Advances in Radiation Oncology (Mar 2022)

Positron Emission Tomography–Derived Metrics Predict the Probability of Local Relapse After Oligometastasis-Directed Ablative Radiation Therapy

  • Carlo Greco, MD,
  • Oriol Pares, MD,
  • Nuno Pimentel, MD,
  • Vasco Louro, MD,
  • Javier Morales, MD,
  • Beatriz Nunes, MD,
  • Inês Antunes, MD,
  • Ana Luisa Vasconcelos, MD,
  • Justyna Kociolek, MD,
  • Joana Castanheira, MD,
  • Carla Oliveira, MD,
  • Angelo Silva, MD,
  • Sofia Vaz, MD,
  • Francisco Oliveira, PhD,
  • Eunice Carrasquinha, PhD,
  • Durval Costa, MD,
  • Zvi Fuks, MD

Journal volume & issue
Vol. 7, no. 2
p. 100864

Abstract

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Purpose: Early positron emission tomography–derived metrics post–oligometastasis radioablation may predict impending local relapses (LRs), providing a basis for a timely ablation. Methods and Materials: Positron emission tomography data of 623 lesions treated with either 24 Gy single-dose radiation therapy (SDRT) (n = 475) or 3 × 9 Gy stereotactic body radiation therapy (SBRT) (n = 148) were analyzed in a training data set (n = 246) to obtain optimal cutoffs for pretreatment maximum standardized uptake value (SUVmax) and its 3-month posttreatment decline (ΔSUVmax) in predicting LR risk, validated in a data set unseen to testing (n = 377). Results: At a median of 21.7 months, 91 lesions developed LRs: 39 of 475 (8.2%) after SDRT and 52 of 148 (35.1%) after SBRT. The optimal cutoff values were 12 for SUVmax and –75% for ΔSUVmax. Bivariate SUVmax/ΔSUVmax permutations rendered a 3-tiered LR risk stratification of dual-favorable (low risk), 1 adverse (intermediate risk) and dual-adverse (high risk). Actuarial 5-year local relapse-free survival rates were 93.9% versus 89.6% versus 57.1% (P < .0001) and 76.1% versus 48.3% versus 8.2% (P < .0001) for SDRT and SBRT, respectively. The SBRT area under the ROC curve was 0.71 (95% CI, 0.61-0.79) and the high-risk subgroup yielded a 76.5% true positive LR prediction rate. Conclusions: The SBRT dual-adverse SUVmax/ΔSUVmax category LR prediction power provides a basis for prospective studies testing whether a timely ablation of impending LRs affects oligometastasis outcomes.