RT Journal Article
SR Electronic
T1 Predictive role of FDG PET-derived parameters on outcome after salvage radiotherapy in progressive malignant pleural mesothelioma
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 604
OP 604
VO 58
IS supplement 1
A1 Incerti, Elena
A1 Mapelli, Paola
A1 Broggi, Sara
A1 Fodor, Andrei
A1 Cuzzocrea, Marco
A1 Samanes Gajate, Ana Maria
A1 Fiorino, Claudio
A1 Cattaneo, Mauro
A1 Dell'Oca, Italo
A1 Pasetti, Marcella
A1 Calandrino, Riccardo
A1 Di Muzio, Nadia
A1 Gianolli, Luigi
A1 Picchio, Maria
YR 2017
UL http://jnm.snmjournals.org/content/58/supplement_1/604.abstract
AB 604Objectives: Malignant pleural mesothelioma (MPM) has an aggressive course, high mortality rate and no standard of care. Aim of the current study was to evaluate the predictive role of FDG PET-derived parameters in MPM patients treated with salvage helical tomotherapy (HTT) on overall survival (OS), local relapse free survival (LRFS) and distant relapse free survival (DRFS).Methods: Fifty-five MPM patients (44 male and 11 female) with a median age of 67 years (range: 39-82 years), treated between March 2006 and February 2015 at San Raffaele Scientific Institute were retrospectively investigated. The patients were treated with FDG PET/CT guided salvage HTT after previous surgery plus chemotherapy. Univariate Cox regression analysis was performed to assess the impact of several quantitative FDG PET-derived parameters: biological target volume (BTV), mean and maximum standard uptake value (SUVmean-max), metabolic tumour volume (MTV) and total lesion glycolysis (TLG), the last three parameters considered at different uptake threshold 40-50-60%. By considering patients with OS, LRFS and DRFS inferior and superior to the corresponding median time, a logistic regression was performed to select FDG PET-derived parameters able to better select patients with the worst prognosis.Results: 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 (p= 0.0007; RR= 1.0013) and TLG (p< 0.0001, RR= 1.001) were the most significant predictors of OS. The median values of MTV60 (p= 0.015; RR= 2.1) and TLG40-50 (p= 0.0047; RR= 2.4) significantly predict OS; a median OS equal to 4.8 months was found for patients with MTV60> 5.0 cc and for TLG40> 334.4 cc compared to 13.8/16.1 months, respectively for patients with smaller MTV60 and TLG40. Median LRFS and DRFS were 6.2 months (range: 1.2 - 39.4 months) and 6.5 months (0.0 - 66.4 months), respectively. TLG40-50-60 were found significantly (p< 0.015) correlated to LRFS. Almost all FDG PET-derived parameters were found significantly correlated with DRFS. In particular, a median DRFS equal to 6.4 /6.2 months was found for patients with a MTV40> 39.6 cc /TLG40> 334.4 cc compared to 17.0/18.8 months for patients with MTV40 and TLG40 smaller than these values. FDG PET-derived parameters well discriminated patients with poor OS/LRFS/DRFS (less than the median values): BTV (p= 0.0044; RR= 5.8); BTV(p= 0.055; RR= 3) and TLG40 (p= 0.039; RR= 3.4); MTV40 (p= 0.0036; RR= 6.5), MTV60 and TLG40-50 (p= 0.0018; RR= 7.6) were the best parameters for OS, LRFS and DRFS, respectively.Conclusion: FDG PET-derived parameters predict outcome of MPM patients treated with salvage HTT. The predictive value of PET-derived parameters may be helpful in identifying patients with the worst prognosis, potentially allowing a better selection of MPM patients for salvage HTT. Research Support: None