Abstract
To assess the predictive and prognostic aim of interim and end-treatment 18F-fluorocholine PET/CT (FCH-PET/CT) and 99mTc-methilen diphosphonate bone scintigraphy (BS) in patients with castration-resistant prostate cancer and bone metastases (CRPC-BM) treated with Radium 223 dichloride (223Ra). Prospective and multicentre ChoPET-Rad study including 82 patients with CRPC-BM. Baseline, after 3 (interim) and 6 doses (end-treatment) BS and FCH PET/CT were performed in patients who meet the study criteria. Clinical variables, imaging and clinical progression were obtained and their association with progression free survival (PFS), and overall survival (OS) was studied. Agreement between BS and FCH PET/CT response was assessed using Kappa (K) analysis. Median of PFS and OS was 3 and 16 months, respectively. Agreement between interim BS and FCH PET/CT was weak (K: 0.28; p = 0.004). No agreement was observed between end-treatment diagnostic studies. Interim and end-treatment FCH PET/CT were related to PFS (p = 0.011 and p < 0.001, respectively). Therapeutic failure and interim BS and FCH PET/CT showed association with OS (p < 0.001, p = 0.037 and p = 0.008, respectively). Interim and end-treatment FCH PET/CT were good predictors of biochemical progression in patients treated with 223Ra. Therapeutic failure and progression in interim BS or FCH PET/CT were adverse factors for OS.
Highlights
To assess the predictive and prognostic aim of interim and end-treatment 18F-fluorocholine PET/computed tomography (CT) (FCH-PET/CT) and 99mTc-methilen diphosphonate bone scintigraphy (BS) in patients with castrationresistant prostate cancer and bone metastases (CRPC-BM) treated with Radium 223 dichloride (223Ra)
In clinical practice, monitoring of treatment with 223Ra is based on clinical and biochemical markers, being the role of imaging not well documented, with few works regarding to bone scintigraphy (BS) and computed tomography (CT), and only case reports for positron emission tomography/computed tomography using radiolabeled choline analogues[5,6,7,8,9,10,11,12]
Evaluation of the clinical and hematological conditions dismissed 16 cases: four for hematological constraints, five attending to FCH PET/CT results consisted on metastatic disease in three patients and two with locorregional invasiveness, three for diffuse bone marrow involvement defined by BS and/or FCH PET/CT, one for a probably second primary tumor without a definite diagnosis, two for clinical deterioration with Eastern Cooperative Oncology Group (ECOG) > 2 and one for medullar compression days previous to 223Ra initiation
Summary
To assess the predictive and prognostic aim of interim and end-treatment 18F-fluorocholine PET/CT (FCH-PET/CT) and 99mTc-methilen diphosphonate bone scintigraphy (BS) in patients with castrationresistant prostate cancer and bone metastases (CRPC-BM) treated with Radium 223 dichloride (223Ra). In clinical practice, monitoring of treatment with 223Ra is based on clinical and biochemical markers, being the role of imaging not well documented, with few works regarding to bone scintigraphy (BS) and computed tomography (CT), and only case reports for positron emission tomography/computed tomography using radiolabeled choline analogues (choline-PET/CT)[5,6,7,8,9,10,11,12]. Based on: (1) the limited experience about the use of 18F-Fluorocholine (FCH) PET/CT, BS and CT in patients treated with 223Ra and (2) the reduced accuracy of BS and CT in the response assessment in patients with CRPCBM a prospective and multicentre study was designed to assess the value of FCH PET/CT and BS in the response
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