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CT evaluation of response in advanced gastroenteropancreatic neuroendocrine tumors treated with long-acting-repeatable octreotide: what is the optimal size variation threshold?

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To identify a reliable early indicator of deriving progression-free survival (PFS) benefit in patients with advanced gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with octreotide long-acting repeatable (LAR).

Methods

We investigated the images of 50 patients with well-differentiated advanced GEP-NETs treated with LAR octreotide and underwent baseline and follow-up thoracic, abdominal, and pelvic computed tomography. Receiver-operating characteristic (ROC) analysis and the Kaplan-Meier method were used to identify the optimal threshold to distinguish between those with and without significant improvement of PFS.

Results

The optimal threshold for determining a response to octreotide LAR was -10% ΔSLD, with a sensitivity and specificity of 85.7% and 80%, respectively. At this threshold, 19 patients were responders and 31 were non-responders; the median PFS was 20.2 and 7.6 months in responders and non-responders (hazard ratio, 2.66; 95% confidence interval, 1.32–5.36).

Conclusion

A 10% shrinkage in tumor size is an optimal early predictor of response to octreotide LAR in advanced GEP-NETs.

Key points

• Octreotide LAR can significantly prolong PFS among patients with well-differentiated advanced GEP-NETs.

• No optimal tumor size-based response criteria are reported in GEP-NETs with octreotide.

• Ten percent tumor shrinkage is a reliable indicator of the response to octreotide for advanced GEP-NETs.

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Abbreviations

CT:

Computed tomography

GEP-NETs:

Gastroenteropancreatic neuroendocrine tumors

Octreotide LAR:

Octreotide long-acting repeatable

PD:

Progressive disease

PFS:

Progression-free survival

PR:

Partial response

RECIST:

Response Evaluation Criteria in Solid Tumors

ROC curve:

Receiver-operating characteristic curve

SD:

Stable disease

SLD:

Sum of the longest diameters

SSAs:

Somatostatin analogs

TACE:

Transhepatic arterial chemotherapy and embolization

WDGEP-NETs:

Well-differentiated advanced gastroenteropancreatic neuroendocrine tumors

ΔSLD:

Change in the sum of the longest tumor diameters

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Funding

National Natural Science Foundation of China (81771908,81571750, 81770654), National Key Research and Development Program of China (2017YFC0113402), Guangzhou Science and Technology Foundation (201804010078). Natural Science Foundation of Guangdong Province (2015A030313043).

Author information

Author notes

  1. Yanji Luo and Jie Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China

    Yanji Luo, Bingqi Shen, Meng Wang, Huasong Cai, Zi-Ping Li & Shi-Ting Feng

  2. Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China

    Jie Chen, Luohai Chen & Minhu Chen

  3. Faculty of Medicine and Dentistry, University of Western Australia, Perth, 6009, Australia

    Ling Xu

Authors
  1. Yanji Luo
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Corresponding authors

Correspondence to Zi-Ping Li or Shi-Ting Feng.

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Guarantor

The scientific guarantor of this publication is Dr. Shi-Ting Feng.

Conflict of interest

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.

Statistics and biometry

Ms. Fangjing Zhou (expert in statistics, Sun Yat-Sen University) kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Luo, Y., Chen, J., Shen, B. et al. CT evaluation of response in advanced gastroenteropancreatic neuroendocrine tumors treated with long-acting-repeatable octreotide: what is the optimal size variation threshold?. Eur Radiol 28, 5250–5257 (2018). https://doi.org/10.1007/s00330-018-5512-1

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  • DOI: https://doi.org/10.1007/s00330-018-5512-1

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