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

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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.

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Authors and Affiliations

  1. Nuclear Medicine Department, University General Hospital, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain

    A. M. García Vicente, B. González García & Á. Soriano Castrejón

  2. Departamento de Matemáticas, Universidad de Castilla La Mancha, Ciudad Real, Spain

    M. Amo-Salas

  3. S. Oncología Médica, Complejo Hospitalario de Toledo, Toledo, Spain

    I. García Carbonero

  4. S. Oncología Médica, Hospital Universitario de Guadalajara, Guadalajara, Spain

    J. Cassinello Espinosa

  5. S. Oncología Médica, Hospital Universitario de Albacete, Albacete, Spain

    J. L. Gómez-Aldaraví Gutierrez

  6. S. Oncología Médica, H. Manzanares, Ciudad Real, Spain

    L. Suarez Hinojosa

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  1. A. M. García Vicente
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Correspondence to A. M. García Vicente.

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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.

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

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García Vicente, A.M., González García, B., Amo-Salas, M. et al. Baseline 18F-Fluorocholine PET/CT and bone scan in the outcome prediction of patients treated with radium 223 dichloride. Clin Transl Oncol 21, 289–297 (2019). https://doi.org/10.1007/s12094-018-1920-6

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  • DOI: https://doi.org/10.1007/s12094-018-1920-6

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