Predictive Value of 18 F-FDG PET in Patients with Advanced Medullary Thyroid Carcinoma Treated with Vandetanib.

Autor: Werner RA; Department of Nuclear Medicine, University Hospital, University of Würzburg, Würzburg, Germany.; Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland., Schmid JS; Department of Nuclear Medicine, University Hospital, University of Würzburg, Würzburg, Germany., Higuchi T; Department of Nuclear Medicine, University Hospital, University of Würzburg, Würzburg, Germany.; Department of Bio-Medical Imaging, National Cardiovascular and Cerebral Research Center, Osaka, Japan., Javadi MS; Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland., Rowe SP; Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland., Märkl B; Institute for Pathology, Hospital Augsburg, Augsburg, Germany., Aulmann C; Medical Department II, Hospital Augsburg, Augsburg, Germany., Fassnacht M; Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany.; Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany., Kroiss M; Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany.; Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany., Reiners C; Department of Nuclear Medicine, University Hospital, University of Würzburg, Würzburg, Germany., Buck AK; Department of Nuclear Medicine, University Hospital, University of Würzburg, Würzburg, Germany., Kreissl MC; Department of Nuclear Medicine, Hospital Augsburg, Augsburg, Germany; and.; Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany., Lapa C; Department of Nuclear Medicine, University Hospital, University of Würzburg, Würzburg, Germany lapa_c@ukw.de.
Jazyk: angličtina
Zdroj: Journal of nuclear medicine : official publication, Society of Nuclear Medicine [J Nucl Med] 2018 May; Vol. 59 (5), pp. 756-761. Date of Electronic Publication: 2017 Oct 12.
DOI: 10.2967/jnumed.117.199778
Abstrakt: Therapeutic options in advanced medullary thyroid carcinoma (MTC) have markedly improved since the introduction of tyrosine kinase inhibitors (TKIs). We aimed to assess the role of metabolic imaging using 18 F-FDG PET/CT shortly before and 3 mo after initiation of TKI treatment. Methods: Eighteen patients with advanced and progressive MTC scheduled for vandetanib treatment underwent baseline 18 F-FDG PET/CT before and 3 mo after TKI treatment initiation. During follow-up, CT scans were obtained every 3 mo and analyzed according to RECIST. The predictive value for estimating progression-free survival (PFS) and overall survival (OS) was examined by investigating the 18 F-FDG SUV mean/max of the metabolically most active lesion, as well as by analyzing clinical parameters (tumor marker doubling times [calcitonin, carcinoembryonic antigen], prior therapies, rearranged-during-transfection mutational status, and disease type). Results: Within a median follow-up of 5.2 y, 9 patients experienced disease progression after a median interval of 2.1 y, whereas the remainder had ongoing disease control (5 with a partial response and 4 with stable disease). Eight of the 9 patients with progressive disease died from MTC after a median of 3.5 y after TKI initiation. A pretherapeutic SUV mean of more than 4.0 predicted a significantly shorter PFS (1.9 y vs. 5.2 y, P = 0.04). Furthermore, sustained high 18 F-FDG uptake at 3 mo with a SUV mean of more than 2.8 tended to portend an unfavorable prognosis, with a PFS of 1.9 y (vs. 3.5 y, P = 0.3). Prolonged carcinoembryonic antigen doubling times were significantly correlated with longer PFS ( r = 0.7) and OS ( r = 0.76, P < 0.01). None of the other clinical parameters had prognostic significance. Conclusion: Pretherapeutic 18 F-FDG PET/CT provides prognostic information in patients with advanced MTC scheduled for treatment with the TKI vandetanib. A low tumor metabolism with an SUV mean of less than 4.0 before treatment predicts a longer PFS.
(© 2018 by the Society of Nuclear Medicine and Molecular Imaging.)
Databáze: MEDLINE
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