1. Volumetric and texture analysis of pretherapeutic 18 F-FDG PET can predict overall survival in medullary thyroid cancer patients treated with Vandetanib.
- Author
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Werner RA, Bundschuh RA, Higuchi T, Javadi MS, Rowe SP, Zsótér N, Kroiss M, Fassnacht M, Buck AK, Kreissl MC, and Lapa C
- Subjects
- Carcinoma, Neuroendocrine pathology, Carcinoma, Neuroendocrine ultrastructure, Follow-Up Studies, Humans, Neoplasm Staging, Predictive Value of Tests, Prognosis, Progression-Free Survival, Retrospective Studies, Sensitivity and Specificity, Thyroid Neoplasms pathology, Thyroid Neoplasms ultrastructure, Treatment Outcome, Carcinoma, Neuroendocrine diagnosis, Carcinoma, Neuroendocrine drug therapy, Fluorodeoxyglucose F18, Piperidines therapeutic use, Positron Emission Tomography Computed Tomography, Quinazolines therapeutic use, Thyroid Neoplasms diagnosis, Thyroid Neoplasms drug therapy, Tumor Burden
- Abstract
Purpose: The metabolically most active lesion in 2-deoxy-2-(
18 F)fluoro-D-glucose (18 F-FDG) PET/CT can predict progression-free survival (PFS) in patients with medullary thyroid carcinoma (MTC) starting treatment with the tyrosine kinase inhibitor (TKI) vandetanib. However, this metric failed in overall survival (OS) prediction. In the present proof of concept study, we aimed to explore the prognostic value of intratumoral textural features (TF) as well as volumetric parameters (total lesion glycolysis, TLG) derived by pre-therapeutic18 F-FDG PET., Methods: Eighteen patients with progressive MTC underwent baseline18 F-FDG PET/CT prior to and 3 months after vandetanib initiation. By manual segmentation of the tumor burden at baseline and follow-up PET, intratumoral TF and TLG were computed. The ability of TLG, imaging-based TF, and clinical parameters (including age, tumor marker doubling times, prior therapies and RET (rearranged during transfection) mutational status) for prediction of both PFS and OS were evaluated., Results: The TF Complexity and the volumetric parameter TLG obtained at baseline prior to TKI initiation successfully differentiated between low- and high-risk patients. Complexity allocated 10/18 patients to the high-risk group with an OS of 3.3 y (vs. low-risk group, OS = 5.3 y, 8/18, AUC = 0.78, P = 0.03). Baseline TLG designated 11/18 patients to the high-risk group (OS = 3.5 y vs. low-risk group, OS = 5 y, 7/18, AUC = 0.83, P = 0.005). The Hazard Ratio for cancer-related death was 6.1 for Complexity (TLG, 9.5). Among investigated clinical parameters, the age at initiation of TKI treatment reached significance for PFS prediction (P = 0.02, OS, n.s.)., Conclusions: The TF Complexity and the volumetric parameter TLG are both independent parameters for OS prediction.- Published
- 2019
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