Dittrich Daniela, Pyka Thomas, Scheidhauer Klemens, Lütje Susanne, Essler Markus, Bundschuh Ralph A
Klinik und Poliklinik für Nuklearmedizin, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
Zentrum für Radiologie und Nuklearmedizin, Klinikum Dritter Orden, Munich, Germany.
Nuklearmedizin. 2020 Jun;59(3):228-234. doi: 10.1055/a-1140-5458. Epub 2020 Apr 7.
Recently, textural parameters assessed in FDG-PET/CT as surrogate marker for tumor heterogeneity have been shown to provide prognostic power. Therefore, we investigated the use of such parameters in FDG-PET/CT examinations before the start of immunotherapy with vemurafenib or ipilimumab in patients with malignant melanoma.
In this retrospective analysis 26 patients with histologically proven advanced melanoma were included. FGD-PET/CT was performed before the start of treatment either with vemurafenib (n = 9) or ipilimumab (n = 17) and tumors were analyzed for textural parameters as well as conventional PET features. Lesions were classified as responding or not responding following PERCIST criteria. ROC analysis was performed to analyze the predictive power and cut-off values. In addition, the change of maximum SUV of the lesions between pretherapeutic PET/CT and another PET/CT performed about 12 weeks after start of treatment was evaluated and correlated with the pretreatment parameters.
In both groups, six textural parameters showed statistically significant predictive power as well as the metabolic tumor volume. In the group treated with vemurafenib eight additional textural parameters as well as the maximum and mean SUV and the TLG showed significance. A statistically significant correlation between the change of maximum SUV in the course of treatment and the pretherapeutic parameters was found in both treatment groups for three textural features.
In patients with malignant melanoma textural parameters in pretherapeutic FDG-PET/CT examinations seem to have prognostic power for treatment response of immunotherapy with vemurafenib and ipilimumab. This can be an important step towards personalized tumor therapy.
最近，在FDG-PET/CT中评估的纹理参数作为肿瘤异质性的替代标志物已显示出具有预后价值。因此，我们研究了这些参数在恶性黑色素瘤患者使用维莫非尼或伊匹木单抗进行免疫治疗开始前的FDG-PET/CT检查中的应用。
在这项回顾性分析中，纳入了26例经组织学证实的晚期黑色素瘤患者。在开始使用维莫非尼（n = 9）或伊匹木单抗（n = 17）治疗前进行了FDG-PET/CT检查，并对肿瘤的纹理参数以及传统PET特征进行了分析。根据PERCIST标准将病变分类为有反应或无反应。进行ROC分析以分析预测能力和临界值。此外，评估了治疗前PET/CT与治疗开始后约12周进行的另一次PET/CT之间病变最大SUV的变化，并将其与治疗前参数相关联。
在两组中，六个纹理参数以及代谢肿瘤体积均显示出统计学上的显著预测能力。在使用维莫非尼治疗的组中，另外八个纹理参数以及最大和平均SUV以及TLG具有显著性。在两个治疗组中，对于三个纹理特征，均发现治疗过程中最大SUV的变化与治疗前参数之间存在统计学上的显著相关性。
在恶性黑色素瘤患者中，治疗前FDG-PET/CT检查中的纹理参数似乎对维莫非尼和伊匹木单抗免疫治疗的反应具有预后价值。这可能是迈向个性化肿瘤治疗的重要一步。
