Journal
QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
Volume 66, Issue 4, Pages 361-371Publisher
EDIZIONI MINERVA MEDICA
DOI: 10.23736/S1824-4785.20.03238-0
Keywords
Somatostatin receptors; Positron emission tomography computed tomography; Tumor burden; Gallium Ga 68 dotatate; Radionu-clide imaging
Funding
- KlinStrucMed program of the Hannover Biomedical Research School (HBRS) at Hannover Medical School-Else Kroener-Fresenius
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Volumetric parameters derived from SSR-targeted PET/CT provide a quantitative imaging biomarker for whole-body tumor burden and may serve as a clear-cut measure for assessment of treatment response.
BACKGROUND: A quantitative imaging biomarker is desirable to provide a comprehensive measure of whole-body tumor burden in patients with metastatic neuroendocrine tumors, and to standardize the evaluation of treatment-related changes. Therefore, we evaluated volumetric parameters for quantification of whole-body tumor burden from somatostatin receptor (SSR)-targeted PET/CT. METHODS: Thirty-two patients with metastastic grade1/grade 2 gastroenteropancreatic neuroendocrine tumors who underwent a 68Ga-DO-TA-TATE PET/CT for staging of disease before initiation of peptide receptor radionuclide therapy were included in this retrospective cohort analysis. Volumetric parameters of tumor lesions, SSR-derived tumor volume (SSR-TV) and total lesion SSR (TL-SSR), were calculated for each patient using a computerized volumetric technique with a 40% SUVmax cut-off, and compared with serum chromogranin A (CgA) levels. Progression-free survival (PFS) was determined in relation to volumetric parameters. In a subgroup of 18 patients, the feasibility of volumetric parameters for treatment monitoring was evaluated. RESULTS: Mean SSR-TV was 178 +/- 214 cm3 (range, 9-797 cm3), whereas mean TL-SSR was 4096 +/- 5191 cm3 (range, 61-19,203 cm3). Base-line CgA levels were associated with whole-body tumor burden (SSR-TV, r=0.57, P=0.0008; and TL-SSR, r=0.43, P=0.01, respectively). PFS was shorter in patients with high SSR-TV and high TL-SSR (HR 5.16, 95% CI, 1.61-29.67), P=0.009), and SSR-TV (P=0.0067) and TL-SSR (P=0.0215) emerged as the sole predictors of progression in regression analysis. Changes in CgA did not correctly identify treatment response (P=0.25). CONCLUSIONS: SSR-derived volumetric parameters provide a quantitative imaging biomarker for whole-body tumor burden, and may hold potential as a clear-cut measure for assessment of treatment response.
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