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Early Prediction of Response to Chemotherapy and Survival in Malignant Pleural Mesothelioma Using a Novel Semiautomated 3-Dimensional Volume-Based Analysis of Serial ¹⁸F-FDG PET Scans

¹ Department of Nuclear Medicine/WA PET Centre, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; ² Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; ³ School of Medicine and Pharmacology, Faculty of Medicine and Dentistry and Health Science, University of Western Australia, Western Australia, Australia; ⁴ Cancer Council Clinical Trials Biostatistics Department, WA Institute for Medical Research, Sir Charles Gairdner Hospital, University of Western Australia, Nedlands, Western Australia, Australia; ⁵ Department of Radiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and ⁶ Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia

Correspondence: For correspondence or reprints contact: Roslyn Francis, MBBS, PhD, Department of Nuclear Medicine/WA PET Centre, Sir Charles Gairdner Hospital, Verdun St., Nedlands, Western Australia, 6009, Australia. E-mail: Ros.Francis{at}health.wa.gov.au

The aim of chemotherapy for mesothelioma is to palliate symptoms and improve survival. Measuring response using CT is challenging because of the circumferential tumor growth pattern. This study aims to evaluate the role of serial ¹⁸F-FDG PET in the assessment of response to chemotherapy in patients with mesothelioma. Methods: Patients were prospectively recruited and underwent both ¹⁸F-FDG PET and conventional radiological response assessment before and after 1 cycle of chemotherapy. Quantitative volume-based ¹⁸F-FDG PET analysis was performed to obtain the total glycolytic volume (TGV) of the tumor. Survival outcomes were measured. Results: Twenty-three patients were suitable for both radiological and ¹⁸F-FDG PET analysis, of whom 20 had CT measurable disease. After 1 cycle of chemotherapy, 7 patients attained a partial response and 13 had stable disease on CT assessment by modified RECIST (Response Evaluation Criteria in Solid Tumors) criteria. In the 7 patients with radiological partial response, the median TGV on quantitative PET analysis fell to 30% of baseline (range, 11%–71%). After 1 cycle of chemotherapy, Cox regression analysis demonstrated a statistically significant relationship between a fall in TGV and improved patient survival (P = 0.015). Neither a reduction in the maximum standardized uptake value (P = 0.097) nor CT (P = 0.131) demonstrated a statistically significant association with patient survival. Conclusion: Semiquantitative ¹⁸F-FDG PET using the volume-based parameter of TGV is feasible in mesothelioma and may predict response to chemotherapy and patient survival after 1 cycle of treatment. Therefore, metabolic imaging has the potential to improve the care of patients receiving chemotherapy for mesothelioma by the early identification of responding patients. This technology may also be useful in the assessment of new systemic treatments for mesothelioma.

Key Words: ¹⁸F-FDG PET • mesothelioma • response • chemotherapy

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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