Quantitative SSTR-PET/CT for predicting response and survival outcomes in patients with pancreatic neuroendocrine tumors receiving CAPTEM

Maria Ingenerf; Homeira Karim; Christoph Auernhammer; Matthias Zacherl; Vera Wenter; Michael Winkelmann; Jens Ricke; Frank Berger; Christine Schmid-Tannwald

doi:10.2478/raon-2023-0055

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Quantitative SSTR-PET/CT for predicting response and survival outcomes in patients with pancreatic neuroendocrine tumors receiving CAPTEM

Radiology and Oncology

Volume 57 (2023): Issue 4 (December 2023)

By: Maria Ingenerf, Homeira Karim, Christoph Auernhammer, Matthias Zacherl, Vera Wenter, Michael Winkelmann, Jens Ricke, Frank Berger and Christine Schmid-Tannwald

Open Access

|Nov 2023

Abstract

Background

This study aimed to evaluate the predictive and monitoring role of somatostatin receptor (SSTR) positron emission tomography-computed tomography (PET/CT) and clinical parameters in patients with neuroendocrine liver metastases (NELM) from pancreatic neuroendocrine tumors (pNET) receiving capecitabine and temozolomide (CAPTEM).

Patients and methods

This retrospective study included twenty-two patients with pNET and NELM receiving CAPTEM who underwent pre- and post-therapeutic ⁶⁸Ga-DOTATATE/-TOC PET/CT. Imaging (including standardized uptake value [SUV] of target lesions [NELM and pNET], normal spleen and liver) and clinical (Chromogranin A [CgA], Ki-67) parameters were assessed. Treatment outcome was evaluated as response according to RECIST 1.1, progression free survival (PFS) and overall survival (OS).

Results

The median PFS (mPFS) was 7 months. Responders had a significantly longer mPFS compared to non-responders (10 vs. 4 months p = 0.022). Median OS (mOS) was 33 months (mOS: responders = 80 months, non-responders = 24 months p = 0.182). Baseline imaging showed higher SUV in responders, including absolute SUV, tumor-to-spleen (T/S), and tumor-to-liver (T/L) ratios (p < 0.02). All SUV parameters changed only in the responders during follow-up. Univariable Cox regression analysis identified baseline Tmax/Smean ratio and percentage change in size of pNETs as significant factors associated with PFS. A baseline Tmax/Smean ratio < 1.5 was associated with a shorter mPFS (10 vs. 4 months, (p < 0.05)). Prognostic factors for OS included age, percentage change in CgA and in T/S ratios in univariable Cox regression.

Conclusions

SSTR-PET/CT can be useful for predicting response and survival outcomes in pNET patients receiving CAPTEM: Higher baseline SUV values, particularly Tmax/Smean ratios of liver metastases were associated with better response and prolonged PFS.

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Articles in this issue

DOI: https://doi.org/10.2478/raon-2023-0055 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 436 - 445

Submitted on: Jun 5, 2023

Accepted on: Sep 25, 2023

Published on: Nov 30, 2023

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

prognosis,

positron emission tomography–computed tomography,

neuroendocrine tumors,

capecitabine/temozolomide

Related subjects:

Medicine,

Clinical medicine,

Internal medicine,

Haematology, oncology,

Radiology

© 2023 Maria Ingenerf, Homeira Karim, Christoph Auernhammer, Matthias Zacherl, Vera Wenter, Michael Winkelmann, Jens Ricke, Frank Berger, Christine Schmid-Tannwald, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 57 (2023): Issue 4 (December 2023)