FDG PET-derived parameters as prognostic tool in progressive malignant pleural mesothelioma treated patients

  • E. Incerti
  • S. Broggi
  • A. Fodor
  • M. Cuzzocrea
  • A. M. Samanes Gajate
  • P. Mapelli
  • C. Fiorino
  • I. Dell’Oca
  • M. Pasetti
  • M. Cattaneo
  • R. Calandrino
  • L. Gianolli
  • N. Di Muzio
  • Maria PicchioEmail author
Original Article



The value of FDG PET-derived parameters in predicting overall survival (OS), local relapse-free survival (LRFS) and distant relapse-free survival (DRFS) in treated patients with malignant pleural mesothelioma (MPM) was evaluated.


This retrospective evaluation included 55 MPM patients treated between March 2006 and February 2015 with FDG PET/CT-guided salvage helical tomotherapy (HTT) after previous surgery plus chemotherapy. Univariate Cox regression analysis was performed to assess the impact of the following FDG PET-derived parameters: biological target volume (BTV), mean and maximum standardized uptake values (SUVmean/max), metabolic tumour volume (MTV) and total lesion glycolysis (TLG), measured using different uptake thresholds (40%, 50% and 60%). Logistic regression was then performed to identify the best FDG PET-derived parameters for selecting patients with poorer survival.


The median OS was 9.1 months (range 0.0 – 69.6 months) after the end of HTT; 54/55 patients were dead at the last follow-up. BTV and TLG40, TLG50 and TLG60 were the most significant predictors of OS (p < 0.005). The median OS was 4.8 months in patients with MTV60 >5 cm3 and TLG40 >334.4, compared with 13.8 months and 16.1 months in patients with smaller values, respectively. The median LRFS and DRFS were 6.2 months (range 1.2 – 39.4 months) and 6.5 months (0.0 – 66.4 months), respectively. TLG40, TLG50 and TLG60 were significantly correlated with LRFS (p < 0.015). Median DRFS was 6.4 months in patients with MTV40 >39.6 cm3 and 6.2 months in patients with TLG40 >334.4, compared with 17 months and 18.8 months in patients with smaller values. BTV, TLG40 and MTV40 were also found to be good predictors in patients with poor OS/LRFS/DRFS (median survival times less than the median values).


FDG PET-derived parameters effectively discriminated patients with a poor prognosis and may be helpful in the selection of MPM patients for salvage HTT.


Malignant pleural mesothelioma FDG PET/CT Helical tomotherapy Survival MTV TLG 


Compliance with ethical standards

Conflicts of interest


Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • E. Incerti
    • 1
  • S. Broggi
    • 2
  • A. Fodor
    • 3
  • M. Cuzzocrea
    • 4
  • A. M. Samanes Gajate
    • 1
  • P. Mapelli
    • 1
    • 5
  • C. Fiorino
    • 2
  • I. Dell’Oca
    • 3
  • M. Pasetti
    • 3
  • M. Cattaneo
    • 2
  • R. Calandrino
    • 2
  • L. Gianolli
    • 1
  • N. Di Muzio
    • 3
  • Maria Picchio
    • 1
    • 5
    Email author
  1. 1.Unit of Nuclear MedicineIRCCS San Raffaele Scientific InstituteMilanItaly
  2. 2.Unit of Medical PhysicsIRCCS San Raffaele Scientific InstituteMilanItaly
  3. 3.Unit of RadiotherapyIRCCS San Raffaele Scientific InstituteMilanItaly
  4. 4.University of Milano-BicoccaMilanItaly
  5. 5.Vita-Salute San Raffaele UniversityMilanItaly

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