Impact of18F-FDG-PET/CT on surgical management in patients with advanced melanoma: an outcome based analysis.
OBJECTIVE
To evaluate the influence of18F-FDG-PET/CT on clinical decision making and outcome in advanced melanoma patients planned for radical metastasectomy.


METHODS
A cohort of 333 patients with mainly stage III/IV melanoma having a PET/CT for clinical reasons was prospectively enrolled in our oncologic PET/CT registry between 2013 and 2015. Referring physicians completed questionnaires regarding their intended management for each patient before and after PET/CT. Management changes after PET/CT were classified as major and minor changes. A subgroup of 107 patients (stage I, N = 5; stage II, N = 3; stage III, N = 42; stage IV, N = 57) was planned for complete metastasectomy initially, based on conventional imaging. Management changes and outcome were evaluated by linkage with the information obtained from patients' medical records.


RESULTS
In 28 of 107 patients (26%), the surgical treatment plan remained unchanged after PET/CT. In 24 patients (22%), minor changes were performed, such as enlargement or reduction of the surgical field. In 55 patients (51%, 95% CI 42%-61%) major changes of the intended treatment plan occurred; of those, 20 patients (19%) were classified to be tumor-free with PET/CT, 32 patients (30%) were found to have multiple previously unrecognized metastases and had to be treated by systemic therapy, three patients (3%) had to be changed to palliative radiotherapy or isolated extremity perfusion. The 1-year and 2-year overall survival (OS) in patients with complete metastasectomy (N = 52) was 90% and 79%, respectively. Systemically treated patients (N = 32) resulted in 1-year OS of 72% and 2-year OS of 61%. Eleven of 32 patients (34%) with systemic therapy experienced a complete response. Until December 2016, all 20 patients classified as tumor-free by PET/CT were alive.


CONCLUSIONS
The study confirms the high impact of PET/CT on clinical management in patients with advanced melanoma planned for radical metastasectomy. PET/CT resulted in frequent management changes, preventing futile surgery in half of the patients.
Department of Dermatology, Eberhard-Karls-University Tuebingen, Liebermeisterstr. 25, 72076, Tübingen, Germany. andrea.forschner@med.uni-tuebingen.de.
Andrea
A
Forschner
Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany.
Susann-Cathrin
SC
Olthof
Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany.
Brigitte
B
Gückel
Department of Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University Tuebingen, Tübingen, Germany.
Peter
P
Martus
Institute of Medical Biometry and Statistics, University Freiburg, Freiburg, Germany.
Werner
W
Vach
Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard-Karls-University Tuebingen, Tübingen, Germany.
Christian
C
la Fougère
Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany.
Konstantin
K
Nikolaou
Department of Dermatology, Eberhard-Karls-University Tuebingen, Liebermeisterstr. 25, 72076, Tübingen, Germany.
Ulrike
U
Keim
Department of Dermatology, Eberhard-Karls-University Tuebingen, Liebermeisterstr. 25, 72076, Tübingen, Germany.
Thomas Kurt
TK
Eigentler
Department of Dermatology, Eberhard-Karls-University Tuebingen, Liebermeisterstr. 25, 72076, Tübingen, Germany.
Claus
C
Garbe
Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany.
Christina
C
Pfannenberg
D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D059146:Metastasectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D016019:Survival Analysis; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D019788:Fluorodeoxyglucose F18
Melanoma; Metastases; PET/CT; Surgery; Survival