Diagnosis, Treatment Response and Prognosis. The role of 18F-DOPA PET/CT in children affected by Neuroblastoma in comparison with 123I-mIBG scan. The first prospective study

Arnoldo Piccardo, Giovanni Morana, Matteo Puntoni, Sara Campora, Sorrentino Stefania, Pietro Zucchetta, Martina Ugolini, Massimo Conte, Angelin Cistaro, Giulia Ferrarazzo, Marco Pescetto, Marco Lattuada, Gianluca Bottoni, Alberto Garaventa, Luca Giovanella, Egesta Lopci

Research output: Contribution to journalArticlepeer-review

Abstract

To evaluate the diagnostic role of 18F-DOPA PET/CT at the time of staging, in children with Neuroblastoma (NB) and to investigate its ability to assess treatment response. We also investigated the prognostic value of 18F-DOPA PET/CT at the same time-points. Methods: We enrolled children with NB at onset. Before and after induction chemotherapy, all patients underwent 18F-DOPA PET/CT and 123I-mIBG scan plus SPECT/CT. 18F-DOPA PET/CT results were compared with those of 123I-mIBG WBS. For each modality, patient-based (PBA) and lesion-based analyses (LBA) were performed and sensitivity was calculated. We applied scoring systems to 123I-mIBG scan and 18F-DOPA PET/CT (i.e.123I-mIBG whole body score (WBS) and whole-body metabolic burden (WBMB), respectively) and evaluated the association between these parameters, the principal NB risk-factors and outcome. Results: We enrolled 16 high- and 2 intermediate-risk NB patients. On PBA, the sensitivity of 123I-mIBG WBS and 18F-DOPA PET/CT in detecting primary tumours, soft tissue and bone/bone-marrow metastases was 83%, 50% and 92%, versus 94%, 92% and 100%, respectively. On LBA, the sensitivity of 18F-DOPA PET/CT in detecting soft tissue and bone/bone-marrow metastases was 86% and 99% - significantly higher than that of 123I-mIBG WBS: 41% and 93%. After therapy, on PBA, the sensitivity of 123I-mIBG WBS and 18F-DOPA PET/CT in detecting primary tumours, soft tissue and bone/bone-marrow metastases was 72%, 33% and 38%, versus 83%, 75% and 54%, respectively. On LBA, the sensitivity of 18F-DOPA PET/CT in detecting soft tissue and bone/bone-marrow metastases was 77% and 86% - significantly higher than that of 123I-mIBG WBS (28% and 69%). During follow-up, 8 cases of disease progression and 5 deaths occurred. On multivariate analysis, only post-therapeutic 18F-DOPA WBMB (>7.5) was associated to progression-free survival. Conclusion:18F-DOPA PET/CT is more sensitive than 123I-mIBG WBS in staging NB patients and evaluating disease persistence after chemotherapy. In a time-to-event analysis, post-therapeutic 18F-DOPA WBMB remained the only risk factor associated to disease progression.

Original languageEnglish
JournalJournal of Nuclear Medicine
DOIs
Publication statusE-pub ahead of print - Sep 20 2019

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