Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma

Lewin, Jeremy; Sayers, Louise; Kee, Damien; Walpole, Imogen; Sanelli, Alexandra; Marvelde, Luc te; Herschtal, Alan; Spillane, John; Gyorki, David E.; Speakman, David; Estall, Vanessa; Donahoe, Simon; Pohl, Miklos; Pope, Kathy; Chua, Margaret; Sandhu, Shahneen; McArthur, Grant A.; McCormack, Christopher; Henderson, Michael A.; Hicks, Rodney J.; Shackleton, Mark

doi:10.1093/annonc/mdy124

Cited by 47 publications

(46 citation statements)

References 26 publications

(44 reference statements)

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“…Although costly, Podlipnik et al concluded recently that 6‐monthly surveillance CT scans were cost‐effective in stages IIB, IIC, and III patients for the first 3 years after diagnosis. Of note, although uncommon, curable secondary malignancies may be incidentally discovered (reported 6% in a melanoma surveillance series with PET) during posttreatment serial imaging, which is an ancillary benefit …”

Section: Surveillance Modalitiesmentioning

confidence: 99%

“…There are few data on PET/CT in melanoma surveillance, and a wide range of opinions regarding utility have been published. Three recent retrospective reports, each with between 170 and 370 stage II or III patients, found an imaging surveillance regimen involving PET/CT detected 50% to 69% of recurrences, with median follow‐up ranging approximately 2 to 4 years . In another, a single PET/CT at a median of 7 months detected 24% of all recurrences .…”

Section: Surveillance Modalitiesmentioning

confidence: 99%

“…Indeed, survival is significantly improved if relapses are resectable . As approximately half of all recurrences detected on surveillance imaging involving PET/CT are amenable to potentially curative resection, a hypothetical survival benefit of follow‐up regimens exists but has not been definitively demonstrated . For those recurrences that are not resectable and treated with systemic therapy, median overall survival has been reported at just over one year .…”

Section: Surveillance Modalitiesmentioning

confidence: 99%

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Follow‐up of the melanoma patient

Deschner

Wayne

2018

Journal of Surgical Oncology

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Follow‐up of the melanoma patient involves many different methods of surveillance. Specific guidelines for modalities and frequency are flexible and largely open to physician preference. Patient education and self‐examination are generally viewed as crucial and cost‐effective for recurrence detection. Increased frequency of clinical follow‐up, laboratory studies, and imaging has not demonstrated survival benefit in surveillance. However, appropriate application of these different methods is controversial and evolving, especially with changing surgical management and new medical therapies.

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Section: Surveillance Modalitiesmentioning

confidence: 99%

Section: Surveillance Modalitiesmentioning

confidence: 99%

Section: Surveillance Modalitiesmentioning

confidence: 99%

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Follow‐up of the melanoma patient

Deschner

Wayne

2018

Journal of Surgical Oncology

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“…Blank et al suggested a 'cancer immunogram' wherein a combination of biomarkers such as tumoral mutational load, presence of T-cell checkpoints, soluble cytokines, metabolic factors and host immune factors should be considered. Here we explore how existing non-invasive functional imaging might provide a readily translatable source of novel biomarkers, given the current increase of 18 F-fluorodeoxyglucose positron emission tomography/computerised tomography (FDG PET/CT) in the surveillance of high-risk melanoma [12] or at suspected relapse [13]. 18 F-fluoro-deoxy-glucose positron emission tomography (FDG PET) has long been the preferred functional imaging technique in melanoma in our facility [14].…”

Section: Introductionmentioning

confidence: 99%

18F-FDG PET/CT based spleen to liver ratio associates with clinical outcome to ipilimumab in patients with metastatic melanoma

et al. 2020

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Background: Immune checkpoint blockade such as ipilimumab and anti-PD1 monoclonal antibodies have significantly improved survival in advanced melanoma. Biomarkers are urgently needed as a majority of patients do not respond, despite treatment-related toxicities. We analysed pre-treatment 18 F-fluorodeoxyglucose positron emission tomography/computerised tomography (FDG PET/CT) parameters to assess its correlation with patient outcome. Methods: This retrospective study evaluated pre-treatment FDG PET/CT scans in a discovery cohort of patients with advanced melanoma treated with ipilimumab or anti-PD1. Pre-treatment scans were assessed for maximum tumoral standardised uptake value (SUVmax), metabolic tumour volume (MTV) and spleen to liver ratio (SLR). Progression-free survival (PFS) and overall survival (OS) were characterised and modelled using univariable and multivariable analyses. Correlation of SLR and OS was validated in an independent cohort. Blood parameters and stored sera of patients from the discovery cohort was analysed to investigate biological correlates with SLR. Results: Of the 90 evaluable patients in the discovery cohort: 50 received ipilimumab monotherapy, 20 received anti-PD1 monotherapy, and 20 patients received ipilimumab followed by anti-PD1 upon disease progression. High SLR > 1.1 was associated with poor PFS (median 1 vs 3 months; HR 3.14, p = 0.008) for patients treated with ipilimumab. High SLR was associated with poor OS after ipilimumab (median 1 vs 21 months; HR 5.83, p = 0.0001); as well as poor OS after first line immunotherapy of either ipilimumab or anti-PD1 (median 1 vs 14 months; HR 3.92, p = 0.003). The association of high SLR and poor OS after ipilimumab was validated in an independent cohort of 110 patients (median 2.3 months versus 11.9 months, HR 3.74). SLR was associated with poor OS in a multi-variable model independent of stage, LDH, absolute lymphocyte count and MTV. Conclusions: Pre-treatment Spleen to liver ratio (SLR) > 1.1 was associated with poor outcome after ipilimumab in advanced melanoma. This parameter warrants prospective evaluation.

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“…This makes the population more heterogeneous and might influence the recurrence risk. It could be one reason for the slightly lower number of recurrences (30%) than the 38% reported in a recent published study that used routine, substage‐specific stage III PET/CT scanning schedule . Secondly, the present study cannot determine the exact survival gain associated with earlier stage IV diagnosis, or the effect of lead‐time bias.…”

Section: Discussionmentioning

confidence: 57%

S‐100B as an extra selection tool for FDG PET/CT scanning in follow‐up of AJCC stage III melanoma patients

Deckers

Wevers

Kobold

et al. 2019

Journal of Surgical Oncology

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Background and ObjectivesThis current study assessed the value of S‐100B measurement to guide fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scanning for detecting recurrent disease in stage III melanoma patients.MethodsThis study included 100 stage III melanoma patients in follow‐up after curative lymph node dissection. Follow‐up visits included physical examination and S‐100B monitoring. FDG PET/CT scanning was indicated by clinical symptoms and/or elevated S‐100B.ResultsOf 100 patients, 13 (13%) had elevated S‐100B without clinical symptoms, of whom 7 (54%) showed disease evidence upon FDG PET/CT scanning. Twenty‐six patients (26%) had clinical symptoms with normal S‐100B and FDG PET/CT revealed metastasis in 20 (77%). Three patients had clinical symptoms and elevated S‐100B, and FDG PET/CT revealed metastasis in all three (100%). Overall, FDG PET/CT scanning revealed metastasis in 30 of the 42 patients (71.4%). For seven recurrences, elevated S‐100B prompted early detection of asymptomatic disease; 10% of all asymptomatic patients in follow‐up, 23% of all patients with recurrent disease.ConclusionS‐100B cannot exclude recurrent disease during follow‐up of stage III melanoma. However, adding S‐100B measurement to standard clinical assessment can guide FDG PET/CT scanning for detecting recurrent melanoma.

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Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma

Abstract: Application of sub-stage-specific PET in stage 3 melanoma enables asymptomatic detection of most recurrences, has high NPVs that may provide patient reassurance, and is associated with a high rate of detection of resectable and potentially curable disease at relapse.

Cited by 47 publications

References 26 publications

Follow‐up of the melanoma patient

Follow‐up of the melanoma patient

18F-FDG PET/CT based spleen to liver ratio associates with clinical outcome to ipilimumab in patients with metastatic melanoma

S‐100B as an extra selection tool for FDG PET/CT scanning in follow‐up of AJCC stage III melanoma patients

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