18F-FDG-PET/CT imaging as an Early Survival Predictor in Patients with Primary High Grade Soft Tissue Sarcomas undergoing Neoadjuvant Therapy
Menée sur 95 patients atteints d'un sarcome des tissus mous, cette étude évalue l'intérêt d'une tomographie par émissions de positons au 18F-fluorodésoxyglucose, après un premier cycle de chimiothérapie néoadjuvante, pour prédire la survie des patients
Purpose:Neoadjuvant therapy is associated with considerable toxicity and limited survival benefits in patients with soft tissue sarcoma (STS). We prospectively evaluated whether 18F-FDG PET/CT imaging after the initial cycle of neoadjuvant therapy could predict overall survival in these patients. Experimental Design:39 patients underwent 18F-FDG PET/CT prior to and after one cycle of neoadjuvant therapy. 56 patients underwent end of treatment PET. Overall survival was, among others, correlated with changes of SUVpeak and histopathology. Results:One-, two- and five-year survival rates were 95±3.0%, 86±4.6% and 68±6.6%, respectively. Median time to death was 30.9 months (mean: 27.7; range: 6.9 - 50.1). Optimal cut-offs for early and late decreases in SUV peak (26% and 57%, respectively) were significant predictors of survival in univariate survival analysis (p=0.041, HR=0.27 95%CI: 0.08 to 0.95, and p=0.045, HR=0.31 95%CI: 0.10 to 0.98). Seven/15 early PET non-responders but only 4/24 early PET responders died during follow up (p=0.068). The only other significant survival predictor was surgical margin positivity (p=0.041, HR 3.31 95%CI: 1.05 to 10.42). By multivariable analysis early metabolic response (p=0.016) and positivity of surgical margins (p=0.036) remained significant survival predictors. Conclusions:18F-FDG-PET predicted survival after the initial cycle of neoadjuvant chemotherapy in patients with STS and can potentially serve as an intermediate endpoint biomarker in clinical research and patient care.
Clinical Cancer Research , résumé, 2012