Volume-based parameter of 18)F-FDG PET/CT in malignant pleural mesothelioma: prediction of therapeutic response and prognostic implications

Our plain-English summary of Volume-based parameter of 18)F-FDG PET/CT in malignant pleural mesothelioma: prediction of therapeutic response and prognostic implications, by H.Y. Lee, S.H. Hyun, K.S. Lee, et al (Annals of Surgical Oncology, 2010).

The study

• Authors: H.Y. Lee, S.H. Hyun, K.S. Lee, B.T. Kim, J. Kim, Y.M. Shim, M.J. Ahn, T.S. Kim, C.A. Yi, M.J. Chung
• Journal: Annals of Surgical Oncology
• Published: 2010;17(10):2787-94
• Cited by: 140 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: To evaluate the importance of assessing volume-based parameter of (18)F-FDG PET/CT in patients with malignant pleural mesothelioma (MPM) for the prediction of response and patient outcome early in the course of treatment.

Materials And Methods: Patients (n = 13; M:F = 9:4, mean age, 54 years) with histopathologically proven MPM, all of whom were scheduled to undergo curative extrapleural pneumonectomy (EPP) or palliative chemotherapy, were included in this study. They were evaluated using integrated (18)F-FDG PET/CT at baseline. Maximum standardized uptake value (SUVmax), average SUV (SUVavg), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured using PET/CT data. Relationships between tumor progression and PET parameters were statistically analyzed.

Results: Of the 13 patients, 8 (62%) developed disease recurrence after surgery or tumor progression after chemotherapy (median follow-up, 329 days; range, 28-536 days). Between subgroups with and without tumor progression, significant differences were noted in MTV (P = 0.045). On ROC curve analysis, MTV (AUC = 0.850, 95% confidence interval [95% CI] 0.550-0.977) and TLG (AUC = 0.800, 95% CI 0.494-0.960) showed good predictive performance for tumor progression. Multivariate analysis adjusted for treatment modality showed that MTV (HR 1.003, P = 0.025) and TLG (HR 1.001, P = 0.031) were independent factors associated with tumor progression. Time to tumor progression was shorter in patients with a high volume-based parameter of PET than in those with a low value.

Conclusions: Volume-based parameters of (18)F-FDG PET/CT have the potential to provide prognostic information in MPM patients who are receiving surgery or palliative chemotherapy.

In plain English

This retrospective study from Samsung Medical Center in Seoul, Korea, asked whether measurements from a PET/CT scan taken before treatment could predict outcomes in malignant pleural mesothelioma. From a 2004–2008 biopsy database, 13 patients (9 men, 4 women, mean age 54) were included. Six had extrapleural pneumonectomy and seven had pemetrexed and cisplatin chemotherapy. The article did not report the patients' asbestos exposure. Over a median follow-up of 329 days, 8 of 13 patients (62%) were classified as non-responders. Metabolic tumor volume (MTV), the volume of metabolically active tumor, was higher in non-responders (mean 676.4) than in responders (mean 70.1; P = 0.045). After adjusting for treatment type, MTV and total lesion glycolysis (TLG) were each associated with tumor progression. Maximum and average uptake values were not significant predictors. Patients with high MTV or TLG had a shorter time to progression. The authors concluded that these volume measures have the potential to provide prognostic information. They noted the small sample, the retrospective design and the mixed treatments, and said a larger prospective study is needed.

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: retrospective study of PET/CT imaging measurements and treatment outcome
• Who was studied: 13 patients (9 men, 4 women, mean age 54) with histopathologically confirmed malignant pleural mesothelioma, drawn from 23 patients found in the surgical biopsy database of Samsung Medical Center, Seoul, Korea, between January 2004 and August 2008
• Exposure: No asbestos exposure information was reported. The study measured baseline 18F-FDG PET/CT values (SUVmax, SUVavg, metabolic tumor volume, total lesion glycolysis) taken before extrapleural pneumonectomy (6 patients) or pemetrexed/cisplatin chemotherapy (7 patients).
• Main results:
  • Of the 13 patients, 5 (38%) were classified as responders and 8 (62%) as non-responders. Non-responders were 3 of 6 surgery patients with recurrence and 5 of 7 chemotherapy patients with stable or progressive disease.
  • Mean MTV was 676.4 plus or minus 1019.6 in non-responders (n = 8) versus 70.1 plus or minus 85.4 in responders (n = 5), P = 0.045. The difference in TLG was marginal (P = 0.093), and SUVmax and SUVavg did not differ significantly.
  • In ROC analysis for predicting tumor progression, MTV had an AUC of 0.850 (95% CI 0.550–0.977) and TLG 0.800 (95% CI 0.494–0.960). SUVmax had an AUC of 0.575 (95% CI 0.282–0.833), which the authors called a poor predictor.
  • In univariate analysis, neither SUVmax (HR 1.080, P = 0.365) nor SUVavg (HR 0.575, P = 0.199) predicted tumor progression.
  • In multivariate analysis adjusted for treatment modality, MTV (HR 1.003, P = 0.025) and TLG (HR 1.001, P = 0.031) were independent factors associated with tumor progression.
  • Time to tumor progression was shorter in patients with TLG greater than 1250 SUV mL or MTV greater than 250 than in those with lower values (P = 0.009).
• The authors' conclusion: The authors concluded that volume-based 18F-FDG PET/CT parameters have the potential to provide prognostic information in patients receiving surgery or palliative chemotherapy, and that this remains to be validated in a larger prospective series.
• Limitations the authors state:
  • Retrospective design with possible selection bias
  • Small sample size and mixed treatment types may limit how widely the results apply
  • The threshold method for measuring metabolic volume is not standardized, and in a few patients with right diaphragmatic pleural lesions it was difficult to separate tumor from the liver
  • Too few non-epithelial cases to analyze the link between histologic subtype and outcome
  • Findings need validation in a larger prospective series

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, Extrapleural Pneumonectomy (EPP), Palliative Care, Chemotherapy, confidence interval, Multivariate Analysis.

Related studies

• 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)
• 18-Fluorodeoxyglucose positron emission tomography as a tool for response prediction in solid tumours — D.J. De Maeseneer, B. Lambert, et al. (2010)
• The association of 18F-FDG PET/CT parameters with survival in malignant pleural mesothelioma — A. Klabatsa, S. Chicklore, et al. (2014)
• Whole-Body MRI: Comparison of Its Capability for TNM Staging of Malignant Pleural Mesothelioma With That of Coregistered PET/MRI, Integrated FDG PET/CT, and Conventional Imaging — Y. Ohno, M. Yui, et al. (2019)
• 18F-FDG PET/CT in the management of patients with malignant pleural mesothelioma being considered for multimodality therapy: experience of a tertiary referral center — H.S. Elliott, U. Metser, et al. (2018)
• Integrated positron emission tomography-computed tomography does not accurately stage intrathoracic disease of patients undergoing trimodality therapy for malignant pleural mesothelioma — J. Pilling, J.A. Dartnell, et al. (2010)

Browse more research in Annals of Surgical Oncology, or return to medical research.