Skip to main content
SpringerLink
Log in

Predictive and prognostic value of 18F-DOPA PET/CT in patients affected by recurrent medullary carcinoma of the thyroid

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

A Correction to this article was published on 24 May 2018

This article has been updated

Abstract

Introduction

Medullary thyroid carcinoma (MTC) is a malignancy accounting for about 5–8% of thyroid cancers. Serum calcitonin and carcinoembryonic antigen (CEA) levels are widely used to monitor disease progression. However, prognostic factors able to predict outcomes are highly desirable. We, therefore, aimed to assess the prognostic role of 18F-DOPA PET/CT in patients with recurrent MTC.

Materials and methods

60 patients (mean age 64 ± 13 years, range 44–82) with recurrent MTC were eligible from a multicenter database. All patients underwent a restaging 18F-DOPA PET/CT, performed at least 6 months after surgery. CEA/calcitonin levels, local recurrences, nodal involvement and metastases at PET/CT were recorded. SUVmax, SUVmean (also normalized to mediastinal uptake) and metabolic tumor volume were automatically calculated for each lesion, by placing a volume of interest around the lesion with 40% of peak activity as threshold for the automatic contouring. The patients were clinically and radiologically followed up for 21 ± 11 months. Rate of progression-free survival (PFS), disease-specific survival (DSS) and incremental prognostic value of 18F-DOPA PET/CT over conventional imaging modalities were assessed by Kaplan–Meier curves and Log-Rank test. Cox regression univariate and multivariate analyses were performed for assessing predictors of prognosis.

Results

18F-DOPA PET/CT showed abnormal findings in 27 patients (45%) and resulted unremarkable in 33 (55%). PFS was significantly longer in patients with an unremarkable PET/CT scan (p = 0.018). Similarly, an unremarkable PET/CT study was associated with a significantly longer DSS (p = 0.04). 18F-DOPA PET/CT added prognostic value over other imaging modalities both for PFS and for DSS (p < 0.001 and p = 0.012, respectively). Neither semiquantitative PET parameters nor clinical or laboratory data were predictive of a worse PFS and DSS in patients with recurrent MTC.

Conclusion

18F-DOPA PET/CT scan has an important prognostic value in predicting disease progression and mortality rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Change history

  • 24 May 2018

    The following affiliation should be added to the authors Agostino Chiaravalloti and Orazio Schillaci.

References

  1. Pacini F, Castagna MG, Cipri C, Schlumberger M. Medullary thyroid carcinoma. Clin Oncol. 2010;22:475–85.

    Article  CAS  Google Scholar 

  2. Kebebew E, Ituarte PH, Siperstein AE, Duh QY, Clark OH. Medullary thyroid carcinoma: clinical characteristics, treatment, prognostic factors, and a comparison of staging systems. Cancer. 2000;88:1139–48.

    Article  PubMed  CAS  Google Scholar 

  3. Pellegriti G, Leboulleux S, Baudin E, Bellon N, Scollo C, Travagli JP, Schlumberger M. Long-term outcome of medullary thyroid carcinoma in patients with normal postoperative medical imaging. Br J Cancer. 2003;88:1537–42.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Marzola MC, Pelizzo MR, Ferdeghini M, Toniato A, Massaro A, Ambrosini V, et al. Dual PET/CT with (18)F-DOPA and (18)F FDG in metastatic medullary thyroid carcinoma and rapidly increasing calcitonin levels: comparison with conventional imaging. Eur J Surg Oncol. 2010;36:414–21.

    Article  PubMed  CAS  Google Scholar 

  5. Kauhanen S, Schalin-Jantti C, Seppanen M, Kajander S, Virtanen S, Schildt J, et al. Complementary roles of 18F-DOPA PET/CT and 18F-FDG PET/CT in medullary thyroid cancer. J Nucl Med. 2011;52:1855–63.

    Article  PubMed  CAS  Google Scholar 

  6. Luster M, Karges W, Zeich K, Pauls S, Verburg FA, Dralle H, et al. Clinical value of 18-fluorine-fluorodihydroxyphenylalanine positron emission tomography/computed tomography in the follow-up of medullary thyroid carcinoma. Thyroid. 2010;20:527–33.

    Article  PubMed  CAS  Google Scholar 

  7. Bergström M, Eriksson B, Oberg K, Sundin A, Ahlström H, Lindner KJ, Bjurling P, Långström B. In vivo demonstration of enzyme activity in endocrine pancreatic tumors: decarboxylation of carbon-11-DOPA to carbon-11-dopamine. J Nucl Med. 1996;37:32–7.

    PubMed  Google Scholar 

  8. Gilbert JA, Bates LA, Ames MM. Elevated aromatic-l-amino acid decarboxylase in human carcinoid tumors. Biochem Pharmacol. 1995;50:845 – 50.

    Article  PubMed  CAS  Google Scholar 

  9. Treglia G, Castaldi P, Villani MF, Perotti G, de Waure C, Filice A, Ambrosini V, Cremonini N, Santimaria M, Versari A, Fanti S, Giordano A, Rufini V. Comparison of 18F-DOPA, 18F-FDG and 68 Ga-somatostatin analogue PET/CT in patients with recurrent medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2012;39:569–80.

    Article  PubMed  CAS  Google Scholar 

  10. Slavikova K, Montravers F, Treglia G, Kunikowska J, Kaliska L, Vereb M, et al. What is currently the best radiopharmaceutical for the hybrid PET/CT detection of recurrent medullary thyroid carcinoma? Curr Radiopharm. 2013;6:96–105.

    Article  PubMed  CAS  Google Scholar 

  11. Verbeek HH, Plukker JT, Koopmans KP, de Groot JW, Hofstra RM, Muller Kobold AC, van der Horst-Schrivers AN, Brouwers AH, Links TP. Clinical relevance of 18F-FDG PET and 18F-DOPA PET in recurrent medullary thyroid carcinoma. J Nucl Med. 2012;53:1863–71.

    Article  PubMed  CAS  Google Scholar 

  12. Bozkurt MF, Virgolini I, Balogova S, Beheshti M, Rubello D, Decristoforo C, Ambrosini V, Kjaer A, Delgado-Bolton R, Kunikowska J, Oyen WJG, Chiti A, Giammarile F, Fanti S. Guideline for PET/CT imaging of neuroendocrine neoplasms with 68 Ga-DOTA-conjugated somatostatin receptor targeting peptides and 18F-DOPA. Eur J Nucl Med Mol Imaging. 2017;44:1588–601.

    Article  PubMed  CAS  Google Scholar 

  13. Wells SA Jr, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, Lee N, Machens A, Moley JF, Pacini F, Raue F, Frank-Raue K, Robinson B, Rosenthal MS, Santoro M, Schlumberger M, Shah M, Waguespack SG. American thyroid association guidelines task force on medullary thyroid carcinoma. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25:567–610.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Treglia G, Castaldi P, Villani MF, Perotti G, Filice A, Ambrosini V, et al. Comparison of different positron emission tomography tracers in patients with recurrent medullary thyroid carcinoma: our experience and a review of the literature. Recent Results Cancer Res. 2013;194:385–93.

    Article  PubMed  CAS  Google Scholar 

  15. Treglia G, Rufini V, Salvatori M, Giordano A, Giovanella L. PET imaging in recurrent medullary thyroid carcinoma. Int J Mol Imaging. 2012;2012:324686.

    PubMed  PubMed Central  Google Scholar 

  16. Wong KK, Laird AM, Moubayed A, Chondrogiannis S, Marzola MC, Evangelista L, et al. How has the management of medullary thyroid carcinoma changed with the advent of 18F-FDG and non-18F-FDG PET radiopharmaceuticals. Nucl Med Commun. 2012;33:679–88.

    Article  PubMed  CAS  Google Scholar 

  17. American Thyroid Association Guidelines Task Force, Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, et al. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid. 2009;19:565–612.

    Article  Google Scholar 

  18. Liu CJ, Lu MY, Liu YL, Ko CL, Ko KY, Tzen KY, Chang HH, Yang YL, Jou ST, Hsu WM, Yen RF. Risk stratification of pediatric patients with neuroblastoma using volumetric parameters of 18F-FDG and 18F-DOPA PET/CT. Clin Nucl Med. 2017. doi:10.1097/RLU.0000000000001529. (Epub ahead of print).

    Article  PubMed  Google Scholar 

  19. Liao S, Lan X, Cao G, Yuan H, Zhang Y. Prognostic predictive value of total lesion glycolysis from 18F-FDG PET/CT in postsurgical patients with epithelial ovarian cancer. Clin Nucl Med. 2013;38:715–20.

    Article  PubMed  Google Scholar 

  20. Alongi P, Caobelli F, Gentile R, Stefano A, Russo G, Albano D, Baldari S, Gilardi MC, Midiri M. Recurrent bladder carcinoma: clinical and prognostic role of 18 F-FDG PET/CT. Eur J Nucl Med Mol Imaging. 2017;44:224–33.

    Article  PubMed  CAS  Google Scholar 

  21. Caobelli F, Alongi P, Evangelista L, Picchio M, Saladini G, Rensi M, Geatti O, Castello A, Laghai I, Popescu CE, Dolci C, Crivellaro C, Seghezzi S, Kirienko M, De Biasi V, Cocciolillo F, Quartuccio N. Young AIMN Working Group. Predictive value of (18)F-FDG PET/CT in restaging patients affected by ovarian carcinoma: a multicentre study. Eur J Nucl Med Mol Imaging. 2016;43:404–13.

    Article  PubMed  CAS  Google Scholar 

  22. Werner RA, Schmid JS, Muegge DO, Lückerath K, Higuchi T, Hänscheid H, Grelle I, Reiners C, Herrmann K, Buck AK, Lapa C. Prognostic value of serum tumor markers in medullary thyroid cancer patients undergoing vandetanib treatment. Medicine (Baltimore). 2015;94(45):e2016.

    Article  CAS  Google Scholar 

  23. Koopmans KP, de Groot JW, Plukker JT, et al. 18F-dihydroxyphenylalanine PET in patients with biochemical evidence of medullary thyroid cancer: relation to tumor differentiation. J Nucl Med. 2008;49:524–31.

    Article  PubMed  CAS  Google Scholar 

  24. Luster M, Karges W, Zeich K, et al. Clinical value of 18-fluorine-fluorodihydroxyphenylalanine positron emission tomography/computed tomography in the follow-up of medullary thyroid carcinoma. Thyroid. 2010;20:527–33.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland

    Federico Caobelli

  2. Nuclear Medicine Unit, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy

    Agostino Chiaravalloti & Orazio Schillaci

  3. Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy

    Laura Evangelista & Giorgio Saladini

  4. Department of Nuclear Medicine, State University Milan, Milan, Italy

    Manuela Vadrucci

  5. Department of Nuclear Medicine, S Orsola-Malpighi University Hospital, Bologna, Italy

    Federica Scalorbi

  6. Nuclear Medicine Department, Hospital of Trento, Trento, Italy

    Davide Donner

  7. San Raffaele G. Giglio Institute, Cefalù, PA, Italy

    Pierpaolo Alongi

Authors
  1. Federico Caobelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Agostino Chiaravalloti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Evangelista
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giorgio Saladini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Orazio Schillaci
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Manuela Vadrucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Federica Scalorbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Davide Donner
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Pierpaolo Alongi
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Young AIMN Working Group

Corresponding author

Correspondence to Federico Caobelli.

Ethics declarations

Conflict of interest

The authors disclosure of any personal or financial support or author involvement with organization(s) with financial interest in the subject matter—or any actual or potential conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Caobelli, F., Chiaravalloti, A., Evangelista, L. et al. Predictive and prognostic value of 18F-DOPA PET/CT in patients affected by recurrent medullary carcinoma of the thyroid. Ann Nucl Med 32, 7–15 (2018). https://doi.org/10.1007/s12149-017-1213-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-017-1213-0

Keywords

Search

Navigation