PET/CT-Based Response Evaluation in Cancer: a Systematic Review of Design Issues

Oke Gerke*, Karen Ehlers, Edith Motschall, Poul Flemming Høilund-Carlsen, Werner Vach

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Positron emission tomography/x-ray computed tomography (PET/CT) has long been discussed as a promising modality for response evaluation in cancer. When designing respective clinical trials, several design issues have to be addressed, especially the number/timing of PET/CT scans, the approach for quantifying metabolic activity, and the final translation of measurements into a rule. It is unclear how well these issues have been tackled in quest of an optimised use of PET/CT in response evaluation. Medline via Ovid and Science Citation Index via Web of Science were systematically searched for articles from 2015 on cancer patients scanned with PET/CT before and during/after treatment. Reports were categorised as being either developmental or evaluative, i.e. focusing on either the establishment or the evaluation of a rule discriminating responders from non-responders. Of 124 included papers, 112 (90 %) were accuracy and/or prognostic studies; the remainder were response-curve studies. No randomised controlled trials were found. Most studies were prospective (62 %) and from single centres (85 %); median number of patients was 38.5 (range 5-354). Most (69 %) of the studies employed only one post-baseline scan. Quantification was mainly based on SUVmax (91 %), while change over time was most frequently used to combine measurements into a rule (79 %). Half of the reports were categorised as developmental, the other half evaluative. Most development studies assessed only one element (35/62, 56 %), most frequently the choice of cut-off points (25/62, 40 %). In summary, the majority of studies did not address the essential open issues in establishing PET/CT for response evaluation. Reasonably sized multicentre studies are needed to systematically compare the many different options when using PET/CT for response evaluation.

Original languageEnglish
JournalMolecular Imaging and Biology
Volume22
Issue number1
Pages (from-to)33-46
ISSN1536-1632
DOIs
Publication statusPublished - Feb 2020

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Keywords

  • Cancer
  • Positron emission tomography
  • Response evaluation
  • SUVmax
  • Study design
  • Systematic review

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