Impact of 18F-FDG-PET/CT on surgical management in patients with advanced melanoma: an outcome based analysis

Eur J Nucl Med Mol Imaging. 2017 Aug;44(8):1312-1318. doi: 10.1007/s00259-017-3674-8. Epub 2017 Mar 18.

Abstract

Purpose: To evaluate the influence of 18F-FDG-PET/CT on clinical decision making and outcome in advanced melanoma patients planned for radical metastasectomy.

Methods and materials: A cohort of 333 patients with mainly stage III/IV melanoma having a PET/CT for clinical reasons was prospectively enrolled in our oncologic PET/CT registry between 2013 and 2015. Referring physicians completed questionnaires regarding their intended management for each patient before and after PET/CT. Management changes after PET/CT were classified as major and minor changes. A subgroup of 107 patients (stage I, N = 5; stage II, N = 3; stage III, N = 42; stage IV, N = 57) was planned for complete metastasectomy initially, based on conventional imaging. Management changes and outcome were evaluated by linkage with the information obtained from patients' medical records.

Results: In 28 of 107 patients (26%), the surgical treatment plan remained unchanged after PET/CT. In 24 patients (22%), minor changes were performed, such as enlargement or reduction of the surgical field. In 55 patients (51%, 95% CI 42%-61%) major changes of the intended treatment plan occurred; of those, 20 patients (19%) were classified to be tumor-free with PET/CT, 32 patients (30%) were found to have multiple previously unrecognized metastases and had to be treated by systemic therapy, three patients (3%) had to be changed to palliative radiotherapy or isolated extremity perfusion. The 1-year and 2-year overall survival (OS) in patients with complete metastasectomy (N = 52) was 90% and 79%, respectively. Systemically treated patients (N = 32) resulted in 1-year OS of 72% and 2-year OS of 61%. Eleven of 32 patients (34%) with systemic therapy experienced a complete response. Until December 2016, all 20 patients classified as tumor-free by PET/CT were alive.

Conclusion: The study confirms the high impact of PET/CT on clinical management in patients with advanced melanoma planned for radical metastasectomy. PET/CT resulted in frequent management changes, preventing futile surgery in half of the patients.

Keywords: Melanoma; Metastases; PET/CT; Surgery; Survival.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Biomarkers, Tumor / metabolism
  • Female
  • Fluorodeoxyglucose F18*
  • Humans
  • Male
  • Melanoma / diagnostic imaging
  • Melanoma / metabolism
  • Melanoma / pathology*
  • Melanoma / surgery*
  • Metastasectomy*
  • Middle Aged
  • Neoplasm Staging
  • Positron Emission Tomography Computed Tomography*
  • Survival Analysis
  • Treatment Outcome

Substances

  • Biomarkers, Tumor
  • Fluorodeoxyglucose F18