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Baseline 18F-Fluorocholine PET/CT and bone scan in the outcome prediction of patients treated with radium 223 dichloride

  • A. M. García Vicente
  • B. González García
  • M. Amo-Salas
  • I. García Carbonero
  • J. Cassinello Espinosa
  • J. L. Gómez-Aldaraví Gutierrez
  • L. Suarez Hinojosa
  • Á. Soriano Castrejón
Research Article

Abstract

Aim

To establish the utility of baseline 18F-Fluorocholine (FCH) PET/CT and bone scintigraphy (BS) in the outcome prediction of patients with castration-resistant prostate cancer and bone metastases (CRPC-BM) treated with 223Ra.

Methods

Prospective, multicenter and non-randomized study (ChoPET-Rad study). FCH PET/CT and BS were performed before the initiation of 223Ra (basal FCH PET/CT and BS). Bone disease was classified attending the number of lesions in baseline BS and PET/CT. FCH PET/CT was semiquantitatively evaluated. Gleason score, baseline levels of prostate-specific antigen (PSA), alkaline phosphatase and lactate dehydrogenase were determined. Progression-free survival (PFS) and overall survival (OS) since the onset of 223Ra treatment was calculated. PFS was defined by PSA rising. Relations between clinical and imaging variables with PFS and OS were evaluated by Pearson, Mann–Whitney tests and Kapplan–Meier analysis. Univariate and multivariate Cox regression analysis was performed.

Results

Forty patients were evaluated. The median PFS and OS were of 3.0 ± 2.3 and 23.0 ± 4.2 months, respectively. 33 patients progressed and 13 died during the follow-up. The extension of the bone disease by FCH PET/CT (p = 0.011, χ2 = 10.63), BS (p = 0.044, χ2 = 8.04), SUVmax (p = 0.012) and average SUVmax (p = 0.014) were related to OS. No significant association was found for the PFS. ROC analysis revealed significant association of SUVmax, average SUVmax and basal PSA with OS. Only therapeutic failure was associated with OS in the multivariate analysis (HR = 3.6, p = 0.04).

Conclusion

FCH PET/CT and BS had prognostic aim in the prediction of OS. None clinical or imaging variable was able to predict the PFS, probably due to the high rate of progressive disease.

Keywords

18F-Fluorocholine PET/CT Metastatic prostate cancer Bone scintigraphy 223Radium treatment Prognosis 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

Authors declare that they have no conflict of interest.

Animal and human participant rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2018

Authors and Affiliations

  • A. M. García Vicente
    • 1
  • B. González García
    • 1
  • M. Amo-Salas
    • 2
  • I. García Carbonero
    • 3
  • J. Cassinello Espinosa
    • 4
  • J. L. Gómez-Aldaraví Gutierrez
    • 5
  • L. Suarez Hinojosa
    • 6
  • Á. Soriano Castrejón
    • 1
  1. 1.Nuclear Medicine DepartmentUniversity General HospitalCiudad RealSpain
  2. 2.Departamento de MatemáticasUniversidad de Castilla La ManchaCiudad RealSpain
  3. 3.S. Oncología MédicaComplejo Hospitalario de ToledoToledoSpain
  4. 4.S. Oncología MédicaHospital Universitario de GuadalajaraGuadalajaraSpain
  5. 5.S. Oncología MédicaHospital Universitario de AlbaceteAlbaceteSpain
  6. 6.S. Oncología MédicaH. ManzanaresCiudad RealSpain

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