DOI: 10.1007/s00259-018-3961-zPages: 1224-1232

18F-FDG-PET/CT based total metabolic tumor volume change during neoadjuvant chemotherapy predicts outcome in advanced epithelial ovarian cancer

1. University of Turku and Turku University Hospital, Department of Obstetrics and Gynecology

2. University of Turku and Turku University Hospital, Department of Clinical Physiology and Nuclear Medicine, Turku PET Centre

3. Sao Joao Hospital Centre, Department of Nuclear Medicine

4. University of Turku, Center of Statistics and Department of Clinical Medicine

5. Turku University Hospital, Clinical Research Centre

6. Satakunta Central Hospital, Department of Obstetrics and Gynecology

7. University of Turku and Turku University Hospital, Medical Imaging centre of Southwest Finland

8. University of Tampere and Tampere University Hospital, Department of Obstetrics and Gynecology

Correspondence to:
Tuulia Vallius
Tel: +358 2 3130000
Email: tuulia.vallius@utu.fi

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Abstract

Objective

To evaluate the predictive potential of total metabolic tumor volume (MTV) reduction during neoadjuvant chemotherapy (NACT) with 18F–FDG-PET/CT in an advanced FIGO stage III/IV epithelial ovarian cancer (EOC) patient cohort.

Methods

Twenty-nine primarily inoperable EOC patients underwent 18F–FDG-PET/CT before and after NACT. The pre- and post-NACT total MTV, in addition to the percentage MTV reduction during NACT, were compared with primary therapy outcome and progression-free survival (PFS). ROC-analysis determined an optimal threshold for MTV reduction identifying patients with progressive or stable disease (PD/SD) at the end of primary therapy. A multivariate analysis with residual tumor (0/>0), FIGO stage (III/IV) and MTV reduction compared to PFS was performed. The association between MTV reduction and overall survival (OS) was evaluated.

Results

The median pre- and post-NACT total MTV were 352 cm3 (range 150 to 1322 cm3) and 51 cm3 (range 0 to 417 cm3), respectively. The median MTV reduction during NACT was 89% (range 24% to 100%). Post-NACT MTV and MTV reduction associated with primary therapy outcome (MTV post-NACT p = 0.007, MTV reduction p = 0.001) and PFS (MTV post-NACT p = 0.005, MTV reduction p = 0.005). MTV reduction <85% identified the PD/SD patients (sensitivity 70%, specificity 78%, AUC 0.79). In a multivariate analysis, MTV reduction (p = 0.002) and FIGO stage (p = 0.003) were statistically significant variables associated with PFS. MTV reduction during NACT corresponded to OS (p = 0.05).

Conclusion

18F–FDG-PET/CT is helpful in NACT response evaluation. Patients with total MTV reduction <85% during NACT might be candidates for second-line chemotherapy and clinical trials, instead of interval debulking surgery.

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  • Accepted: Jan 24, 2018
  • Online: Feb 23, 2018

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