¹⁸F-FDG-PET/CT in malignant mesothelioma

Our plain-English summary of ¹⁸F-FDG-PET/CT in malignant mesothelioma, by C. Fuccio, E.G. Spinapolice, A. Ferretti, et al (Biomedicine & Pharmacotherapy = Biomédecine & Pharmacothérapie, 2013).

The study

• Authors: C. Fuccio, E.G. Spinapolice, A. Ferretti, P. Castellucci, M.C. Marzola, G. Trifirò, D. Rubello
• Journal: Biomedicine & Pharmacotherapy = Biomédecine & Pharmacothérapie
• Published: 2013;67(6):539-42
• Type of article: Review
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

It is well known the useful role of ¹⁸F-FDG-PET/CT for differential diagnosis between benign and malignant disease, for staging, for monitoring response and for prognosis regarding mesothelioma. Recently, literature was enriched with new interesting studies regarding the potential applications of ¹⁸F-FDG-PET/CT in this field. The purpose of this review is to evaluate articles published on line (PubMed) from January 2011 until October 2012 in order to obtain an overview of recent progress of molecular imaging in malignant mesothelioma. The main topics concern the use of ¹⁸F-FDG-PET/CT in radiation therapy planning, monitoring of treatment (surgery/chemotherapy) response and prognosis assessment.

Copyright © 2013 Elsevier Masson SAS. All rights reserved.

In plain English

This was a short review, not a new study. The authors reviewed PubMed articles from January 2011 to October 2012 on 18F-FDG-PET/CT, a scan showing tumour metabolic activity, in malignant mesothelioma. It did not study asbestos exposure. One reviewed study of 41 chemotherapy patients found that a CT-based measure (modified RECIST) correlated best with survival, while the PET measure SUVmax did not predict survival at any time point. A study of 14 radiotherapy patients reported 71% local control in the treated area. Another, of two groups of 12 patients given different PET-guided radiation plans, reported median survival from the start of radiotherapy of 8 and 20 months (P = 0.19), which does not establish a survival benefit. A review of eleven studies linked high uptake (SUV above 10) with shorter median survival than low uptake (9.7 vs. 21 months). A further study reported no difference in median survival between high and low uptake, though its medians were 26 and 19 months. The authors concluded that recent studies confirmed a central role for the scan in assessing treatment response and prognosis, and that it may help guide palliative radiotherapy.

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: narrative (short) review of recently published studies
• Who was studied: Studies of patients with malignant mesothelioma (mainly malignant pleural mesothelioma) published on PubMed from January 2011 to October 2012. Table 1 lists nine studies with 8 to 50 patients each. The text also discusses a review of eleven studies (Sharif et al.).
• Exposure: Not an exposure study. The subject is the imaging technique 18F-FDG-PET/CT, used for treatment response, radiotherapy planning and prognosis. Asbestos is mentioned only in the introduction, as the usual cause of mesothelioma.
• Main results:
  • Genestreti et al. [11] studied 8 patients treated with talc pleurodesis and chemotherapy. Under modified RECIST and EORTC criteria, radiological and PET responses agreed in 6 (75%) patients for SUVmean and in 3 (37.5%) for SUVmax.
  • Schaefer et al. [12] studied 41 patients on continued pemetrexed and platin chemotherapy. SUVmax did not predict overall survival at any time point. CT response by modified RECIST had the highest correlation with overall survival.
  • Feigen et al. [13] studied 14 patients with malignant pleural mesothelioma given 45 to 60 Gy radiotherapy. The in-field local control rate was 71%. Median survival was 25 months from diagnosis and 17 months from the start of radiotherapy.
  • Fodor et al. [14] studied two groups of 12 patients given different PET-guided tomotherapy plans. Group I received 56 Gy to the planning target volume. Group II received the same dose to the whole pleura plus a boost to 62.5 Gy on PET-positive areas. Median overall survival from the start of radiotherapy was 8 months in group I and 20 months in group II (P = 0.19). Grade 3 late pneumonitis occurred in three cases, all in group II.
  • Bille et al. [15] reported on the Guy's and St Thomas' trimodality protocol (25 patients per Table 1). 1-year survival was 54.5% and 2-year survival was 18.2%.
  • Sharif et al. [16], a review of eleven studies, reported that high SUV (above 10) was associated with shorter median survival than low SUV (below 10): 9.7 vs. 21 months, P = 0.02.
  • Gerbaudo et al. [17] studied patients with recurrent malignant pleural mesothelioma. Histologic type was the only independent predictor of progression-free survival. After recurrence, survival depended on the intensity of uptake and on PET nodal status.
  • Genestreti et al. [19] studied 27 patients and reported no difference in median survival between high and low SUVmax (26 vs. 19 months) or between high and low SUVmean (26 vs. 19 months).
• The authors' conclusion: The authors concluded that recent studies confirmed a central role for 18F-FDG-PET/CT in mesothelioma patients, particularly for assessing treatment response and prognosis. They added that it may also help guide high-dose palliative radiotherapy.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Differential Diagnosis, Staging, Prognosis, Mesothelioma, Chemotherapy.

Related studies

• Volume-based parameter of 18)F-FDG PET/CT in malignant pleural mesothelioma: prediction of therapeutic response and prognostic implications — H.Y. Lee, S.H. Hyun, et al. (2010)
• Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study — H. Yildirim, M. Metintas, et al. (2009)
• The association of 18F-FDG PET/CT parameters with survival in malignant pleural mesothelioma — A. Klabatsa, S. Chicklore, et al. (2014)
• Characterization of hypoxia in malignant pleural mesothelioma with FMISO PET-CT — R.J. Francis, T. Segard, et al. (2015)
• Prognostic value of 18F-FDG standard uptake value by integrated PET/CT in the staging of malignant pleural mesothelioma — G. Genestreti, A. Moretti, et al. (2012)
• Diagnostic Ability of FDG-PET/CT in the Detection of Malignant Pleural Effusion — R. Nakajima, K. Abe, et al. (2015)

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