Department of Dermatology, Eberhard-Karls-University Tuebingen, Liebermeisterstr. 25, 72076, Tübingen, Germany.
Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany.
Eur J Nucl Med Mol Imaging. 2017 Aug;44(8):1312-1318. doi: 10.1007/s00259-017-3674-8. Epub 2017 Mar 18.
To evaluate the influence of F-FDG-PET/CT on clinical decision making and outcome in advanced melanoma patients planned for radical metastasectomy.
A cohort of 333 patients with mainly stage III/IV melanoma having a PET/CT for clinical reasons was prospectively enrolled in our oncologic PET/CT registry between 2013 and 2015. Referring physicians completed questionnaires regarding their intended management for each patient before and after PET/CT. Management changes after PET/CT were classified as major and minor changes. A subgroup of 107 patients (stage I, N = 5; stage II, N = 3; stage III, N = 42; stage IV, N = 57) was planned for complete metastasectomy initially, based on conventional imaging. Management changes and outcome were evaluated by linkage with the information obtained from patients' medical records.
In 28 of 107 patients (26%), the surgical treatment plan remained unchanged after PET/CT. In 24 patients (22%), minor changes were performed, such as enlargement or reduction of the surgical field. In 55 patients (51%, 95% CI 42%-61%) major changes of the intended treatment plan occurred; of those, 20 patients (19%) were classified to be tumor-free with PET/CT, 32 patients (30%) were found to have multiple previously unrecognized metastases and had to be treated by systemic therapy, three patients (3%) had to be changed to palliative radiotherapy or isolated extremity perfusion. The 1-year and 2-year overall survival (OS) in patients with complete metastasectomy (N = 52) was 90% and 79%, respectively. Systemically treated patients (N = 32) resulted in 1-year OS of 72% and 2-year OS of 61%. Eleven of 32 patients (34%) with systemic therapy experienced a complete response. Until December 2016, all 20 patients classified as tumor-free by PET/CT were alive.
The study confirms the high impact of PET/CT on clinical management in patients with advanced melanoma planned for radical metastasectomy. PET/CT resulted in frequent management changes, preventing futile surgery in half of the patients.
评估 F-FDG-PET/CT 对计划进行根治性转移切除术的晚期黑色素瘤患者的临床决策和预后的影响。
2013 年至 2015 年期间，我们前瞻性地将主要为 III/IV 期黑色素瘤的 333 例患者纳入肿瘤 FDG-PET/CT 登记处，这些患者因临床原因进行了 PET/CT 检查。参考医生在 PET/CT 检查前后为每位患者完成了关于其治疗计划的问卷调查。PET/CT 后管理的变化分为主要变化和次要变化。根据常规影像学检查，最初计划对 107 例患者（I 期 N=5；II 期 N=3；III 期 N=42；IV 期 N=57）进行完全转移切除术。通过与患者病历中获得的信息进行链接，评估管理变化和结果。
在 107 例患者中，28 例（26%）患者的手术治疗计划在 PET/CT 后保持不变。在 24 例（22%）患者中，进行了次要变化，例如手术范围的扩大或缩小。在 55 例（51%，95%CI 42%-61%）患者中，发生了主要治疗计划的变化；其中，20 例（19%）患者被 PET/CT 诊断为无肿瘤，32 例（30%）患者被发现有多个先前未识别的转移灶，需要接受系统治疗，3 例（3%）患者需要改为姑息性放疗或孤立肢体灌注。接受完全转移切除术的患者（N=52）的 1 年和 2 年总生存率（OS）分别为 90%和 79%。接受系统治疗的患者（N=32）的 1 年 OS 为 72%，2 年 OS 为 61%。32 例接受系统治疗的患者中，11 例（34%）达到完全缓解。截至 2016 年 12 月，所有 20 例被 PET/CT 诊断为无肿瘤的患者均存活。
该研究证实了 PET/CT 对计划进行根治性转移切除术的晚期黑色素瘤患者的临床管理具有重大影响。PET/CT 导致频繁的管理变化，使一半的患者避免了无效的手术。
