Dimension of Residual CT Scan Mass in Hodgkin's Lymphoma (HL) Is a Negative Prognostic Factor in Patients with PET Negative After Chemo+/− Radiotherapy

Abstract Abstract 93 BACKGROUND. Positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) currently represents the mainstay for response assessment in HL, as defined by revised response criteria (Cheson, 2007). PET negativity is mandatory to define complete remission (CR), independently from the persistence of residual masses at computed tomography (CT scan). Nevertheless, some reports suggest a slightly worse prognosis among patients (pts) with CT scan residual masses. The aim of this study was to evaluate the unfavorable predictive value of residual CT scan masses in HL pts with PET negative at the end of treatment. MATERIAL AND METHODS. The present analysis was retrospectively conducted in 105 pts with negative PET at the end of first or second line treatment, at our institution, from February 2004 to February 2009. All pts had disease evaluation performed also with CT scan. RESULTS. Main clinical characteristics: median age 58 years, males 62, B-symptoms 25, bulky disease 41, prior radiotherapy 57. Seventy-four pts were evaluated after first line treatment program, while 31 pts after salvage therapy program. In 76 pts, residual CT scan mass (PET-/CT scan +) of at least 2.0 cm in the largest diameter was assessed. Fifty-seven had only one site residual mass, while 19 pts had more than one site. Considering the whole series, with a median follow-up of 45 months, 23 pts relapsed, nine patients died and 94 are alive without disease. The five year disease-free survival (DSF) for PET-/CT scan- vs PET-/CT scan+ pts was 89.4% and 68.7% respectively (P=0.053). The prognostic impact of residual mass at CT scan had a correlation with the dimension of the residual itself in a continuous fashion: the larger is the mass, the lower the DFS: HR 1.03 (1.01; 1.05) p 0.007. This difference is even more pronounced when a cut-off of 4 cm in the largest diameter of the residual mass is applied: in patients with a mass diameter ≥ vs < 4 cm, DFS is 50% vs 82% respectively (HR 3.25: CI 1.5; 7.04, p 0,029 – figure 1). Among all the other prognostic factors analyzed (number of masses, first vs salvage treatment program, sex, bulky disease, B-symptoms), no correlation with DSF or overall survival (OS) emerged. CONCLUSIONS. In our study we observe a significant difference in DFS among PET negative pts with or without CT scan residual masses after therapy for HL. This difference is more significant when the residual mass is larger than 4 cm. Thus, despite PET is the main tool in respons-e definition, CT scan maintains an important role and can not yet be abandoned. The role of consolidation radiotherapy in these cases should be focused. Disclosures: No relevant conflicts of interest to declare.

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The effect of eating on the uptake of PSMA ligands in the salivary glands

EJNMMI Research ◽

10.1186/s13550-021-00838-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

V. Mohan ◽

N. M. Bruin ◽

J. B. van de Kamer ◽

J.-J. Sonke ◽

W. V. Vogel

Keyword(s):

Prostate Cancer ◽

Ct Scan ◽

Salivary Glands ◽

Primary Objective ◽

Whole Body ◽

Parotid Glands ◽

Pet Ct ◽

Significant Difference ◽

Gustatory Stimulation ◽

Pet Ct Scan

Abstract Rationale PSMA-directed therapy for metastatic prostate cancer is gaining adoption as a treatment option. However, accumulation of 177Lu/225Ac-PSMA in the salivary glands remains a problem, with risk of dose-limiting xerostomia and potentially severe effect on the quality of life. Gustatory stimulation is an approach that has commonly been used in radioactive iodine therapy to reduce accumulation in the salivary glands. However, based on theoretical differences in biodistribution, it was hypothesized that this could potentially lead to adverse increased toxicity for PSMA-ligand therapy. The primary objective of this work was to determine if gustatory stimulation by eating an assortment of sweet/fatty/acidic foods during the biodistribution phase of [18F]DCFPyl could result in a clinically relevant (> 30%) change in the uptake of the tracer in the salivary glands. Methods 10 patients who already received a whole-body [18F]DCFPyl PET/CT scan for evaluation of prostate cancer, underwent a repeat (intervention) PET/CT scan within a month of the first (control) scan. During the intervention scan, patients chose from an assortment of sweet/fatty/acidic foods, which they then chewed and swallowed for a period of time starting 1 min before tracer administration to 10 min thereafter. Data from both scans were analyzed by placing VOIs on the major salivary glands and segmenting them using relative thresholds. Results A slight increase in PSMA uptake in the parotid glands was observed on the intervention scan when compared to the baseline scan (+ 7.1% SULmean and + 9.2% SULmax, p < 0.05). No significant difference in PSMA uptake in the submandibular glands was seen. Conclusions Eating only slightly increases uptake of [18F]DCFPyl in the parotid glands. We nonetheless recommend refraining from gustatory stimulation during the administration and early biodistribution phase of radionuclide therapy with PSMA-ligands to reduce the risk of avoidable additional toxicity.

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Muscarinic inhibition of salivary glands with glycopyrronium bromide does not reduce the uptake of PSMA-ligands or radioiodine

EJNMMI Research ◽

10.1186/s13550-021-00770-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

V. Mohan ◽

N. M. Bruin ◽

M. E. T. Tesselaar ◽

J. P. de Boer ◽

E. Vegt ◽

...

Keyword(s):

Prostate Cancer ◽

Thyroid Cancer ◽

Ct Scan ◽

Salivary Glands ◽

Whole Body ◽

Parotid Glands ◽

Glycopyrronium Bromide ◽

Pet Ct ◽

Significant Difference ◽

Pet Ct Scan

Abstract Rationale Salivary glands are highly perfused and express the prostate-specific membrane antigen (PSMA) receptor as well as the sodium—iodide symporter. As a consequence, treatment with 177Lu/225Ac-PSMA for prostate cancer or 131I for thyroid cancer leads to a high radiation dose in the salivary glands, and patients can be confronted with persistent xerostomia and reduced quality of life. Salivation can be inhibited using an antimuscarinic pharmaceutical, such as glycopyrronium bromide (GPB), which may also reduce perfusion. The primary objective of this work was to determine if inhibition with GPB could provide a considerable (> 30%) reduction in the accumulation of administered 123I or 68Ga-PSMA-11 in salivary glands. Methods Ten patients who already received a whole-body 68Ga-PSMA-11 PET/CT scan for (re)staging of prostate cancer underwent a repeat PET/CT scan with tracer administration at 90 min after intravenous injection of 0.2 mg GPB. Four patients in follow-up after thyroid cancer, who had been treated with one round of ablative 131I therapy with curative intent and had no signs of recurrence, received 123I planar scintigraphy at 4 h after tracer administration without GPB and a repeated scan at least one week later, with tracer administration at 30 min after intramuscular injection of 0.4 mg GPB. Tracer uptake in the salivary glands was quantified on PET and scintigraphy, respectively, and values with and without GPB were compared. Results No significant difference in PSMA uptake in the salivary glands was seen without or with GPB (Mean SULmean parotid glands control 5.57, intervention 5.72, p = 0.50. Mean SULmean submandibular glands control 6.25, intervention 5.89, p = 0.12). Three out of 4 patients showed increased 123I uptake in the salivary glands after GPB (Mean counts per pixel control 8.60, intervention 11.46). Conclusion Muscarinic inhibition of salivation with GPB did not significantly reduce the uptake of PSMA-ligands or radioiodine in salivary glands, and can be dismissed as a potential strategy to reduce toxicity from radionuclide therapies.

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Prognostic impact of posttransplant FDG PET/CT scan in multiple myeloma

Blood Advances ◽

10.1182/bloodadvances.2020004131 ◽

2021 ◽

Vol 5 (13) ◽

pp. 2753-2759

Author(s):

Marcella Kaddoura ◽

David Dingli ◽

Francis K. Buadi ◽

Martha Q. Lacy ◽

Morie A. Gertz ◽

...

Keyword(s):

Multiple Myeloma ◽

Ct Scan ◽

Prognostic Significance ◽

Ct Scanning ◽

Prognostic Impact ◽

Cell Transplant ◽

Entire Cohort ◽

Pet Ct ◽

The Impact ◽

Pet Ct Scan

Abstract Multiple myeloma (MM) is a heterogeneous disease that may be evaluated by a broad array of imaging and laboratory techniques to measure disease activity and predict prognosis. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scanning has been shown to be predictive of patient outcomes throughout the disease course. We sought to corroborate these findings by examining the prognostic impact of PET/CT scanning in the posttransplant setting. We retrospectively analyzed PET/CT scans in 229 MM patients receiving an autologous stem cell transplant (ASCT) near day 100, and correlated these findings with time to progression(TTP) and overall survival (OS) to assess the impact of day 100 PET/CT scan findings as an independent prognostic factor. The median OS for the entire cohort was 61.5 months (95% confidence interval [CI], 49-75) and the median TTP was 18.5 months (95% CI, 15.4-21.8). Among patients with abnormal day 100 PET findings (PET+), median TTP was 12.4 months vs 24 months among those with normal PET findings (PET−) (P < .0001). The median OS in the PET+ group was 46 months compared with 99 months in the PET− group (P < .0001). We conclude that an abnormal PET/CT scan near day 100 post-ASCT is predictive of shorter TTP and OS, with prognostic significance retained after adjusting for disease response and other prognostic variables in MM.

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