A multicenter prospective evaluation of the clinical utility of F-18 FDG-PET/CT in patients with AJCC stage IIIB or IIIC extremity melanoma

Georgia M. Beasley, Colin Parsons, Gloria Broadwater, M. Angelica Selim, Suroosh Marzban, Amy P. Abernethy, April K.S. Salama, Edward A. Eikman, Terence Wong, Jonathan S. Zager, Douglas S. Tyler

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23 Scopus citations

Abstract

OBJECTIVE/BACKGROUND: There is a high risk of relapse in stage IIIB/IIIC melanoma. The utility of 2-[fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography integrated with computed tomography (FDG-PET/CT) in these patients to evaluate response to treatment or for surveillance after treatment is currently not well defined. METHODS: Prospective data from 2 centers identified 97 patients with stage IIIB/IIIC extremity melanoma undergoing isolated limb infusion (ILI) who had whole body FDG-PET/CT scans before and every 3 months after treatment. Clinical response was determined at 3 months by Response Evaluation Criteria In Solid Tumors. RESULTS: Complete response (CR) after ILI occurred in 33% (32/97) of patients. FDG-PET/CT accurately identified 59% of patients who were CRs (19/32), whereas 41% (13/32) had residual metabolic activity in the extremity that was histologically negative for melanoma. The 3-year disease-free rate was 62.2% (95% CI: 40.1%-96.4%) for those patients who were CRs by both clinical/pathologic examination and FDG-PET/CT (n = 19) compared to only 29.4% (95% CI: 9.9%-87.2%) of those CRs who still had residual FDG-PET/CT activity (n = 13). FDG-PET/CT was utilized for surveillance of disease recurrence outside the regional field of treatment. Fifty-two percent (51/97) of patients developed disease outside the extremity at a median time of 212 days from pre-ILI FDG-PET/CT. In 47% (29/62) of these cases, the recurrence was resected. CONCLUSIONS: Although FDG-PET/CT does not appear to accurately identify patients who appear to be CRs to ILI, it does appear to identify a subgroup of patients whose regional progression-free survival is markedly worse. However, FDG-PET/CT appears to be an excellent method for surveillance in stage IIIB/IIIC patients after ILI with ability to identify surgically resectable recurrent disease in these high-risk patients.

Original languageEnglish (US)
Pages (from-to)350-356
Number of pages7
JournalAnnals of surgery
Volume256
Issue number2
DOIs
StatePublished - Aug 2012

Keywords

  • PET/CT
  • melanoma
  • regional chemotherapy

ASJC Scopus subject areas

  • Surgery

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    Beasley, G. M., Parsons, C., Broadwater, G., Selim, M. A., Marzban, S., Abernethy, A. P., Salama, A. K. S., Eikman, E. A., Wong, T., Zager, J. S., & Tyler, D. S. (2012). A multicenter prospective evaluation of the clinical utility of F-18 FDG-PET/CT in patients with AJCC stage IIIB or IIIC extremity melanoma. Annals of surgery, 256(2), 350-356. https://doi.org/10.1097/SLA.0b013e318256d1f5