Quantitative SSTR-PET/CT for predicting response and survival outcomes in patients with pancreatic neuroendocrine tumors receiving CAPTEM

Radiol Oncol. 2023 Nov 30;57(4):436-445. doi: 10.2478/raon-2023-0055. eCollection 2023 Dec 1.

Abstract

Background: This study aimed to evaluate the predictive and monitoring role of somatostatin receptor (SSTR) positron emission tomography-computed tomography (PET/CT) and clinical parameters in patients with neuroendocrine liver metastases (NELM) from pancreatic neuroendocrine tumors (pNET) receiving capecitabine and temozolomide (CAPTEM).

Patients and methods: This retrospective study included twenty-two patients with pNET and NELM receiving CAPTEM who underwent pre- and post-therapeutic 68Ga-DOTATATE/-TOC PET/CT. Imaging (including standardized uptake value [SUV] of target lesions [NELM and pNET], normal spleen and liver) and clinical (Chromogranin A [CgA], Ki-67) parameters were assessed. Treatment outcome was evaluated as response according to RECIST 1.1, progression free survival (PFS) and overall survival (OS).

Results: The median PFS (mPFS) was 7 months. Responders had a significantly longer mPFS compared to non-responders (10 vs. 4 months p = 0.022). Median OS (mOS) was 33 months (mOS: responders = 80 months, non-responders = 24 months p = 0.182). Baseline imaging showed higher SUV in responders, including absolute SUV, tumor-to-spleen (T/S), and tumor-to-liver (T/L) ratios (p < 0.02). All SUV parameters changed only in the responders during follow-up. Univariable Cox regression analysis identified baseline Tmax/Smean ratio and percentage change in size of pNETs as significant factors associated with PFS. A baseline Tmax/Smean ratio < 1.5 was associated with a shorter mPFS (10 vs. 4 months, (p < 0.05)). Prognostic factors for OS included age, percentage change in CgA and in T/S ratios in univariable Cox regression.

Conclusions: SSTR-PET/CT can be useful for predicting response and survival outcomes in pNET patients receiving CAPTEM: Higher baseline SUV values, particularly Tmax/Smean ratios of liver metastases were associated with better response and prolonged PFS.

Keywords: capecitabine/temozolomide; neuroendocrine tumors; positron emission tomography–computed tomography; prognosis.

MeSH terms

  • Humans
  • Liver Neoplasms* / diagnostic imaging
  • Liver Neoplasms* / drug therapy
  • Neuroectodermal Tumors, Primitive*
  • Neuroendocrine Tumors* / diagnostic imaging
  • Neuroendocrine Tumors* / drug therapy
  • Neuroendocrine Tumors* / pathology
  • Pancreatic Neoplasms* / diagnostic imaging
  • Pancreatic Neoplasms* / drug therapy
  • Pancreatic Neoplasms* / pathology
  • Positron Emission Tomography Computed Tomography
  • Receptors, Somatostatin
  • Retrospective Studies

Substances

  • Receptors, Somatostatin