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Clinical Utility of (18)F-FDG PET in Neuroendocrine Tumors Prior to Peptide Receptor Radionuclide Therapy: A Systematic Review and Meta-Analysis

SIMPLE SUMMARY: Functional imaging with (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) has evolved into a major clinical tool in cancer diagnosis and management for many malignancies in diverse clinical settings, providing valuable information on tumor behavior and aggressiven...

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Autores principales: Alevroudis, Emmanouil, Spei, Maria-Eleni, Chatziioannou, Sofia N., Tsoli, Marina, Wallin, Göran, Kaltsas, Gregory, Daskalakis, Kosmas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069875/
https://www.ncbi.nlm.nih.gov/pubmed/33920195
http://dx.doi.org/10.3390/cancers13081813
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author Alevroudis, Emmanouil
Spei, Maria-Eleni
Chatziioannou, Sofia N.
Tsoli, Marina
Wallin, Göran
Kaltsas, Gregory
Daskalakis, Kosmas
author_facet Alevroudis, Emmanouil
Spei, Maria-Eleni
Chatziioannou, Sofia N.
Tsoli, Marina
Wallin, Göran
Kaltsas, Gregory
Daskalakis, Kosmas
author_sort Alevroudis, Emmanouil
collection PubMed
description SIMPLE SUMMARY: Functional imaging with (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) has evolved into a major clinical tool in cancer diagnosis and management for many malignancies in diverse clinical settings, providing valuable information on tumor behavior and aggressiveness. In the field of neuroendocrine tumors (NETs), recent advances in molecular imaging and targeted treatments with novel theranostic agents favor a more patient-tailored approach. Although peptide receptor radionuclide therapy (PRRT) has recently become an established therapy for progressive NETs, the role of (18)F-FDG PET prior to PRRT in patients with NETs of different origins and grades remains to be determined. Herein, we provide a comprehensive summary of available evidence in contemporary literature by means of a systematic review and meta-analysis, demonstrating that dual-functional imaging with (68)Ga-DOTA-peptides and (18)F-FDG prior to PRRT appears to be a useful tool in NET management by delineating tumor somatostatin receptor expression and glycolytic metabolic activity, and predicting tumor response and survival outcomes. ABSTRACT: The role of (18)F-FDG PET in patients with variable grades of neuroendocrine tumors (NETs) prior to peptide receptor radionuclide therapy (PRRT) has not been adequately elucidated. We aimed to evaluate the impact of (18)F-FDG PET status on disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) in neuroendocrine tumor (NET) patients receiving PRRT. We searched the MEDLINE, Embase, Cochrane Library, and Web of Science databases up to July 2020 and used the Newcastle-Ottawa scale (NOS) criteria to assess quality/risk of bias. A total of 5091 articles were screened. In 12 studies, 1492 unique patients with NETs of different origins were included. The DCR for patients with negative (18)F-FDG PET status prior to PRRT initiation was 91.9%, compared to 74.2% in patients with positive (18)F-FDG PET status (random effects odds ratio (OR): 4.85; 95% CI: 2.27–10.36). Adjusted analysis of pooled hazard ratios (HRs) confirmed longer PFS and OS in NET patients receiving PRRT with negative (18)F-FDG PET (random effects HR:2.45; 95%CIs: 1.48–4.04 and HR:2.25; 95% CIs:1.55–3.28, respectively). In conclusion, (18)F-FDG PET imaging prior to PRRT administration appears to be a useful tool in NET patients to predict tumor response and survival outcomes and a negative FDG uptake of the tumor is associated with prolonged PFS and OS.
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spelling pubmed-80698752021-04-26 Clinical Utility of (18)F-FDG PET in Neuroendocrine Tumors Prior to Peptide Receptor Radionuclide Therapy: A Systematic Review and Meta-Analysis Alevroudis, Emmanouil Spei, Maria-Eleni Chatziioannou, Sofia N. Tsoli, Marina Wallin, Göran Kaltsas, Gregory Daskalakis, Kosmas Cancers (Basel) Systematic Review SIMPLE SUMMARY: Functional imaging with (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) has evolved into a major clinical tool in cancer diagnosis and management for many malignancies in diverse clinical settings, providing valuable information on tumor behavior and aggressiveness. In the field of neuroendocrine tumors (NETs), recent advances in molecular imaging and targeted treatments with novel theranostic agents favor a more patient-tailored approach. Although peptide receptor radionuclide therapy (PRRT) has recently become an established therapy for progressive NETs, the role of (18)F-FDG PET prior to PRRT in patients with NETs of different origins and grades remains to be determined. Herein, we provide a comprehensive summary of available evidence in contemporary literature by means of a systematic review and meta-analysis, demonstrating that dual-functional imaging with (68)Ga-DOTA-peptides and (18)F-FDG prior to PRRT appears to be a useful tool in NET management by delineating tumor somatostatin receptor expression and glycolytic metabolic activity, and predicting tumor response and survival outcomes. ABSTRACT: The role of (18)F-FDG PET in patients with variable grades of neuroendocrine tumors (NETs) prior to peptide receptor radionuclide therapy (PRRT) has not been adequately elucidated. We aimed to evaluate the impact of (18)F-FDG PET status on disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) in neuroendocrine tumor (NET) patients receiving PRRT. We searched the MEDLINE, Embase, Cochrane Library, and Web of Science databases up to July 2020 and used the Newcastle-Ottawa scale (NOS) criteria to assess quality/risk of bias. A total of 5091 articles were screened. In 12 studies, 1492 unique patients with NETs of different origins were included. The DCR for patients with negative (18)F-FDG PET status prior to PRRT initiation was 91.9%, compared to 74.2% in patients with positive (18)F-FDG PET status (random effects odds ratio (OR): 4.85; 95% CI: 2.27–10.36). Adjusted analysis of pooled hazard ratios (HRs) confirmed longer PFS and OS in NET patients receiving PRRT with negative (18)F-FDG PET (random effects HR:2.45; 95%CIs: 1.48–4.04 and HR:2.25; 95% CIs:1.55–3.28, respectively). In conclusion, (18)F-FDG PET imaging prior to PRRT administration appears to be a useful tool in NET patients to predict tumor response and survival outcomes and a negative FDG uptake of the tumor is associated with prolonged PFS and OS. MDPI 2021-04-10 /pmc/articles/PMC8069875/ /pubmed/33920195 http://dx.doi.org/10.3390/cancers13081813 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Alevroudis, Emmanouil
Spei, Maria-Eleni
Chatziioannou, Sofia N.
Tsoli, Marina
Wallin, Göran
Kaltsas, Gregory
Daskalakis, Kosmas
Clinical Utility of (18)F-FDG PET in Neuroendocrine Tumors Prior to Peptide Receptor Radionuclide Therapy: A Systematic Review and Meta-Analysis
title Clinical Utility of (18)F-FDG PET in Neuroendocrine Tumors Prior to Peptide Receptor Radionuclide Therapy: A Systematic Review and Meta-Analysis
title_full Clinical Utility of (18)F-FDG PET in Neuroendocrine Tumors Prior to Peptide Receptor Radionuclide Therapy: A Systematic Review and Meta-Analysis
title_fullStr Clinical Utility of (18)F-FDG PET in Neuroendocrine Tumors Prior to Peptide Receptor Radionuclide Therapy: A Systematic Review and Meta-Analysis
title_full_unstemmed Clinical Utility of (18)F-FDG PET in Neuroendocrine Tumors Prior to Peptide Receptor Radionuclide Therapy: A Systematic Review and Meta-Analysis
title_short Clinical Utility of (18)F-FDG PET in Neuroendocrine Tumors Prior to Peptide Receptor Radionuclide Therapy: A Systematic Review and Meta-Analysis
title_sort clinical utility of (18)f-fdg pet in neuroendocrine tumors prior to peptide receptor radionuclide therapy: a systematic review and meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069875/
https://www.ncbi.nlm.nih.gov/pubmed/33920195
http://dx.doi.org/10.3390/cancers13081813
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