We report a high incidence of vascular abnormalities in children with craniopharyngioma. The data suggest that intracystic bleomycin may contribute to radiation-related vasculopathy. We now include magnetic resonance angiography as part of our routine follow up in these children.
Purpose
Metabolic response to treatment measured by FDG PET has prognostic implications in many cancers. This study investigated the association between survival and early changes on FDG PET/CT for patients with BRAF-mutant melanoma receiving combined BRAF and MEK inhibition therapy.
Material/Methods
24 patients with advanced BRAF-mutant melanoma were included. Patients were treated with a BRAF inhibitor (Vemurafenib or Dabrafenib) and a MEK inhibitor (Cobimetinib or Trametinib) and were imaged at baseline, and shortly thereafter with FDG PET/CT. Each scan yielded two values of SUVmax: one for the most metabolically active focus and one for the least responsive focus. Short-term treatment response was assessed by evaluating the target lesions using EROTC criteria. A Cox proportional hazards model was used to examine associations between overall survival (OS) and progression-free survival (PFS) and changes in SUVmax.
Results
Mean time to follow-up FDG PET/CT was 26 days. At follow-up, 2 patients had a complete response. For the most metabolically active focus, 22 patients had a partial response. For the least responsive focus, 18 patients had a partial response, 2 had stable disease, and 2 had progressive disease.
16 patients were living at the end of the study. For the most metabolically active tumor, no association was observed between changes in SUVmax and OS (p=0.73) or PFS (p=0.17). For the least responsive tumor, change in SUVmax was associated with PFS (HR=1.34, 95% CI: 1.06 to 1.71, p=0.01) but not OS (p=0.52). ECOG score was associated with OS (HR=11.81, 95% CI: 1.42 to 97.60, p=0.02) and PFS (HR=24.72, 95% CI: 3.23 to 189.42, p=0.002).
Conclusion
Change in SUVmax for the least responsive tumor and baseline functional performance may be useful prognostic indicators for progression-free survival in patients with BRAF-mutant melanoma.
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