title: 18F-fluoride PET used for treatment monitoring of systemic cancer therapy: results from the National Oncologic PET Registry.
abstract: In a national prospective registry, we previously studied the impact of (18)F-sodium fluoride PET (NaF PET) on the intended management of cancer patients with osseous metastases. The clinical impact of NaF PET for monitoring the response to systemic therapies in such patients is unknown. The objective of this study was to assess the impact of NaF PET results obtained for treatment monitoring of systemic cancer therapy.
  
  
  METHODS
  Before and after NaF PET, we collected prospective data from referring and interpreting physicians for cancer patients 65 y or older receiving systemic therapy (use of 1 or more categories including hormonal, chemotherapy, bisphosphonates, or immunotherapy). The analysis set consisted of 2,217 patients who underwent 2,839 scans (68% prostate, 17% breast, 6% lung, and 8% other cancers) ordered for treatment monitoring. Two or more categories of systemic therapy were planned in 56% of prostate and 43% of breast cancer patients.
  
  
  RESULTS
  The overall rates of prior radionuclide bone imaging were 78%, 76%, and 66% for prostate, breast, and other cancers, respectively. Fifty-seven percent of patients underwent prior NaF PET. Overall change in management associated with NaF PET was 40%. In patients with prior NaF PET scans for comparison, continuing current therapy was planned in 79% when scans showed no change or a decrease or absence of osseous metastasis. Treating physicians planned to switch therapy in 59% of patients after scans showed evidence of new or progressive metastasis. When an additional parameter, estimated prognosis, was worse, switching therapy was even more common (76%).
  
  
  CONCLUSIONS
  The impact of NaF PET used for treatment monitoring was high in patients with evidence of progressive osseous metastasis. Most such patients had plans to switch to a new cancer-directed therapy.
authors.affiliation: Department of Internal Medicine and the Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia Hillner@vcu.edu.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Hillner
authors.affiliation: Division of Nuclear Medicine, Mallinckrodt Institute of Radiology and the Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Barry A
authors.initials: BA
authors.lastname: Siegel
authors.affiliation: Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island.
authors.forename: Lucy
authors.initials: L
authors.lastname: Hanna
authors.affiliation: Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island.
authors.forename: Fenghai
authors.initials: F
authors.lastname: Duan
authors.affiliation: Foley Hoag LLC, Boston, Massachusetts; and.
authors.forename: Bruce
authors.initials: B
authors.lastname: Quinn
authors.affiliation: Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Shields
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D016208:Databases, Factual; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D011379:Prognosis; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging; D012042:Registries; D012969:Sodium Fluoride; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18; D012969:Sodium Fluoride
keywords: GU; PET/CT; bone; breast; breast cancer; oncology; positron emission tomography; prostate cancer; sodium flouride PET; treatment monitoring