Abstract
Purpose
To evaluate the influence of 18F-FDG PET/CT in comparison to CT alone on treatment decisions in patients with advanced melanoma and to analyse the 5-year survival data in comparison to literature data.
Methods
Therapy management in 64 consecutive patients (primary staging n = 52; surveillance n = 12) with stage III/IV melanoma who underwent 18F-FDG PET/CT between 2004 and 2005 in our department was retrospectively analysed. Treatment decisions were made by two dermatooncologists for each patient twice, first based on the CT results and then based on the PET/CT results. Therapy changes based on the PET/CT results were classified as “major” (e.g. change from metastasectomy to systemic therapy) or “minor” (e.g. change from first to second line chemotherapy). The 5-year survival data of different patient cohorts were calculated.
Results
In the 52 patients in the primary staging group, the results of 18F-FDG PET/CT led to therapy change in 59 % and a major therapy change in 52 %. 18F-FDG PET/CT led to the avoidance of futile operations in 13 patients with suspicious lesions on CT that were deemed nontumorous on PET/CT. In the 12 patients in the surveillance group, the results of 18F-FDG PET/CT led to therapy change in 33 % and a major change in 17 %. The 5-year survival rates were 30 % in the entire cohort, 34 % in the primary staging group, and 17 % in the surveillance group. A significant overall survival benefit was observed in patients in whom 18F-FDG PET/CT excluded metastases or in whom metastases could be completely removed compared with patients who were not eligible for surgery (41 % vs. 10 %).
Conclusion
Primary staging of patients with stage III/IV melanoma should be performed with 18F-FDG PET/CT, leading to higher diagnostic accuracy and enabling individualized therapeutic management, especially optimal patient selection for metastasectomy. This strategy may extend long-term survival even in patients with advanced disease.
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References
Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199–206.
Chapman PB, Hauschild A, Robert C, Haanen JB, Ascierto P, Larkin J, et al. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med. 2011;364(26):2507–16.
Hodi FS, O’Day SJ, McDermott DF, Weber RW, Sosman JA, Haanen JB, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010;363(8):711–23.
Weide B, Elsasser M, Buttner P, Pflugfelder A, Leiter U, Eigentler TK, et al. Serum markers lactate dehydrogenase and S100B predict independently disease outcome in melanoma patients with distant metastasis. Br J Cancer. 2012;107(3):422–8.
Caudle AS, Ross MI. Metastasectomy for stage IV melanoma: for whom and how much? Surg Oncol Clin N Am. 2011;20(1):133–44.
Pflugfelder A, Kochs C, Blum A, Capellaro M, Czeschik C, Dettenborn T, et al. Malignant melanoma S3-guideline “diagnosis, therapy and follow-up of melanoma”. J Dtsch Dermatol Ges. 2013;11 Suppl 6:1–116.
Kroon BB. Surgery for distant metastatic melanoma improves survival. Ann Surg Oncol. 2012;19(8):2426–7.
Tsao H, Atkins MB, Sober AJ. Management of cutaneous melanoma. N Engl J Med. 2004;351(10):998–1012.
Xing Y, Bronstein Y, Merrick I. Contemporary diagnostic imaging modalities for the staging and surveillance of melanoma patients: a meta-analysis. J Natl Cancer Inst. 2011;103:129–42.
Pfannenberg C, Aschoff P, Schanz S, Eschmann SM, Plathow C, Eigentler TK, et al. Prospective comparison of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and whole-body magnetic resonance imaging in staging of advanced malignant melanoma. Eur J Cancer. 2007;43(3):557–64.
R Development Core Team. R: a language and environment for statistical computing. 31st ed. Vienna: R Foundation for Statistical Computing; 2014.
Larkin J, Ascierto PA, Dreno B, Atkinson V, Liszkay G, Maio M, et al. Combined vemurafenib and cobimetinib in BRAF-mutated melanoma. N Engl J Med. 2014;371(20):1867–76.
Long GV, Stroyakovskiy D, Gogas H, Levchenko E, de Braud F, Larkin J, et al. Combined BRAF and MEK inhibition versus BRAF inhibition alone in melanoma. N Engl J Med. 2014;371(20):1877–88.
Flaherty KT, Robert C, Hersey P, Nathan P, Garbe C, Milhem M, et al. Improved survival with MEK inhibition in BRAF-mutated melanoma. N Engl J Med. 2012;367(2):107–14.
Robert C, Long GV, Brady B, Dutriaux C, Maio M, Mortier L, et al. Nivolumab in previously untreated melanoma without BRAF mutation. N Engl J Med. 2015;372(4):320–30.
Danielsen M, Hojgaard L, Kjaer A, Fischer BM. Positron emission tomography in the follow-up of cutaneous malignant melanoma patients: a systematic review. Am J Nucl Med Mol Imaging. 2013;4(1):17–28.
Bronstein Y, Ng CS, Rohren E, Ross MI, Lee JE, Cormier J, et al. PET/CT in the management of patients with stage IIIC and IV metastatic melanoma considered candidates for surgery: evaluation of the additive value after conventional imaging. AJR Am J Roentgenol. 2012;198(4):902–8.
Schwenzer N, Pfannenberg C. PET/CT, MR and PET/MR in lymphoma and melanoma. Semin Nucl Med. 2015;45(4):322–31.
Pfannenberg C, Schwenzer N. Whole-body staging of malignant melanoma: advantages, limitations and current importance of PET-CT, whole body MRI and PET-MRI. Radiologe. 2015;55(2):120–6.
Hausmann D, Jochum S, Utikal J, Hoffmann RC, Zechmann C, Neff KW, et al. Comparison of the diagnostic accuracy of whole-body MRI and whole-body CT in stage III/IV malignant melanoma. J Dtsch Dermatol Ges. 2011;9:212–22.
Laurent V, Trausch G, Bruot O, Olivier P, Felbinger J, Régent D. Comparative study of two whole-body imaging techniques in the case of melanoma metastases: advantages of multi-contrast MRI examination including a diffusion-weighted sequence in comparison with PET-CT. Eur J Radiol. 2010;75(3):376–83.
Dalrymple-Hay MJR, Rome PD, Kennedy C, Fullham M, Cuaghan BC. Pulmonary metastatic malanoma – the survival benefit of positron emission tomography scanning. Eur J Cardiothorac Surg. 2002;21(4):611–5.
Younes R, Abrao FC, Gross J. Pulmonary metastasectomy for malignant melanoma: prognostic factors for long-term survival. Melanoma Res. 2013;23(4):307–11.
Colman MW, Kirkwood JM, Schott T, Goodman MA, McGough 3rd RL. Does metastasectomy improve survival in skeletal melanoma? Melanoma Res. 2014;24(4):354–9.
Howard JH, Thompson JF, Mozzillo N, Nieweg OE, Hoekstra HJ, Roses DF, et al. Metastasectomy for distant metastatic melanoma: analysis of data from the first Multicenter Selective Lymphadenectomy Trial (MSLT-I). Ann Surg Oncol. 2012;19(8):2547–55.
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Susann-Cathrin Schüle and Thomas Kurt Eigentler contributed equally to this work.
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Schüle, SC., Eigentler, T.K., Garbe, C. et al. Influence of 18F-FDG PET/CT on therapy management in patients with stage III/IV malignant melanoma. Eur J Nucl Med Mol Imaging 43, 482–488 (2016). https://doi.org/10.1007/s00259-015-3187-2
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DOI: https://doi.org/10.1007/s00259-015-3187-2