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. 2021 May 21;7(8):FSO719.
doi: 10.2144/fsoa-2021-0053. eCollection 2021 Sep.

Combined bone scintigraphy and fluorocholine PET/computed tomography predicts response to radium-223 therapy in patients with prostate cancer

Michele Klain  1 , Valeria Gaudieri  1 , Mario Petretta  2 , Emilia Zampella  1 , Giovanni Storto  3 , Carmela Nappi  1 , Carlo Buonerba  4 , Felice Crocetto  5 , Rosj Gallicchio  3 , Fabio Volpe  1 , Leonardo Pace  6 , Martin Schlumberger  1 , Alberto Cuocolo  1
Affiliations

Combined bone scintigraphy and fluorocholine PET/computed tomography predicts response to radium-223 therapy in patients with prostate cancer

Michele Klain et al. Future Sci OA. .

Abstract

Aim: To assess the value of bone scintigraphy and 18F-fluorocholine PET/computed tomography (CT) in predicting outcome in patients with prostate cancer and bone metastases treated with 223radium.

Materials & methods: Retrospective analysis of 48 patients that underwent 223radium therapy. End points were pain relief and overall survival.

Results: After therapy, pain relief was observed in 27 patients. Patients without pain relief had more bone lesions at PET/CT than at bone scintigraphy (pretherapy imaging mismatch). In 39 patients who completed treatment protocol, post-therapy alkaline phosphatase and pretherapy imaging mismatch were independent predictors of poor overall survival.

Conclusion: Patients with more lesions at 18F-fluorocholine PET/CT than at bone scintigraphy had a poor prognosis. The combined imaging approach could be useful to predict outcome after 223radium therapy.

Keywords: 18F-fluorocholine PET/CT outcome; 223radium; bone scintigraphy; prostate cancer.

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Conflict of interest statement

Financial & competing interests disclosure The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

Figures

Figure 1.
Figure 1.. Agreement between bone scintigraphy and 18F-fluorocholine PET/CT in the identification of bone metastases.
(A) Scatter plots of bone metastases detected by bone scintigraphy and 18F-fluorocholine PET/CT. Red line indicates the reduced major axis, green line perfect concordance and Lin’s concordance correlation co-efficient. (B) Bland–Altman analysis. The mean difference (95% limits of agreement) is 0.958 (-4.405 to 6.321). CT: Computed tomography.
Figure 2.
Figure 2.. Example of a patient with baseline imaging mismatch.
(A)18F-fluorocholine PET/CT. (B) Bone scintigraphy. The number of bone lesions detected by PET/CT is higher than that detected by bone scintigraphy. CT: Computed tomography.
Figure 3.
Figure 3.. Pain intensity variation from baseline to post-treatment.
After 223radium therapy, there is a significant (p < 0.001) change in pain intensity, with pain relief in 27 (56%) patients.
Figure 4.
Figure 4.. Overall survival curves after 223radium therapy.
(A) Patients stratified by post-therapy ALP level (≤208 vs >208 U/l). (B) Patients stratified by imaging findings (PET/CT vs bone scintigraphy). (C) Patients with post-therapy ALP level ≤208 U/l stratified by imaging findings. Patients with post-therapy ALP >208 U/l level have the worst outcome. Imaging mismatch (number of bone lesions detected by PET/CT >number of bone lesions detected by bone scintigraphy) predicts death in the overall population and in patients with post-therapy ALP levels ≤208 U/l. ALP: Alkaline phosphatase; BS: Bone scintigraphy; CT: Computed tomography.
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