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3 '-Deoxy-3 '-18F-fluorothymidine positron emission tomography as an early predictor of disease progression in patients with advanced and metastatic pancreatic cancer

Lookup NU author(s): Dr Rachel Pearson, Elizabeth Howell, Dr Kate Sumpter


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Purpose 3'-Deoxy-3'-F-18-fluorothymidine (FLT) positron emission tomography (PET) has limited utility in abdominal imaging due to high physiological hepatic uptake of tracer. We evaluated FLT PET/CT combined with a temporal-intensity information-based voxel-clustering approach termed kinetic spatial filtering (FLT PET/CTKSF) for early prediction of response and survival outcomes in locally advanced and metastatic pancreatic cancer patients receiving gemcitabine-based chemotherapy.Methods Dynamic FLT PET/CT data were collected before and 3 weeks after the first cycle of chemotherapy. Changes in tumour FLT PET/CT variables were determined. The primary end point was RECIST 1.1 response on contrast-enhanced CT after 3 months of therapy.Results Twenty patients were included. Visual distinction between tumours and normal pancreas was seen in FLT PETKSF images. All target lesions (> 2 cm), including all primary pancreatic tumours, were visualised. Of the 11 liver metastases, 3 (< 2 cm) were not visible after kinetic filtering. Of the 20 patients, 7 progressed (35 %). Maximum standardised uptake value at 60 min post-injection (SUV60,max) significantly increased in patients with disease progression (p = 0.04). Receiver-operating characteristic curve analysis indicated that a threshold of SUV60,max increase of a parts per thousand yenaEuro parts per thousand 12 % resulted in sensitivity, specificity and positive predictive value (PPV) of 71, 100 and 100 %, respectively [area under the curve (AUC) 0.90, p = 0.0001], to predict patients with disease progression. Changes in SUV60,max were not predictive of survival.Conclusion FLT PET/CT detected changes in proliferation, with early increase in SUV60,max predicting progressive disease with a high specificity and PPV. Therefore, FLT PET/CT could be used as an early response biomarker for gemcitabine-based chemotherapy, to select a poor prognostic group who may benefit from novel therapeutic agents in advanced and metastatic pancreatic cancer.

Publication metadata

Author(s): Challapalli A, Barwick T, Pearson RA, Merchant S, Mauri F, Howell EC, Sumpter K, Maxwell RJ, Aboagye EO, Sharma R

Publication type: Article

Publication status: Published

Journal: European Journal of Nuclear Medicine and Molecular Imaging

Year: 2015

Volume: 42

Issue: 6

Pages: 831-840

Print publication date: 01/05/2015

Online publication date: 12/02/2015

Acceptance date: 16/01/2015

ISSN (print): 1619-7070

ISSN (electronic): 1619-7089

Publisher: Springer


DOI: 10.1007/s00259-015-3000-2


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Funder referenceFunder name
Joint Cancer Research-UK (CRUK)
National Institute for Health Research Biomedical Research Centre
Engineering and Physical Sciences Research Council Cancer Imaging Centre, Imperial College London (ICL)
10348Cancer Research UK
12011Cancer Research UK
16584Cancer Research UK
10337Cancer Research UK
C2536/A10337Department of Health
C29821/A10348CRUK Award
C37/A7283Experimental Cancer Medicine Centres'
MC-A652-5PY80UK Medical Research Council (MRC)
MR/J007986/1Medical Research Council
NIHR/CS/009/009National Institute for Health Research