Comparison of the Impact of 68Ga-DOTATATE and 18F-FDG PET/CT on Clinical Management in Patients with Neuroendocrine Tumors
| Autor: | Sofia Michopoulou, Christos Toumpanakis, Martyn Caplin, Alshaima Alshammari, Emmanouil Maragkoudakis, Emmanouil Panagiotidis, Evangelia Skoura, Keval Naik, Jamshed Bomanji, Maria Belda, Mohammed Al-Harbi, Mullan Mohmaduvesh |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Pathology Proliferation index medicine.medical_treatment Neuroendocrine tumors Gastroenterology Sensitivity and Specificity 030218 nuclear medicine & medical imaging Metastasis 03 medical and health sciences 0302 clinical medicine Fluorodeoxyglucose F18 Internal medicine Positron Emission Tomography Computed Tomography medicine Organometallic Compounds Prevalence Humans Radiology Nuclear Medicine and imaging Aged Retrospective Studies Aged 80 and over Chemotherapy biology business.industry Bone metastasis Chromogranin A Reproducibility of Results Retrospective cohort study Middle Aged medicine.disease Prognosis United Kingdom Patient Care Management Neuroendocrine Tumors Treatment Outcome 030220 oncology & carcinogenesis Radionuclide therapy biology.protein Female Radiopharmaceuticals business |
| Zdroj: | Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 58(1) |
| ISSN: | 1535-5667 |
| Popis: | This study aimed to assess the clinical impact of 68Ga-DOTATATE and 18F-FDG with respect to the management plan and to evaluate the prognostic value of both tracers. Methods: A total of 104 patients (55 male and 49 female; median age, 58 y; range, 20–90 y) with histologically proven neuroendocrine tumors (NETs) underwent both 68Ga-DOTATATE and 18F-FDG PET/CT. Twenty-eight patients (26.9%) had poorly differentiated tumors, and 76 (73.1%) had well-differentiated tumors. PET/CT results and SUVs were compared with prognostic factors such as histologic grade (G1, G2, or G3, for low-grade [well differentiated], intermediate-grade [moderately differentiated], and high-grade [poorly differentiated], respectively), chromogranin A, and proliferation index (Ki-67). Results: The 68Ga-DOTATATE and 18F-FDG PET/CT findings were discordant in 65 patients (62.5%) and concordant in 39 patients (37.5%). The results changed the therapeutic plan in 84 patients (80.8%). In 22 patients (21.1%), decision making was based on the 18F-FDG findings; in 32 (30.8%), on the findings with both radiotracers; and in 50 (48.1%), on the 68Ga-DOTATATE findings. The most frequent management decision based on 18F-FDG was initiation of chemotherapy (10 patients, 47.6%). The most common treatment decision due to 68Ga-DOTATATE was initiation of peptide receptor radionuclide therapy (14 patients, 27.4%). In 11 (39.2%) of 28 patients with poorly differentiated NETs, the management decision was based on only the 18F-FDG results. For 68Ga-DOTATATE, SUVmax was higher for G1 tumors and lower for G3 tumors (P = 0.012). However, no significant differences in 18F-FDG-derived SUVs were observed between different grades (P = 0.38). The Mann–Whitney test showed significant differences in 68Ga-DOTATATE SUVmax between tumors with a Ki-67 of less than 5% and tumors with a Ki-67 of more than 5% (P = 0.004), without significance differences in 18F-FDG SUVmax. Log-rank analysis showed statistically significant differences in survival for patients with bone metastasis versus soft-tissue or no metastasis for both 18F-FDG (P = 0.037) and 68Ga-DOTATATE (P = 0.047). Overall survival declined rapidly with increasing grade (P = 0.001), at an estimated 91 mo for G1, 59 mo for G2, and 48 mo for G3. Conclusion:18F-FDG PET/CT had no clinical impact on G1 NETs and a moderate impact on G2 NETs. However, in poorly differentiated NETs, 18F-FDG PET/CT plays a significant clinical role in combination with 68Ga-DOTATATE. 68Ga DOTATATE SUVmax relates to grade and Ki-67 and can be used prognostically. |
| Databáze: | OpenAIRE |
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