Molecular Imaging and Biology

, Volume 22, Issue 1, pp 33–46 | Cite as

PET/CT-Based Response Evaluation in Cancer—a Systematic Review of Design Issues

  • Oke GerkeEmail author
  • Karen Ehlers
  • Edith Motschall
  • Poul Flemming Høilund-Carlsen
  • Werner Vach
Review Article


Positron emission tomography/x-ray computed tomography (PET/CT) has long been discussed as a promising modality for response evaluation in cancer. When designing respective clinical trials, several design issues have to be addressed, especially the number/timing of PET/CT scans, the approach for quantifying metabolic activity, and the final translation of measurements into a rule. It is unclear how well these issues have been tackled in quest of an optimised use of PET/CT in response evaluation. Medline via Ovid and Science Citation Index via Web of Science were systematically searched for articles from 2015 on cancer patients scanned with PET/CT before and during/after treatment. Reports were categorised as being either developmental or evaluative, i.e. focusing on either the establishment or the evaluation of a rule discriminating responders from non-responders. Of 124 included papers, 112 (90 %) were accuracy and/or prognostic studies; the remainder were response-curve studies. No randomised controlled trials were found. Most studies were prospective (62 %) and from single centres (85 %); median number of patients was 38.5 (range 5–354). Most (69 %) of the studies employed only one post-baseline scan. Quantification was mainly based on SUVmax (91 %), while change over time was most frequently used to combine measurements into a rule (79 %). Half of the reports were categorised as developmental, the other half evaluative. Most development studies assessed only one element (35/62, 56 %), most frequently the choice of cut-off points (25/62, 40 %). In summary, the majority of studies did not address the essential open issues in establishing PET/CT for response evaluation. Reasonably sized multicentre studies are needed to systematically compare the many different options when using PET/CT for response evaluation.

Key words

Cancer Positron emission tomography Response evaluation Study design SUVmax Systematic review 



The authors would like to express their gratitude to Claire Gudex (University of Southern Denmark) for proofreading the manuscript.

Compliance with Ethical Standards

For this type of study, formal consent is not required.

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11307_2019_1351_MOESM1_ESM.pdf (262 kb)
ESM 1 (PDF 261 kb)


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Copyright information

© World Molecular Imaging Society 2019

Authors and Affiliations

  1. 1.Department of Nuclear MedicineOdense University HospitalOdenseDenmark
  2. 2.Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
  3. 3.Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
  4. 4.Department of Orthopaedics and TraumatologyUniversity Hospital BaselBaselSwitzerland

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