Retrospective web-based multicenter evaluation of ¹⁸F-FDG-PET and CT derived predictive factors

Summary

Aim: Although predictive factors (PF) for conventional lymphoma therapy are established and frequently used in clinical practice and medical research, the PF for radioimmunotherapy (RIT) have not been fully defined until now. The aim of this multicenter evaluation is to prove the feasibility of the multicenter web-based data collection and to preliminary explore imaging findings and prediction of therapy response in patients with follicular lymphoma (FL) following radioimmuno therapy (RIT) with ⁹⁰Y-ibritumomab tiuxetan. Patients, methods: We retrospectively analyzed and correlated clinical and imaging data (CT and FDG-PET) before and after RIT as documented by the RIT-Network. Evaluation of treatment response was done on both patient and lesion basis. Every measurable lesion was analyzed in terms of standardized uptake value (SUV), volume (CT and PET) and response. PF were identified using a uni- and multivariate model. A web-based system was used for the documentation and evaluation of clinical and imaging data. Results: 16 patients with at least one PET before and after RIT were eligible for analysis. Concerning response three months postRIT, 5 patients achieved a CR, 6 patients a PR and 4 patients remained with NC. A total of 159 lesions were measured (mean 10 ± 8). In the multivariate model the log lesion volume (p < 0.0001), the total (p = 0.03) and maximum lesion volume (p = 0.05) were predictors for response (CR + PR). Concerning the lesional CR initial small lesion volume (p = 0.009) and its high metabolic activity (p = 0.01) were identified as predictors. The web-based system showed no major disturbances allowing secure data transfer and central image interpretation in a reasonable time. Conclusion: The use of a web-based multicenter archiving system for clinical and imaging data is technically feasible in a multicenter setting and allows a central analysis. This preliminary analysis suggests that FDG-PET may predict the likelihood of response to RIT.

Zusammenfassung

Obwohl die prädiktiven Faktoren (PF) für die konventionelle Lymphomtherapie bekannt sind und häufig sowohl im klinischen Alltag als auch in der Forschung angewendet werden, sind diejenigen für die Radioimmuntherapie (RIT) dagegen nicht hinreichend belegt. Ziel dieser multizentrischen Evaluation ist die Umsetzbarkeit der netzbasierten Datenerhebung zu prüfen und die vorläufige Auswertung der Bilddatensätze im Hinblick auf die PF bei Patienten mit follikulärem Lymphom nach RIT mit ⁹⁰Y-Ibritumomab tiuxetan durchzuführen. Patienten, Methoden: Diese retrospektive Analyse umfasst klinische und Bilddatensätze (FDG-PET und CT) der Patienten vor und nach durchgeführter RIT, die analysiert und miteinander korreliert wurden. Die Evaluation des Ansprechens wurde sowohl patienten- als auch läsionsbezogen vorgenommen. Jede messbare Läsion wurde hinsichtlich SUV, Volumen und Response ausgewertet. Die PF wurden mithilfe eines uni- und multivariaten Modells getestet. Zur Dokumentation und Evaluation der klinischen und der Bildgebungsdaten wurde ein netzbasiertes System angewendet. Ergebnisse: 16 Patienten, die mindestens eine PET-Untersuchung vor und nach der RIT hatten, wurden berücksichtigt. In Bezug auf das Ansprechen drei Monate nach der RIT zeigten 5 Patienten eine CR, 6 Patienten eine PR und 4 Patienten verblieben in NC. Insgesamt wurden 159 Läsionen (im Durchschnitt 10±8 / Patient) gemessen. Im multivariaten Modell wurde der log des Läsionsvolumens (p < 0,0001), das totale (p = 0,03) und maximale Läsionsvolumen (p = 0,05) als PF für das Ansprechen (CR + PR) identifiziert. Allerdings konnte nur das initial kleine Läsionsvolumen (p = 0,009) und die korrespondierende hohe metabolische Aktivität (p = 0,01) einen statistisch signifikanten Einfluss auf eine CR zeigen. Die netzbasierte Datenarchivierung und -auswertung zeigte keine wesentlichen Störungen und gestaltete sich problemlos. Schlussfolgerung: Die netzbasierte multizentrische Archivierung und Auswertung von Patienten- und Bilddaten ist technisch umsetzbar und erlaubt deren zentrale Auswertung. Basierend auf den Ergebnissen dieser Pilot-Analyse kann die FDG-PET die Responsewahrscheinlichkeit nach der RIT voraussagen.

Keywords

Radioimmunotherapy - ⁹⁰Y-ibritumomab tiuxetan - ¹⁸F-FDG PET - follicular lymphoma - predictive factors

Schlüsselwörter

Radioimmuntherapie - ⁹⁰Y-Ibritumomab Tiuxetan - ¹⁸F-FDG PET - follikuläres Lymphom - prädiktive Faktoren

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