FDG PET-derived parameters as prognostic tool in progressive malignant pleural mesothelioma treated patients

E Incerti, S Broggi, A Fodor, M Cuzzocrea, AM Samanes Gajate, P Mapelli, C Fiorino, I Dell’Oca, M Pasetti, M Cattaneo, R Calandrino, L Gianolli, N Di Muzio, M Picchio

Research output: Contribution to journalArticlepeer-review


Purpose: The value of FDG PET-derived parameters in predicting overall survival (OS), local relapse-free survival (LRFS) and distant relapse-free survival (DRFS) in treated patients with malignant pleural mesothelioma (MPM) was evaluated. Methods: This retrospective evaluation included 55 MPM patients treated between March 2006 and February 2015 with FDG PET/CT-guided salvage helical tomotherapy (HTT) after previous surgery plus chemotherapy. Univariate Cox regression analysis was performed to assess the impact of the following FDG PET-derived parameters: biological target volume (BTV), mean and maximum standardized uptake values (SUVmean/max), metabolic tumour volume (MTV) and total lesion glycolysis (TLG), measured using different uptake thresholds (40%, 50% and 60%). Logistic regression was then performed to identify the best FDG PET-derived parameters for selecting patients with poorer survival. Results: The median OS was 9.1 months (range 0.0 – 69.6 months) after the end of HTT; 54/55 patients were dead at the last follow-up. BTV and TLG40, TLG50 and TLG60 were the most significant predictors of OS (p <0.005). The median OS was 4.8 months in patients with MTV60 >5 cm3and TLG40 >334.4, compared with 13.8 months and 16.1 months in patients with smaller values, respectively. The median LRFS and DRFS were 6.2 months (range 1.2 – 39.4 months) and 6.5 months (0.0 – 66.4 months), respectively. TLG40, TLG50 and TLG60 were significantly correlated with LRFS (p <0.015). Median DRFS was 6.4 months in patients with MTV40 >39.6 cm3and 6.2 months in patients with TLG40 >334.4, compared with 17 months and 18.8 months in patients with smaller values. BTV, TLG40 and MTV40 were also found to be good predictors in patients with poor OS/LRFS/DRFS (median survival times less than the median values). Conclusion: FDG PET-derived parameters effectively discriminated patients with a poor prognosis and may be helpful in the selection of MPM patients for salvage HTT. © 2018 Springer-Verlag GmbH Germany, part of Springer Nature
Original languageEnglish
Pages (from-to)2071-2078
Number of pages8
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Issue number12
Publication statusPublished - 2018


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