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The value of 18F-FDG PET/CT in the management of malignant peripheral nerve sheath tumors

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Abstract

Purpose

Our objective was to determine how positron emission tomography (PET)/CT had been used in the clinical treatment of malignant peripheral nerve sheath tumor (MPNST) patients at The University of Texas MD Anderson Cancer Center.

Methods

We reviewed a database of MPNST patients referred to MD Anderson Cancer Center during 1995–2011. We enrolled 47 patients who underwent PET/CT imaging. Disease stage was based on conventional imaging and PET/CT findings using National Comprehensive Cancer Network (NCCN) guidelines. Treatment strategies based on PET/CT and conventional imaging were determined by chart review. The maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), change in SUVmax, change in MTV, and change in TLG were calculated from the PET/CT studies before and after treatment. Response prediction was based on imaging studies performed before and after therapy and categorized as positive or negative for residual tumor. Clinical outcome was determined from chart review.

Results

PET/CT was performed for staging in 16 patients, for restaging in 29 patients, and for surveillance in 2 patients. Of the patients, 88 % were correctly staged with PET/CT, whereas 75 % were correctly staged with conventional imaging. The sensitivity to detect local recurrence and distant metastasis at restaging was 100 and 100 % for PET/CT compared to 86 and 83 % for conventional imaging, respectively. PET/CT findings resulted in treatment changes in 31 % (5/16) and 14 % (4/29) of patients at staging and restaging, respectively. Recurrence, MTV, and TLG were prognostic factors for survival, whereas SUVmax and SUVmean were not predictive. For 21 patients who had imaging studies performed both before and after treatment, PET/CT was better at predicting outcome (overall survival, progression-free survival) than conventional imaging. A decreasing SUVmax ≥ 30 % and decrease in TLG and MTV were significant predictors for overall and progression-free survival.

Conclusion

PET/CT is valuable in MPNST management because of its high accuracy in staging and high sensitivity and accuracy in restaging as well as improvements in treatment planning. MTV from baseline staging studies is predictive of survival. Additionally, change in SUVmax, TLG, and MTV accurately predicted outcomes after treatment.

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Acknowledgments

We thank Treva Greer, Nancy M. Swanson, Richelle D. Millican, and Dr. Pan Tinsu for providing help with data transfer and image acquisition. This article was edited by Luanne Jorewicz in the Department of Scientific publications at The University of Texas MD Anderson Cancer Center.

Conflicts of interest

This work was supported in part by the National Cancer Institute through Cancer Center Support Grant (P30 CA016672), the MD Anderson Cancer Center James E. Anderson Distinguished Professorship. Dr. Hubert H. Chuang is a collaborator on a clinical trial sponsored by Spectrum Pharmaceuticals. The other authors have no other potential conflicts of interest relevant to this article. This work was presented in part at the Society of Nuclear Medicine and Molecular Imaging Annual Meeting, Vancouver, Canada, between 8 and 12 June 2013.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1483,1515 Holcombe Blvd., Houston, TX, 77230-1402, USA

    Benjapa Khiewvan, Homer A. Macapinlac & Hubert H. Chuang

  2. Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road Siriraj Bangkoknoi, Bangkok, 10700, Thailand

    Benjapa Khiewvan

  3. Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Unit 0085, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Dina Lev & Ghadah Al Sannaa

  4. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Unit 0442, 1400 Holcombe Blvd., Houston, TX, 77030, USA

    Ian E. McCutcheon

  5. Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Unit 0431, 1400 Holcombe Blvd., Houston, TX, 77030, USA

    John M. Slopis

  6. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Unit 1411, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Wei Wei

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  1. Benjapa Khiewvan
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Correspondence to Hubert H. Chuang.

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Khiewvan, B., Macapinlac, H.A., Lev, D. et al. The value of 18F-FDG PET/CT in the management of malignant peripheral nerve sheath tumors. Eur J Nucl Med Mol Imaging 41, 1756–1766 (2014). https://doi.org/10.1007/s00259-014-2756-0

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  • DOI: https://doi.org/10.1007/s00259-014-2756-0

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