FDG PET-derived parameters as prognostic tool in progressive malignant pleural mesothelioma treated patients
- 246 Downloads
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.
KeywordsMalignant pleural mesothelioma FDG PET/CT Helical tomotherapy Survival MTV TLG
Compliance with ethical standards
Conflicts of interest
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 was obtained from all individual participants included in the study.
- 3.Vogelzang NJ, Rusthoven JJ, Symanowski J, Denham C, Kaukel E, Ruffie P, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol. 2003;21:2636–44. https://doi.org/10.1200/Jco.2003.11.136.CrossRefPubMedPubMedCentralGoogle Scholar
- 4.van Meerbeeck JP, Gaafar R, Manegold C, Van Klaveren RJ, Van Marck EA, Vincent M, et al. Randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an intergroup study of the European Organisation for Research and Treatment of Cancer Lung Cancer Group and the National Cancer Institute of Canada. J Clin Oncol. 2005;23:6881–9. https://doi.org/10.1200/Jco.20005.14.589.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Rosenzweig KE, Gupta V, Mychalczak B, Krug LM, Flores R, Rusch VW. Hemithoracic radiation therapy and brachytherapy after pleurectomy/decortication for malignant pleural mesothelioma: results from a 30-year experience. J Clin Oncol. 2005;23(16_suppl):7180. https://doi.org/10.1200/jco.2005.23.16_suppl.7180.CrossRefGoogle Scholar
- 13.Kanemura S, Kuribayashi K, Funaguchi N, Shibata E, Mikami K, Doi H, et al. Metabolic response assessment with 18F-FDG-PET/CT is superior to modified RECIST for the evaluation of response to platinum-based doublet chemotherapy in malignant pleural mesothelioma. Eur J Radiol. 2017;86:92–8. https://doi.org/10.1016/j.ejrad.2016.11.009.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Schneider DB, Clary-Macy C, Challa S, Sasse KC, Merrick SH, Hawkins R, et al. Positron emission tomography with F18-fluorodeoxyglucose in the staging and preoperative evaluation of malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2000;120:128–33. https://doi.org/10.1067/mtc.2000.106529.CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Gregianin M, Dei Rossi F, Cracco E, Zaccaria A, Canton A, Pagan V. PET/CT in the preoperative evaluation of patients with malignant pleural mesothelioma (MPM). Eur J Nucl Med Mol Imaging. 2007;34:S142.Google Scholar
- 21.Francis RJ, Byrne MJ, van der Schaaf AA, Boucek JA, Nowak AK, Phillips M, et al. Early prediction of response to chemotherapy and survival in malignant pleural mesothelioma using a novel semiautomated 3-dimensional volume-based analysis of serial F-18-FDG PET scans. J Nucl Med. 2007;48:1449–58. https://doi.org/10.2967/jnumed.107.042333.CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341–6. https://doi.org/10.1016/0360-3016(95)00060-C.CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Munter MW, Nill S, Thilmann C, Hof H, Hoss A, Haring P, et al. Stereotactic intensity-modulated radiation therapy (IMRT) and inverse treatment planning for advanced pleural mesothelioma – feasibility and initial results. Strahlenther Onkol. 2003;179:535–41. https://doi.org/10.1007/s00066-003-1055-7.CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Rice DC, Smythe WR, Liao ZX, Guerrero T, Chang JY, McAleer MF, et al. Dose-dependent pulmonary toxicity after postoperative intensity-modulated radiotherapy for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys. 2007;69:350–7. https://doi.org/10.1016/j.ijrobp.2007.03.011.CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Nowak AK, Francis RJ, Phillips MJ, Millward MJ, van der Schaaf AA, Boucek J, et al. A novel prognostic model for malignant mesothelioma incorporating quantitative FDG-PET imaging with clinical parameters. Clin Cancer Res. 2010;16:2409–17. https://doi.org/10.1158/1078-0432.CCR-09-2313.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Schaefer NG, Veit-Haibach P, Soyka JD, Steinert HC, Stahel RA. Continued pemetrexed and platin-based chemotherapy in patients with malignant pleural mesothelioma (MPM): value of 18F-FDG-PET/CT. Eur J Radiol. 2012;81:E19–25. https://doi.org/10.1016/j.ejrad.2010.11.006.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Lee HY, Hyun SH, Lee KS, Kim BT, Kim J, Shim YM, et al. Volume-based parameter of F-18-FDG PET/CT in malignant pleural mesothelioma: prediction of therapeutic response and prognostic implications. Ann Surg Oncol. 2010;17:2787–94. https://doi.org/10.1245/s10434-010-1107-z.CrossRefPubMedPubMedCentralGoogle Scholar