18F-Fluoride PET/CT tumor burden quantification predicts survival in breast cancer

Brito, Ana Emília Teixeira; Santos, Allan O.; Sasse, André Deeke; Cabello, César; Oliveira, Paulo de; Mosci, Camila; Souza, Tiago Henrique de; Amorim, Bárbara Juarez; Lima, Mariana; Ramos, Celso Darío; Etchebehere, Elba

doi:10.18632/oncotarget.16418

Cited by 25 publications

(16 citation statements)

References 19 publications

(23 reference statements)

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“…The starkest differences occurred among lung cancer patients. Our findings that positive NaF PET assessed qualitatively is associated with lower survival rates are consistent with other published reports that have focused on the association between tumor burden assessed quantitatively by NaF PET and survival (20)(21)(22)(23)(24). We could find no similar research on admission to hospice.…”

Section: Discussionsupporting

confidence: 90%

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Hospice Admission and Survival After ¹⁸F-Fluoride PET Performed for Evaluation of Osseous Metastatic Disease in the National Oncologic PET Registry

et al. 2017

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We have previously reported that PET using F-fluoride (NaF PET) for assessment of osseous metastatic disease was associated with substantial changes in intended management in Medicare beneficiaries participating in the National Oncologic PET Registry (NOPR). Here, we use Medicare administrative data to examine the association between NaF PET results and hospice claims within 180 d and 1-y survival. We classified NOPR NaF PET results linked to Medicare claims by imaging indication (initial staging [IS]; detection of suspected first osseous metastasis [FOM]; suspected progression of osseous metastasis [POM]; or treatment monitoring [TM]) and type of cancer (prostate, lung, breast, or other). Results were classified as definitely positive scan findings versus probably positive scan findings versus negative scan findings for osseous metastasis for IS and FOM; more extensive disease versus no change or less extensive disease for POM; and worse prognosis versus no change or better prognosis for TM, based on the postscan assessment. Our study included 21,167 scans obtained from 2011 to 2014 of consenting NOPR participants aged 65 y or older. The relative risk of hospice claims within 180 d of a NaF PET scan was 2.0-7.5 times higher for patients with evidence of new or progressing osseous metastasis than for those without, depending on indication and cancer type (all < 0.008). The percentage difference in hospice claims for those with a finding of new or more advanced osseous disease ranged from 3.9% for IS prostate patients to 28% for FOM lung patients. Six-month survival was also associated with evidence of new or increased osseous disease; risk of death was 1.8-5.1 times as likely (all ≤ 0.0001), with percentage differences of approximately 30% comparing positive and negative scans in patients with lung cancer imaged for IS or FOM. Our analyses demonstrated that NaF PET scan results are highly associated with subsequent hospice claims and, ultimately, with patient survival. NaF PET provides important information on the presence of osseous metastasis and prognosis to assist patients and their physicians when making decisions on whether to select palliative care and transition to hospice or whether to continue treatment.

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Section: Discussionsupporting

confidence: 90%

“…Only a few small, single-center studies have evaluated the association between NaF PET results and cancer survival (20)(21)(22)(23)(24). The relative survivals reported in these studies were similar to those reported here, except for 2 studies (22,24) that reported differences of lesser magnitude, based on NaF PET results, than we found.…”

Section: Discussionsupporting

confidence: 84%

Hospice Admission and Survival After ¹⁸F-Fluoride PET Performed for Evaluation of Osseous Metastatic Disease in the National Oncologic PET Registry

et al. 2017

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“…Previous studies have shown that a baseline 18 F-fluoride PET/CT study plays a prognostic role in patients with breast or prostate cancer treated with 223 RaCl 2 ( 1 , 14 ) . However, 18 F-fluoride PET/CT is not traditionally used in evaluating the response to any therapy, because the process of bone healing involves an osteoblastic reaction than can increase 18 F-fluoride uptake, as in conventional bone scintigraphy ( 15 ) .…”

Section: Discussionmentioning

confidence: 99%

Is interim 18F-fluoride PET/CT a predictor of outcomes after radium-223 therapy?

Etchebehere

Brito

Kairemo³

et al. 2019

Radiol Bras

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ObjectiveTo determine whether an interim 18F-fluoride positron-emission tomography/computed tomography (PET/CT) study performed after the third cycle of radium-223 dichloride (223RaCl2) therapy is able to identify patients that will not respond to treatment.Materials and MethodsWe retrospectively reviewed 34 histologically confirmed cases of hormone-refractory prostate cancer with bone metastasis in patients submitted to 223RaCl2 therapy. All of the patients underwent baseline and interim 18F-fluoride PET/CT studies. The interim study was performed immediately prior to the fourth cycle of 223RaCl2. The skeletal tumor burden-expressed as the total lesion fluoride uptake above a maximum standardized uptake value of 10 (TLF10)-was calculated for the baseline and the interim studies. The percent change in TLF10 between the baseline and interim studies (%TFL10) was calculated as follows: %TFL10 = interim TLF10 - baseline TLF10 / baseline TLF10. End points were overall survival, progression-free survival, and skeletal-related events.ResultsThe mean age of the patients was 72.4 ± 10.2 years (range, 43.3-88.8 years). The %TLF10 was not able to predict overall survival (p = 0.6320; hazard ratio [HR] = 0.753; 95% confidence interval [CI]: 0.236-2.401), progression-free survival (p = 0.5908; HR = 1.248; 95% CI: 0.557-2.797) nor time to a bone event (p = 0.5114; HR = 1.588; 95% CI: 0.399-6.312).ConclusionThe skeletal tumor burden on an interim 18F-fluoride PET/CT, performed after three cycles of 223RaCl2, is not able to predict overall survival, progression-free survival, or time to bone event, and should not be performed to monitor response at this time.

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“…Semiautomatic quantification of wholebody skeletal tumor burden with 18 F-fluoride PET/CT (TLF 10 and FTV 10 ) has been shown to be a strong and independent prognostic biomarker in breast (6) and prostate (7,14) cancers. To the best of our knowledge, semiautomatic quantification of 18 Ffluoride PET/CT had not previously been validated for clinical use.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the determination of 18 F-fluoride PET/CT whole-body skeletal tumor burden is able to objectively assess response to treatment and is a better prognostic indicator than visual analysis (4,5). Investigators have demonstrated a prognostic role for 18 F-fluoride PET/CT in breast (6) and prostate (7) cancers. Therefore, quantitative parameters with 18 F-fluoride PET/CT can be important for clinical evaluation of patient outcome and for clinical trials, by eliminating subjectivity and assessing response to therapy.…”

mentioning

confidence: 99%

Validation of the Semiautomatic Quantification of ¹⁸F-Fluoride PET/CT Whole-Body Skeletal Tumor Burden

Brito

Mourato

Santos

et al. 2018

J. Nucl. Med. Technol.

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Our purpose was to validate a semiautomatic quantification of the skeletal tumor burden on F-fluoride PET/CT using manual quantification as a reference. We quantified 51 F-fluoride PET/CT examinations performed on female breast cancer patients. Clinical information (age; time of disease presentation; presence of visceral metastases; and time to death, progression, or a bone event) was recorded. The total volume ofF-fluoride-avid skeletal metastases and the total activity of F-fluoride-avid metastases were calculated manually and semiautomatically. Manual and semiautomatic metrics correlated strongly ( < 0.0001; 95% confidence interval, 0.9300-0.9769). On multivariable analysis, the semiautomatic measures of total activity for F-fluoride-avid metastasis correlated significantly with overall survival ( = 0.0001) and progression-free survival ( = 0.0006). Approximate times for calculating skeletal tumor burden (semiautomatic vs. manual) were, respectively, 30 s versus 321 s in patients with fewer than 5 metastases, 120 s versus 640 s in patients with 5-10 metastases, and 240 s versus 1207s in patients with more than 10 metastases. Semiautomatic quantification of whole-bodyF-fluoride PET/CT skeletal tumor burden can replace manual quantification in breast cancer patients and is a strong independent biomarker of prognosis.

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18F-Fluoride PET/CT tumor burden quantification predicts survival in breast cancer

Cited by 25 publications

References 19 publications

Hospice Admission and Survival After ¹⁸F-Fluoride PET Performed for Evaluation of Osseous Metastatic Disease in the National Oncologic PET Registry

Hospice Admission and Survival After ¹⁸F-Fluoride PET Performed for Evaluation of Osseous Metastatic Disease in the National Oncologic PET Registry

Is interim 18F-fluoride PET/CT a predictor of outcomes after radium-223 therapy?

Validation of the Semiautomatic Quantification of ¹⁸F-Fluoride PET/CT Whole-Body Skeletal Tumor Burden

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18F-Fluoride PET/CT tumor burden quantification predicts survival in breast cancer

Cited by 25 publications

References 19 publications

Hospice Admission and Survival After 18F-Fluoride PET Performed for Evaluation of Osseous Metastatic Disease in the National Oncologic PET Registry

Hospice Admission and Survival After 18F-Fluoride PET Performed for Evaluation of Osseous Metastatic Disease in the National Oncologic PET Registry

Is interim 18F-fluoride PET/CT a predictor of outcomes after radium-223 therapy?

Validation of the Semiautomatic Quantification of 18F-Fluoride PET/CT Whole-Body Skeletal Tumor Burden

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Hospice Admission and Survival After ¹⁸F-Fluoride PET Performed for Evaluation of Osseous Metastatic Disease in the National Oncologic PET Registry

Hospice Admission and Survival After ¹⁸F-Fluoride PET Performed for Evaluation of Osseous Metastatic Disease in the National Oncologic PET Registry

Validation of the Semiautomatic Quantification of ¹⁸F-Fluoride PET/CT Whole-Body Skeletal Tumor Burden