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Open Access 01-02-2019 | Original Article

Volumetric and texture analysis of pretherapeutic ¹⁸F-FDG PET can predict overall survival in medullary thyroid cancer patients treated with Vandetanib

Authors: Rudolf A. Werner, Ralph A. Bundschuh, Takahiro Higuchi, Mehrbod S. Javadi, Steven P. Rowe, Norbert Zsótér, Matthias Kroiss, Martin Fassnacht, Andreas K. Buck, Michael C. Kreissl, Constantin Lapa

Published in: Endocrine | Issue 2/2019

Abstract

Purpose

The metabolically most active lesion in 2-deoxy-2-(¹⁸F)fluoro-D-glucose (¹⁸F-FDG) PET/CT can predict progression-free survival (PFS) in patients with medullary thyroid carcinoma (MTC) starting treatment with the tyrosine kinase inhibitor (TKI) vandetanib. However, this metric failed in overall survival (OS) prediction. In the present proof of concept study, we aimed to explore the prognostic value of intratumoral textural features (TF) as well as volumetric parameters (total lesion glycolysis, TLG) derived by pre-therapeutic ¹⁸F-FDG PET.

Methods

Eighteen patients with progressive MTC underwent baseline ¹⁸F-FDG PET/CT prior to and 3 months after vandetanib initiation. By manual segmentation of the tumor burden at baseline and follow-up PET, intratumoral TF and TLG were computed. The ability of TLG, imaging-based TF, and clinical parameters (including age, tumor marker doubling times, prior therapies and RET (rearranged during transfection) mutational status) for prediction of both PFS and OS were evaluated.

Results

The TF Complexity and the volumetric parameter TLG obtained at baseline prior to TKI initiation successfully differentiated between low- and high-risk patients. Complexity allocated 10/18 patients to the high-risk group with an OS of 3.3 y (vs. low-risk group, OS = 5.3 y, 8/18, AUC = 0.78, P = 0.03). Baseline TLG designated 11/18 patients to the high-risk group (OS = 3.5 y vs. low-risk group, OS = 5 y, 7/18, AUC = 0.83, P = 0.005). The Hazard Ratio for cancer-related death was 6.1 for Complexity (TLG, 9.5). Among investigated clinical parameters, the age at initiation of TKI treatment reached significance for PFS prediction (P = 0.02, OS, n.s.).

Conclusions

The TF Complexity and the volumetric parameter TLG are both independent parameters for OS prediction.

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Title: Volumetric and texture analysis of pretherapeutic 18F-FDG PET can predict overall survival in medullary thyroid cancer patients treated with Vandetanib
Authors: Rudolf A. Werner
Ralph A. Bundschuh
Takahiro Higuchi
Mehrbod S. Javadi
Steven P. Rowe
Norbert Zsótér
Matthias Kroiss
Martin Fassnacht
Andreas K. Buck
Michael C. Kreissl
Constantin Lapa
Publication date: 01-02-2019
Publisher: Springer US
Published in: Endocrine / Issue 2/2019
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-018-1749-3

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Volumetric and texture analysis of pretherapeutic ¹⁸F-FDG PET can predict overall survival in medullary thyroid cancer patients treated with Vandetanib

Abstract

Purpose

Methods

Results

Conclusions

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Abstract

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