PT - JOURNAL ARTICLE AU - Werner, Rudolf A. AU - Schmid, Jan-Stefan AU - Higuchi, Takahiro AU - Javadi, Mehrbod S. AU - Rowe, Steven P. AU - Märkl, Bruno AU - Aulmann, Christoph AU - Fassnacht, Martin AU - Kroiss, Matthias AU - Reiners, Christoph AU - Buck, Andreas K. AU - Kreissl, Michael C. AU - Lapa, Constantin TI - Predictive Value of <sup>18</sup>F-FDG PET in Patients with Advanced Medullary Thyroid Carcinoma Treated with Vandetanib AID - 10.2967/jnumed.117.199778 DP - 2018 May 01 TA - Journal of Nuclear Medicine PG - 756--761 VI - 59 IP - 5 4099 - http://jnm.snmjournals.org/content/59/5/756.short 4100 - http://jnm.snmjournals.org/content/59/5/756.full SO - J Nucl Med2018 May 01; 59 AB - Therapeutic options in advanced medullary thyroid carcinoma (MTC) have markedly improved since the introduction of tyrosine kinase inhibitors (TKIs). We aimed to assess the role of metabolic imaging using 18F-FDG PET/CT shortly before and 3 mo after initiation of TKI treatment. Methods: Eighteen patients with advanced and progressive MTC scheduled for vandetanib treatment underwent baseline 18F-FDG PET/CT before and 3 mo after TKI treatment initiation. During follow-up, CT scans were obtained every 3 mo and analyzed according to RECIST. The predictive value for estimating progression-free survival (PFS) and overall survival (OS) was examined by investigating the 18F-FDG SUVmean/max of the metabolically most active lesion, as well as by analyzing clinical parameters (tumor marker doubling times [calcitonin, carcinoembryonic antigen], prior therapies, rearranged-during-transfection mutational status, and disease type). Results: Within a median follow-up of 5.2 y, 9 patients experienced disease progression after a median interval of 2.1 y, whereas the remainder had ongoing disease control (5 with a partial response and 4 with stable disease). Eight of the 9 patients with progressive disease died from MTC after a median of 3.5 y after TKI initiation. A pretherapeutic SUVmean of more than 4.0 predicted a significantly shorter PFS (1.9 y vs. 5.2 y, P = 0.04). Furthermore, sustained high 18F-FDG uptake at 3 mo with a SUVmean of more than 2.8 tended to portend an unfavorable prognosis, with a PFS of 1.9 y (vs. 3.5 y, P = 0.3). Prolonged carcinoembryonic antigen doubling times were significantly correlated with longer PFS (r = 0.7) and OS (r = 0.76, P &lt; 0.01). None of the other clinical parameters had prognostic significance. Conclusion: Pretherapeutic 18F-FDG PET/CT provides prognostic information in patients with advanced MTC scheduled for treatment with the TKI vandetanib. A low tumor metabolism with an SUVmean of less than 4.0 before treatment predicts a longer PFS.