 31
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 31
(iii) Remarques .............................................................................................................................................................................................. 32
10. Système nerveux central (SNC) ........................................................................................................................................ 32
a) Indications ESMO 2014 ............................................................................................................................................................................. 32
b) Indications NCCN 2015 ............................................................................................................................................................................. 32
c) Remarques ....................................................................................................................................................................................................... 32
11. Génito-urinaire ....................................................................................................................................................................... 32
a) Verge ................................................................................................................................................................................................................... 32
(i) Indications ESMO 2013 ....................................................................................................................................................................... 32
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 32
(iii) Remarques .............................................................................................................................................................................................. 32
b) Prostate ............................................................................................................................................................................................................. 32
(i) Indications ESMO 2015 ....................................................................................................................................................................... 32
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 33
c) Testicule ............................................................................................................................................................................................................ 33
(i) Indications ESMO 2013 ....................................................................................................................................................................... 33
(ii) Indications NCCN 2015 ...................................................................................................................................................................... 33
(iii) Remarques .............................................................................................................................................................................................. 33
IV. CANCERS POUR LESQUELS LA TEP N’A PAS DE RECOMMANDATION .................................................... 33
H EPATOCARCINOMES ................................................................................................................................................................... 33 A.
R EIN ................................................................................................................................................................................................ 33 B.
V ESSIE U RETERES ......................................................................................................................................................................... 33 C.
V. EVALUATION DES INDICATIONS DE TEP AU 18F-FDG DANS UN CENTRE DE LUTTE CONTRE LE
CANCER SUR 400 EXAMENS ONCOLOGIQUES CONSECUTIFS ............................................................................ 34

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VI. CONCLUSION .............................................................................................................................................................. 38
VII. ANNEXE ........................................................................................................................................................................ 39
VIII. BIBLIOGRAPHIE .............................................................................................................................................. 40