Department of Internal Medicine, Clinic for Medical Oncology, University Hospital Zurich, Switzerland.
Eur J Radiol. 2012 Jan;81(1):e19-25. doi: 10.1016/j.ejrad.2010.11.006. Epub 2010 Dec 3.
To prospectively analyze different FDG-PET/CT-parameters (modified RECIST, SUVmax, TLG, PETvol) in patients with malignant pleural mesothelioma (MPM) under continued pemetrexed and platin based treatment.
Patients with biopsy proven MPM undergoing treatment with pemetrexed and platin based treatment were prospectively included in the study. Integrated FDG-PET/CT imaging was performed within 2 weeks before therapy and after every three consecutive cycles of combined chemotherapy. All CT-images were evaluated according to the modified RECIST (modRECIST) criteria. All FDG-PET/CT images were analyzed using SUVmax (maximum Standard Uptake Value) according to the EORTC criteria, change in Total Lesion Glycolysis (TLG) and FDG volume (PETvol). Percent change in all parameters compared to the initial, pre-therapeutic and the previous FDG-PET/CT scan. ModRECIST, EORTC guidelines, increase or decrease in TLG and PETvol was correlated with overall survival (OS) using the Log Rank Test.
41 patients with MPM were prospectively included in this study. The median OS of the study population is 439 days (111-1128). 41 patients had initial staging, 41 patients completed 3 cycles, 28 patients completed 6 cycles, 19 patients completed 9 cycles, 11 patients completed 12 cycles, 5 patients completed 15 cycles, 4 patients completed 18 cycles and 1 patient completed 21 cycles of chemotherapy. Chemotherapy was well tolerated up to 21 cycles. SUVmax showed a high variance over time for individual patients and change in SUVmax using EORTC guidelines did not predict OS at any time point. Ongoing morphological response in CT using modRECIST had highest correlation with OS and predicted survival up to the 15th cycle of continued permetrexed and platin based treatment. The correlations of response of the volume based PET parameters (TLG and PETvol) and OS are inferior to the morphological modRECIST parameter.
Permetrexed and platin based treatment in MPM patients can be given over a prolonged time with good tolerance. Therapy response should be assessed by modRECIST in CT but not with SUVmax in FDG-PET. Long term permetrexed and platin therapy should be considered in MPM patients with good tolerance of treatment and ongoing morphological response in CT.
前瞻性分析恶性胸膜间皮瘤（MPM）患者在继续培美曲塞和铂类治疗下不同的 FDG-PET/CT 参数（改良 RECIST、SUVmax、TLG、PETvol）。
本研究前瞻性纳入经活检证实的 MPM 患者，接受培美曲塞和铂类联合治疗。在治疗前 2 周内和连续 3 个周期联合化疗后进行整合 FDG-PET/CT 成像。所有 CT 图像均根据改良 RECIST（modRECIST）标准进行评估。所有 FDG-PET/CT 图像均根据 EORTC 标准使用 SUVmax（最大标准摄取值）、总病变糖酵解（TLG）和 FDG 体积（PETvol）进行分析。与初始、治疗前和前一次 FDG-PET/CT 扫描相比，所有参数的百分比变化。使用 Log Rank 检验将 modRECIST、EORTC 指南、TLG 和 PETvol 的增加或减少与总生存期（OS）相关联。
本研究前瞻性纳入 41 例 MPM 患者。研究人群的中位 OS 为 439 天（111-1128）。41 例患者进行了初始分期，41 例患者完成了 3 个周期，28 例患者完成了 6 个周期，19 例患者完成了 9 个周期，11 例患者完成了 12 个周期，5 例患者完成了 15 个周期，4 例患者完成了 18 个周期，1 例患者完成了 21 个周期的化疗。化疗至 21 周期耐受性良好。SUVmax 随时间变化对个体患者具有较高的变异性，并且使用 EORTC 指南的 SUVmax 变化在任何时间点均不能预测 OS。使用 modRECIST 的 CT 持续形态学反应与 OS 相关性最高，并预测直至继续使用培美曲塞和铂类治疗的第 15 个周期的生存情况。基于体积的 PET 参数（TLG 和 PETvol）与 OS 的反应相关性低于形态学 modRECIST 参数。
在 MPM 患者中，培美曲塞和铂类联合治疗可以在良好的耐受性下延长时间。治疗反应应通过 CT 中的 modRECIST 进行评估，而不是 FDG-PET 中的 SUVmax。对于耐受性良好且 CT 中持续存在形态学反应的 MPM 患者，应考虑长期使用培美曲塞和铂类治疗。
