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PET/CT-Based Response Evaluation in Cancer—a Systematic Review of Design Issues

Abstract

Positron emission tomography/x-ray computed tomography (PET/CT) has long been discussed as a promising modality for response evaluation in cancer. When designing respective clinical trials, several design issues have to be addressed, especially the number/timing of PET/CT scans, the approach for quantifying metabolic activity, and the final translation of measurements into a rule. It is unclear how well these issues have been tackled in quest of an optimised use of PET/CT in response evaluation. Medline via Ovid and Science Citation Index via Web of Science were systematically searched for articles from 2015 on cancer patients scanned with PET/CT before and during/after treatment. Reports were categorised as being either developmental or evaluative, i.e. focusing on either the establishment or the evaluation of a rule discriminating responders from non-responders. Of 124 included papers, 112 (90 %) were accuracy and/or prognostic studies; the remainder were response-curve studies. No randomised controlled trials were found. Most studies were prospective (62 %) and from single centres (85 %); median number of patients was 38.5 (range 5–354). Most (69 %) of the studies employed only one post-baseline scan. Quantification was mainly based on SUVmax (91 %), while change over time was most frequently used to combine measurements into a rule (79 %). Half of the reports were categorised as developmental, the other half evaluative. Most development studies assessed only one element (35/62, 56 %), most frequently the choice of cut-off points (25/62, 40 %). In summary, the majority of studies did not address the essential open issues in establishing PET/CT for response evaluation. Reasonably sized multicentre studies are needed to systematically compare the many different options when using PET/CT for response evaluation.

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Acknowledgements

The authors would like to express their gratitude to Claire Gudex (University of Southern Denmark) for proofreading the manuscript.

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Correspondence to Oke Gerke.

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Gerke, O., Ehlers, K., Motschall, E. et al. PET/CT-Based Response Evaluation in Cancer—a Systematic Review of Design Issues. Mol Imaging Biol 22, 33–46 (2020). https://doi.org/10.1007/s11307-019-01351-4

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Key words

  • Cancer
  • Positron emission tomography
  • Response evaluation
  • Study design
  • SUVmax
  • Systematic review