Advertisement

European Radiology

, Volume 25, Issue 11, pp 3348–3353 | Cite as

Volume-based quantitative FDG PET/CT metrics and their association with optimal debulking and progression-free survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery

  • H. A. VargasEmail author
  • I. A. Burger
  • D. A. Goldman
  • M. Miccò
  • R. E. Sosa
  • W. Weber
  • D. S. Chi
  • H. Hricak
  • E. Sala
Urogenital

Abstract

Objective

Our aim was to evaluate the associations between quantitative 18 F-fluorodeoxyglucose positron-emission tomography (FDG-PET) uptake metrics, optimal debulking (OD) and progression-free survival (PFS) in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery.

Methods

Fifty-five patients with recurrent ovarian cancer underwent FDG-PET/CT within 90 days prior to surgery. Standardized uptake values (SUVmax), metabolically active tumour volumes (MTV), and total lesion glycolysis (TLG) were measured on PET. Exact logistic regression, Kaplan-Meier curves and the log-rank test were used to assess associations between imaging metrics, OD and PFS.

Results

MTV (p = 0.0025) and TLG (p = 0.0043) were associated with OD; however, there was no significant association between SUVmax and debulking status (p = 0.83). Patients with an MTV above 7.52 mL and/or a TLG above 35.94 g had significantly shorter PFS (p = 0.0191 for MTV and p = 0.0069 for TLG). SUVmax was not significantly related to PFS (p = 0.10). PFS estimates at 3.5 years after surgery were 0.42 for patients with an MTV ≤ 7.52 mL and 0.19 for patients with an MTV > 7.52 mL; 0.46 for patients with a TLG ≤ 35.94 g and 0.15 for patients with a TLG > 35.94 g.

Conclusion

FDG-PET metrics that reflect metabolic tumour burden are associated with optimal secondary cytoreductive surgery and progression-free survival in patients with recurrent ovarian cancer.

Key Points

• Both TLG and MTV were associated with optimal tumour debulking.

• There was no significant association between SUVmax and tumour debulking status.

• Patients with higher MTV and/or TLG had significantly shorter PFS.

SUVmax was not significantly related to PFS.

Keywords

Ovarian cancer PET/CT Imaging Recurrence Secondary cytoreduction 

Abbreviations

FDG

18 F-fluorodeoxyglucose

MTV

Metabolically active tumour volume

PET

Positron emission tomography

SUV

Standardized uptake value

TLG

Total lesion glycolysis

Notes

Acknowledgments

The scientific guarantor of this publication is Evis Sala. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This project was supported in part by NIH grant P30 CA008748. HA Vargas is supported by the Kaleidoscope of Hope Foundation. One of the authors (Debra A Goldman) has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Some study subjects or cohorts have been previously reported in: Sala, E., et al., (2010) Recurrent ovarian cancer: use of contrast-enhanced CT and PET/CT to accurately localize tumor recurrence and to predict patients' survival. Radiology 257(1):125-34. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

References

  1. 1.
    Hennessy BT, Coleman RL, Markman M (2009) Ovarian cancer. Lancet 374:1371–1382CrossRefPubMedGoogle Scholar
  2. 2.
    Piccart MJ, Bertelsen K, Stuart G et al (2003) Long-term follow-up confirms a survival advantage of the paclitaxel-cisplatin regimen over the cyclophosphamide-cisplatin combination in advanced ovarian cancer. Int J Gynecol Cancer 13(Suppl 2):144–148CrossRefPubMedGoogle Scholar
  3. 3.
    Rochon J, du Bois A (2011) Clinical research in epithelial ovarian cancer and patients' outcome. Ann Oncol 22(Suppl 7):vii16–vii19CrossRefPubMedGoogle Scholar
  4. 4.
    Baumann KH, Wagner U, du Bois A (2012) The changing landscape of therapeutic strategies for recurrent ovarian cancer. Future Oncol 8:1135–1147CrossRefPubMedGoogle Scholar
  5. 5.
    Harter P, Sehouli J, Reuss A et al (2011) Prospective validation study of a predictive score for operability of recurrent ovarian cancer: the Multicenter Intergroup Study DESKTOP II. A project of the AGO Kommission OVAR, AGO Study Group, NOGGO, AGO-Austria, and MITO. Int J Gynecol Cancer 21:289–295CrossRefPubMedGoogle Scholar
  6. 6.
    Bristow RE, Puri I, Chi DS (2009) Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis. Gynecol Oncol 112:265–274CrossRefPubMedGoogle Scholar
  7. 7.
    Friedlander M, Trimble E, Tinker A et al (2011) Clinical trials in recurrent ovarian cancer. Int J Gynecol Cancer 21:771–775CrossRefPubMedGoogle Scholar
  8. 8.
    Forstner R, Sala E, Kinkel K, Spencer JA (2010) ESUR guidelines: ovarian cancer staging and follow-up. Eur Radiol 20:2773–2780CrossRefPubMedGoogle Scholar
  9. 9.
    Gu P, Pan LL, Wu SQ, Sun L, Huang G (2009) CA 125, PET alone, PET-CT, CT and MRI in diagnosing recurrent ovarian carcinoma: a systematic review and meta-analysis. Eur J Radiol 71:164–174CrossRefPubMedGoogle Scholar
  10. 10.
    Chung HH, Kwon HW, Kang KW et al (2012) Prognostic value of preoperative metabolic tumor volume and total lesion glycolysis in patients with epithelial ovarian cancer. Ann Surg Oncol 19:1966–1972CrossRefPubMedGoogle Scholar
  11. 11.
    Yoo J, Choi JY, Moon SH et al (2012) Prognostic significance of volume-based metabolic parameters in uterine cervical cancer determined using 18 F-fluorodeoxyglucose positron emission tomography. Int J Gynecol Cancer 22:1226–1233CrossRefPubMedGoogle Scholar
  12. 12.
    Burger IA, Vargas HA, Donati OF et al (2013) The value of 18 F-FDG PET/CT in recurrent gynecologic malignancies prior to pelvic exenteration. Gynecol Oncol 129:586–592PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Sala E, Kataoka M, Pandit-Taskar N et al (2010) Recurrent ovarian cancer: contrast-enhanced CT and PET/CT can accurately localize tumor recurrence and to predict patients’ survival. Radiology 257(1):125–134Google Scholar
  14. 14.
    Erdi YE, Mawlawi O, Larson SM et al (1997) Segmentation of lung lesion volume by adaptive positron emission tomography image thresholding. Cancer 80:2505–2509CrossRefPubMedGoogle Scholar
  15. 15.
    Kitajima K, Murakami K, Yamasaki E et al (2008) Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent ovarian cancer: comparison with integrated FDG-PET/non-contrast-enhanced CT and enhanced CT. Eur J Nucl Med Mol Imaging 35:1439–1448CrossRefPubMedGoogle Scholar
  16. 16.
    Nanni C, Rubello D, Farsad M et al (2005) (18)F-FDG PET/CT in the evaluation of recurrent ovarian cancer: a prospective study on forty-one patients. Eur J Surg Oncol 31:792–797CrossRefPubMedGoogle Scholar
  17. 17.
    Sironi S, Messa C, Mangili G et al (2004) Integrated FDG PET/CT in patients with persistent ovarian cancer: correlation with histologic findings. Radiology 233:433–440CrossRefPubMedGoogle Scholar
  18. 18.
    Thrall MM, DeLoia JA, Gallion H, Avril N (2007) Clinical use of combined positron emission tomography and computed tomography (FDG-PET/CT) in recurrent ovarian cancer. Gynecol Oncol 105:17–22CrossRefPubMedGoogle Scholar
  19. 19.
    Fulham MJ, Carter J, Baldey A, Hicks RJ, Ramshaw JE, Gibson M (2009) The impact of PET-CT in suspected recurrent ovarian cancer: A prospective multi-centre study as part of the Australian PET Data Collection Project. Gynecol Oncol 112:462–468CrossRefPubMedGoogle Scholar
  20. 20.
    Simcock B, Neesham D, Quinn M, Drummond E, Milner A, Hicks RJ (2006) The impact of PET/CT in the management of recurrent ovarian cancer. Gynecol Oncol 103:271–276CrossRefPubMedGoogle Scholar
  21. 21.
    Soussan M, Wartski M, Cherel P et al (2008) Impact of FDG PET-CT imaging on the decision making in the biologic suspicion of ovarian carcinoma recurrence. Gynecol Oncol 108:160–165CrossRefPubMedGoogle Scholar
  22. 22.
    Chi DS, McCaughty K, Diaz JP et al (2006) Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum-sensitive epithelial ovarian carcinoma. Cancer 106:1933–1939CrossRefPubMedGoogle Scholar
  23. 23.
    Burger IA, Vargas HA, Apte A et al (2014) PET quantification with a histogram derived total activity metric: superior quantitative consistency compared to total lesion glycolysis with absolute or relative SUV thresholds in phantoms and lung cancer patients. Nucl Med Biol 41:410–418PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Burger IA, Vargas HA, Beattie BJ et al (2014) How to assess background activity: introducing a histogram-based analysis as a first step for accurate one-step PET quantification. Nucl Med Commun 35:316–324CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • H. A. Vargas
    • 1
    Email author
  • I. A. Burger
    • 1
  • D. A. Goldman
    • 2
  • M. Miccò
    • 1
  • R. E. Sosa
    • 1
  • W. Weber
    • 1
  • D. S. Chi
    • 3
  • H. Hricak
    • 1
  • E. Sala
    • 1
  1. 1.Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA

Personalised recommendations