Rational use of 18F-FDG PET/CT in patients with advanced cutaneous melanoma: A systematic review

Bisschop, Kees; Heer, E. C. de; Brouwers, Adrienne H.; Hospers, Geke A.P.; Jalving, Mathilde

doi:10.1016/j.critrevonc.2020.103044

Cited by 35 publications

(33 citation statements)

References 125 publications

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“…The role of volumetric parameters in FDG-PET/CT as a predictive biomarker has been demonstrated in different types of cancers [5,[13][14][15][16][17]. The total metabolic tumor volume is a valuable parameter as it reflects the extent and activity of the tumor [18][19][20]. In this study, we calculated the TMTV in follow-up FDG-PET/CT 2-4 and 5-6 months after baseline PET/CT in patients with an advanced melanoma treated with Pembrolizumab.…”

Section: Discussionmentioning

confidence: 99%

Early Reassessment of Total Metabolic Tumor Volume on FDG-PET/CT in Advanced Melanoma Patients Treated with Pembrolizumab Predicts Long-Term Outcome

et al. 2021

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PD-1 Immune checkpoint inhibitors, such as Pembrolizumab, can have a durable beneficial therapeutic effect in patients with advanced melanoma. However, not all patients will benefit equally from these therapies, and (potentially life-threatening) immune-related adverse events may occur. In this study, we investigate the value of early response assessment by FDG-PET/CT as a biomarker for predicting survival. We identified all patients with advanced melanoma who were treated with Pembrolizumab in our medical center and underwent a baseline and at least one follow-up FDG-PET/CT. The total metabolic tumor volume (TMTV) was calculated, and the evolution was compared to survival parameters. A total of 77 patients underwent a baseline and at least one follow-up FDG-PET/CT, 36 patients had follow-up imaging within 2–4 months, and 21 patients an FDG-PET/CT 5–6 months after baseline. When the TMTV evolution was categorized into two subgroups (stable/decrease versus increase), an association was found between stability or decrease in TMTV and better PFS and OS. A similar trend, however non-significant, was observed at 5–6 months. The evolution in TMTV as assessed by FDG-PET/CT 2–4 months after treatment initiation is associated with long-term outcomes in patients with advanced melanoma treated with Pembrolizumab.

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Section: Discussionmentioning

confidence: 99%

Early Reassessment of Total Metabolic Tumor Volume on FDG-PET/CT in Advanced Melanoma Patients Treated with Pembrolizumab Predicts Long-Term Outcome

et al. 2021

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“…The first one is the search for other biomarker definitions accounting for the location of highest metabolic activity. Second, it would be interesting to test our findings in other tumor histologies, such as lymphoma or melanoma (58,59). PET is a mainstream technique, increasingly employed in clinics and in many…”

Section: Discussionmentioning

confidence: 98%

Evolutionary dynamics at the tumor edge reveal metabolic imaging biomarkers

Jiménez-Sánchez

Bosque

Londoño

et al. 2021

Proc. Natl. Acad. Sci. U.S.A.

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Human cancers are biologically and morphologically heterogeneous. A variety of clonal populations emerge within these neoplasms and their interaction leads to complex spatiotemporal dynamics during tumor growth. We studied the reshaping of metabolic activity in human cancers by means of continuous and discrete mathematical models and matched the results to positron emission tomography (PET) imaging data. Our models revealed that the location of increasingly active proliferative cellular spots progressively drifted from the center of the tumor to the periphery, as a result of the competition between gradually more aggressive phenotypes. This computational finding led to the development of a metric, normalized distance from 18F-fluorodeoxyglucose (18F-FDG) hotspot to centroid (NHOC), based on the separation from the location of the activity (proliferation) hotspot to the tumor centroid. The NHOC metric can be computed for patients using 18F-FDG PET–computed tomography (PET/CT) images where the voxel of maximum uptake (standardized uptake value [SUV]max) is taken as the activity hotspot. Two datasets of 18F-FDG PET/CT images were collected, one from 61 breast cancer patients and another from 161 non–small-cell lung cancer patients. In both cohorts, survival analyses were carried out for the NHOC and for other classical PET/CT-based biomarkers, finding that the former had a high prognostic value, outperforming the latter. In summary, our work offers additional insights into the evolutionary mechanisms behind tumor progression, provides a different PET/CT-based biomarker, and reveals that an activity hotspot closer to the tumor periphery is associated to a worst patient outcome.

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“…Although treatments do not influence baseline MATV measurements or correlations among the segmentation methods, the associations with survival might change. Furthermore, in the standard of care PET/CT acquisition a non-contrast-enhanced low-dose CT is obtained, which has a lower sensitivity than PET combined with contrast-enhanced CT for most metastatic locations [ 22 ]. Although this can have implications for lesion detection and management in specific clinical cases, it is highly unlikely that the PET-based MATV segmentations will change by non-contrast-enhanced vs. contrast-enhanced CT.…”

Section: Discussionmentioning

confidence: 99%

“…In brief, all adult patients with histologically proven cutaneous or mucosal metastatic melanoma (American Joint Committee on Cancer [AJCC] [10] 7th edition stage IV melanoma) without prior systemic treatment and with a baseline 18 F-FDG PET/CT scan performed between May 2014 and December 2015 with PET-positive lesions were included in the cohort. Patients also underwent a baseline contrast-enhanced diagnostic CT scan around the time of PET/CT scanning [22]. Patient and tumour characteristics were retrieved retrospectively from the electronic patient files (see Table 1 in [13] or Supplemental Table 1 for a modified version).…”

Section: Patient Populationmentioning

confidence: 99%

Clinically feasible semi-automatic workflows for measuring metabolically active tumour volume in metastatic melanoma

Sluis

Heer

Boellaard

et al. 2020

Eur J Nucl Med Mol Imaging

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Purpose Metabolically active tumour volume (MATV) is a potential quantitative positron emission tomography (PET) imaging biomarker in melanoma. Accumulating data indicate that low MATV may predict increased chance of response to immunotherapy and overall survival. However, metastatic melanoma can present with numerous (small) tumour lesions, making manual tumour segmentation time-consuming. The aim of this study was to evaluate multiple semi-automatic segmentation workflows to determine reliability and reproducibility of MATV measurements in patients with metastatic melanoma. Methods An existing cohort of 64 adult patients with histologically proven metastatic melanoma was used in this study. 18F-FDG PET/CT diagnostic baseline images were acquired using a European Association of Nuclear Medicine (EANM) Research Limited–accredited Siemens Biograph mCT PET/CT system (Siemens Healthineers, Knoxville, USA). PET data were analysed using manual, gradient-based segmentation and five different semi-automatic methods: three direct PET image–derived delineations (41MAX, A50P and SUV40) and two based on a majority-vote approach (MV2 and MV3), without and with (suffix ‘+’) manual lesion addition. Correlation between the different segmentation methods and their respective associations with overall survival was assessed. Results Correlation between the MATVs derived by the manual segmentation and semi-automated tumour segmentations ranged from R2 = 0.41 for A50P to R2 = 0.85 for SUV40+ and MV2+, respectively. Manual MATV segmentation did not differ significantly from the semi-automatic methods SUV40 (∆MATV mean ± SD 0.08 ± 0.60 mL, P = 0.303), SUV40+ (∆MATV − 0.10 ± 0.51 mL, P = 0.126), MV2+ (∆MATV − 0.09 ± 0.62 mL, P = 0.252) and MV3+ (∆MATV − 0.03 ± 0.55 mL, P = 0.615). Log-rank tests showed statistically significant overall survival differences between above and below median MATV patients for all segmentation methods with areas under the ROC curves of 0.806 for manual segmentation and between 0.756 [41MAX] and 0.807 [MV3+] for semi-automatic segmentations. Conclusions Simple and fast semi-automated FDG PET segmentation workflows yield accurate and reproducible MATV measurements that correlate well with manual segmentation in metastatic melanoma. The most readily applicable and user-friendly SUV40 method allows feasible MATV measurement in prospective multicentre studies required for validation of this potential PET imaging biomarker for clinical use.

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Rational use of 18F-FDG PET/CT in patients with advanced cutaneous melanoma: A systematic review

Cited by 35 publications

References 125 publications

Early Reassessment of Total Metabolic Tumor Volume on FDG-PET/CT in Advanced Melanoma Patients Treated with Pembrolizumab Predicts Long-Term Outcome

Early Reassessment of Total Metabolic Tumor Volume on FDG-PET/CT in Advanced Melanoma Patients Treated with Pembrolizumab Predicts Long-Term Outcome

Evolutionary dynamics at the tumor edge reveal metabolic imaging biomarkers

Clinically feasible semi-automatic workflows for measuring metabolically active tumour volume in metastatic melanoma

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