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DOI: 10.1055/a-1542-6211
Early response evaluation using 18F-FDG-PET/CT does not influence management of patients with metastatic gastrointestinal stromal tumors (GIST) treated with palliative intent
Evaluierung des frühen Ansprechens mit 18F-FDG-PET/CT hat keinen Einfluss auf das Management von Patienten mit metastasierten gastrointestinalen Stromatumoren (GIST) und palliativer BehandlungSupported by: Deciphera 4EE9EEC-7F19-484D-86A4-646CFE0950A5Supported by: Novartis 3017/13
Supported by: Pfizer WI189378
Research Grant was received for the Dutch GIST Registry. These funding sources did not have any involvement in the conduction of this research.
Abstract
Aim The aim of this study was to investigate the impact of 18F-FDG-PET/CT on treatment decision making in metastatic gastrointestinal stromal tumor (GIST) patients.
Methods This study retrospectively evaluated 18F-FDG-PET/CT scans to monitor response of metastatic GIST patients treated with palliative intent. Data from the Dutch GIST Registry was used. Early scans (<10 weeks after start of treatment) and late scans (>10 weeks after start of treatment) were scored on the impact in change of treatment.
Results Sixty-one PET/CT scans were performed for treatment evaluation in 39 patients with metastatic GIST of which 36 were early scans and 25 were late scans. Early PET/CT scans led to a change in management in 5.6% of patients and late PET/CT scans led to a change in management in 56% of patients. Change in management was more often seen after scans with lack of metabolic response (48% vs. 11% in scans with metabolic response, p=0.002). Neither metabolic response nor change in treatment were more often seen in patients with KIT mutations compared to patients with non-KIT mutations (metabolic response 65% KIT vs. 46% non-KIT, p=0.33, and change in management 28% KIT vs. 21% non-KIT, p=0.74).
Conclusion 18F-FDG-PET/CT is not recommended for early response evaluation in an unselected patient population with metastatic GIST, since it does not influence treatment decisions. 18F-FDG-PET/CT, however, can be useful for late response assessment, especially in case of indeterminate CT results.
Zusammenfassung
Ziel Das Ziel dieser Studie war es, den Einfluss der 18F-FDG-PET/CT auf die Behandlungsentscheidung bei Patienten mit metastasierten gastrointestinalen Stromatumoren (GIST) zu untersuchen.
Methoden Diese Studie wertete retrospektiv 18F-FDG-PET/CT-Aufnahmen aus, um das Ansprechen von Patienten mit metastasiertem GIST und palliativer Behandlung zu überwachen. Es wurden Daten aus dem niederländischen GIST-Register verwendet. Frühe Aufnahmen (<10 Wochen nach Beginn der Behandlung) und späte Aufnahmen (>10 Wochen nach Beginn der Behandlung) wurden hinsichtlich der Auswirkung auf eine Änderung der Behandlung bewertet.
Ergebnisse 61 PET/CT-Aufnahmen wurden zur Evaluation der Behandlung bei 39 Patienten mit metastasiertem GIST durchgeführt, von denen 36 frühe Aufnahmen und 25 späte Aufnahmen waren. Frühe PET/CT-Aufnahmen führten bei 5,6% der Patienten und späte PET/CT-Aufnahmen bei 56% der Patienten zu einer Änderung der Behandlung. Eine Änderung der Behandlung wurde häufiger nach Aufnahmen mit fehlendem metabolischem Ansprechen gefunden (48% vs. 11% bei Aufnahmen mit metabolischem Ansprechen; p=0,002). Weder metabolisches Ansprechen noch eine Änderung der Behandlung wurden bei Patienten mit KIT-Mutationen häufiger beobachtet als bei Patienten mit Nicht-KIT-Mutationen (metabolisches Ansprechen: 65% KIT vs. 46% Nicht-KIT, p=0,33; Änderung der Behandlung: 28% KIT vs. 21% Nicht-KIT, p=0,74).
Schlussfolgerung 18F-FDG-PET/CT wird nicht für die Evaluation des frühen Ansprechens in einer nichtselektierten Patientenpopulation mit metastasiertem GIST empfohlen, da es keinen Einfluss auf Behandlungsentscheidungen hat. 18F-FDG-PET/CT kann jedoch zur Beurteilung des späten Ansprechens nützlich sein, insbesondere bei unklaren CT-Ergebnissen.
Publication History
Received: 22 December 2020
Accepted after revision: 01 July 2021
Article published online:
03 September 2021
© 2021. Thieme. All rights reserved.
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