Combined FDG-PET/CT in response evaluation of malignant pleural mesothelioma

Our plain-English summary of Combined FDG-PET/CT in response evaluation of malignant pleural mesothelioma, by P. Veit-Haibach, N.G. Schaefer, H.C. Steinert, et al (Lung Cancer, 2010).

The study

• Authors: P. Veit-Haibach, N.G. Schaefer, H.C. Steinert, J.D. Soyka, B. Seifert, R.A. Stahel
• Journal: Lung Cancer
• Published: 2010;67(3):311-7
• Cited by: 59 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: Based on the complex growth pattern of MPM, conventional response evaluation in this cancer entity is challenging. Therefore, there is growing interest in therapy response evaluation with FDG-PET/CT. The aim of the study was to evaluate the value of several FDG-PET/CT-parameters in therapy response evaluation concerning prediction of survival at baseline and after three cycles of therapy.

Patients And Methods: The study was performed in accordance with the regulations of the local ethics committee. Forty-one patients with proven MPM and treated with palliative pemetrexed and platinum-based chemotherapy were included. All patients were evaluated by FDG-PET/CT at baseline and after three cycles of chemotherapy. Responders and non-responders were evaluated based on modified RECIST- and EORTC-criteria. Additional PET-parameters (SUVmean, tumor lesion glycolysis (TLG) and tumor volume (PETvol)) were evaluated. Results were evaluated using the COX regression and the Kaplan-Meier method.

Results: None of the baseline CT-measurements or the initial PET-parameters were predictive for survival. Based on CT, after three cycles of therapy 10 patients were categorized as responders, 30 were classified as stable disease and 1 had progressive disease. Based on PET-evaluation, 14 responders were identified, 23 patients with stable disease and 4 patients were progressive. CT-response after 3 cycles of chemotherapy was significantly related to overall survival (p=0.001). However, neither SUVmax-response (p=0.61) nor SUVmean-response (p=0.68) were related to survival. A decrease of TLG and PETvol, however, was found to be predictive (TLG: p=0.01; PETvol: p=0.002).

Conclusion: Response evaluation based on modified RECIST by CT as well as response evaluation by TLG and PETvol in FDG-PET, but not SUVmax-measurements are predictive for survival in MPM.

In plain English

This study asked whether scans could predict survival in 41 patients with malignant pleural mesothelioma, a cancer of the lining around the lung. The patients were treated at University Hospital of Zürich from December 2002 until June 2004 with palliative pemetrexed chemotherapy combined with cisplatin or carboplatin. It did not study asbestos exposure. Patients had combined FDG-PET/CT scans, which show tumor size and the tumor's uptake of a sugar tracer. No measurement taken before treatment predicted survival. After three cycles, CT measurements using modified RECIST criteria classed 10 patients as responders, 30 as stable and 1 as progressing. This CT response was significantly related to overall survival (p = 0.001). Response measured by the highest (SUVmax) or average (SUVmean) PET uptake was not related to survival. A decrease in tumor lesion glycolysis (TLG), which combines tumor volume and uptake, and a decrease in PET tumor volume were predictive (p = 0.01 and p = 0.002). The authors concluded that CT response, TLG and PET volume, but not SUVmax, predicted survival. They said their newly proposed reduction categories need confirmation in a prospective trial.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Analysis of prospectively collected data on consecutive patients undergoing repeated FDG-PET/CT imaging during chemotherapy (imaging and survival study)
• Who was studied: 41 consecutive patients with biopsy-proven malignant pleural mesothelioma (MPM) treated at the University Hospital of Zürich, Switzerland, December 2002 to June 2004
• Exposure: Not an asbestos exposure study. Patients received palliative pemetrexed combined with cisplatin (14 patients) or carboplatin (27 patients) and were imaged with FDG-PET/CT at baseline and after three cycles
• Main results:
  • Baseline CT measurements and baseline PET parameters (SUVmax, SUVmean, TLG, PETvol) were not related to survival
  • By CT (modified RECIST) after three cycles: 10 responders, 30 stable disease, 1 progressive disease
  • By PET (EORTC criteria) after three cycles: 14 responders, 23 stable disease, 4 progressive
  • CT response by modified RECIST was significantly related to overall survival: p = 0.001, HR 3.07, 95% CI 1.52 to 6.21
  • SUVmax response (EORTC) was not related to overall survival: p = 0.61, HR 1.17, 95% CI 0.65 to 2.11. SUVmean response was also not related: p = 0.68, HR 0.92, 95% CI 0.62 to 1.37
  • A decrease in TLG (p = 0.01, HR 1.70, 95% CI 1.13 to 2.56) and in PETvol (p = 0.002, HR 1.92, 95% CI 1.28 to 2.88) was predictive of survival
  • Median survival for the whole group was 12.5 months
• The authors' conclusion: The authors concluded that response evaluation by CT using modified RECIST, and by TLG and PET volume on FDG-PET, was predictive of overall survival in MPM, while SUVmax was not
• Limitations the authors state:
  • No comparison of measurement variability within or between readers was performed
  • The newly proposed TLG and PETvol reduction categories need confirmation in a prospective trial
  • Talc pleurodesis can cause chronic inflammation that may alter PET measurements for years
  • Imaging at earlier time points than three cycles was not available

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Palliative Care, Pemetrexed (Alimta), Chemotherapy, Modified RECIST (mRECIST), Overall Survival.

Related studies

• Continued pemetrexed and platin-based chemotherapy in patients with malignant pleural mesothelioma (MPM): value of 18F-FDG-PET/CT — N.G. Schaefer, P. Veit-Haibach, et al. (2012)
• Combined chemotherapy with cytotoxic and targeted compounds for the management of human malignant pleural mesothelioma — R.E. Favoni, T. Florio (2011)
• Pemetrexed in the treatment of malignant mesothelioma: results from an expanded access program in Germany — M. Reck, R.A. Stahel, et al. (2010)
• Combined hyaluronate-based films loaded with pemetrexed and cisplatin for the treatment of malignant pleural mesothelioma: Preliminary evaluation in an orthotopic tumor recurrence model — F. Sonvico, S. Barbieri, et al. (2018)
• Metabolic response to pegylated arginine deiminase in mesothelioma with promoter methylation of argininosuccinate synthetase — P.W. Szlosarek, P. Luong, et al. (2013)
• Extrapleural pneumonectomy for malignant pleural mesothelioma: outcomes of treatment and prognostic factors — T.D. Yan, M. Boyer, et al. (2009)

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