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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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