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Impact of 18F-FDG-PET/CT on surgical management in patients with advanced melanoma: an outcome based analysis

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the influence of 18F-FDG-PET/CT on clinical decision making and outcome in advanced melanoma patients planned for radical metastasectomy.

Methods and materials

A cohort of 333 patients with mainly stage III/IV melanoma having a PET/CT for clinical reasons was prospectively enrolled in our oncologic PET/CT registry between 2013 and 2015. Referring physicians completed questionnaires regarding their intended management for each patient before and after PET/CT. Management changes after PET/CT were classified as major and minor changes. A subgroup of 107 patients (stage I, N = 5; stage II, N = 3; stage III, N = 42; stage IV, N = 57) was planned for complete metastasectomy initially, based on conventional imaging. Management changes and outcome were evaluated by linkage with the information obtained from patients’ medical records.

Results

In 28 of 107 patients (26%), the surgical treatment plan remained unchanged after PET/CT. In 24 patients (22%), minor changes were performed, such as enlargement or reduction of the surgical field. In 55 patients (51%, 95% CI 42%-61%) major changes of the intended treatment plan occurred; of those, 20 patients (19%) were classified to be tumor-free with PET/CT, 32 patients (30%) were found to have multiple previously unrecognized metastases and had to be treated by systemic therapy, three patients (3%) had to be changed to palliative radiotherapy or isolated extremity perfusion. The 1-year and 2-year overall survival (OS) in patients with complete metastasectomy (N = 52) was 90% and 79%, respectively. Systemically treated patients (N = 32) resulted in 1-year OS of 72% and 2-year OS of 61%. Eleven of 32 patients (34%) with systemic therapy experienced a complete response. Until December 2016, all 20 patients classified as tumor-free by PET/CT were alive.

Conclusion

The study confirms the high impact of PET/CT on clinical management in patients with advanced melanoma planned for radical metastasectomy. PET/CT resulted in frequent management changes, preventing futile surgery in half of the patients.

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Authors and Affiliations

  1. Department of Dermatology, Eberhard-Karls-University Tuebingen, Liebermeisterstr. 25, 72076, Tübingen, Germany

    Andrea Forschner, Ulrike Keim, Thomas Kurt Eigentler & Claus Garbe

  2. Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany

    Susann-Cathrin Olthof, Brigitte Gückel, Konstantin Nikolaou & Christina Pfannenberg

  3. Department of Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University Tuebingen, Tübingen, Germany

    Peter Martus

  4. Institute of Medical Biometry and Statistics, University Freiburg, Freiburg, Germany

    Werner Vach

  5. Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard-Karls-University Tuebingen, Tübingen, Germany

    Christian la Fougère

Authors
  1. Andrea Forschner
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  2. Susann-Cathrin Olthof
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  3. Brigitte Gückel
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  4. Peter Martus
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  5. Werner Vach
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  6. Christian la Fougère
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  7. Konstantin Nikolaou
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  8. Ulrike Keim
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  9. Thomas Kurt Eigentler
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  10. Claus Garbe
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  11. Christina Pfannenberg
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Corresponding author

Correspondence to Andrea Forschner.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This study was approved by the local ethics committee of the University of Tuebingen (reference number 064/2013B01).

Informed consent

Informed consent was obtained from all patients included in this study.

Funding

The study was funded by the young scientists’ programme of the German network ‘Health Services Research Baden-Württemberg’ of the Ministry of Science, Research and Arts in collaboration with the Ministry of Employment and Social Order, Family, Women and Senior Citizens, Baden-Württemberg.

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Forschner, A., Olthof, SC., Gückel, B. et al. Impact of 18F-FDG-PET/CT on surgical management in patients with advanced melanoma: an outcome based analysis. Eur J Nucl Med Mol Imaging 44, 1312–1318 (2017). https://doi.org/10.1007/s00259-017-3674-8

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  • DOI: https://doi.org/10.1007/s00259-017-3674-8

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