Evaluation of metabolic response with (18)F-FDG PET-CT in patients with advanced or recurrent thymic epithelial tumors

BACKGROUND: Patients with advanced or recurrent thymic epithelial tumors (TETs) often need several consecutive lines of chemotherapy. The aim of this retrospective monocentric study was to test whether (18)F-Fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG PET-CT) is able to monitor standard chemotherapy efficacy in those patients and whether metabolic response correlates with morphovolumetric response as assessed by Response Evaluation Criteria in Solid Tumor (RECIST). METHODS: We evaluated 27 consecutive patients with advanced (16 patients) or recurrent (11 patients) TETs. All patients underwent (18)F-FDG PET-CT before and after at least 3 cycles of chemotherapy. Maximum standardized uptake value (SUV(max)) of all detected lesions was recorded and the most (18)F-FDG avid lesion in each patient was selected for determination of percentage change of SUV(max) (ΔSUV(max)) in pre- and post-treatment scans. Tumor response was assessed by contrast-enhanced computed tomography (CE-CT) using RECIST criteria. Receiver operating characteristic (ROC) curve analysis was performed to define the optimal threshold of ΔSUV(max) discriminating responders from non-responders. RESULTS: Metabolic response expressed as ΔSUV(max) was significantly correlated with morphovolumetric response (Spearman’s rank correlation, r = 0.64, p = 0.001). ROC curve analysis showed that a ΔSUV(max) value of -25% could discriminate responders from non-responders with a sensitivity of 88% and a specificity of 80%. Conversely, basal SUV(max) values were not predictive of morphovolumetric tumor response. CONCLUSIONS: Our findings indicate that metabolic response assessed by (18)F-FDG PET-CT, through evaluation of ΔSUV(max), may allow identification of responders and non-responders thus guiding adaptation of therapy in patients with advanced or recurrent TETs.