The Prognostic Value of Quantitative Bone SPECT/CT Before 223Ra Treatment in Metastatic Castration-Resistant Prostate Cancer

Helmut Dittmann; Sabine Kaltenbach; Matthias Weissinger; Francesco Fiz; Peter Martus; Maren Pritzkow; Juergen Kupferschlaeger; Christian la Fougère

doi:10.2967/jnumed.119.240408

The Prognostic Value of Quantitative Bone SPECT/CT Before ²²³Ra Treatment in Metastatic Castration-Resistant Prostate Cancer

J Nucl Med. 2021 Jan;62(1):48-54. doi: 10.2967/jnumed.119.240408. Epub 2020 May 22.

Authors

Helmut Dittmann¹, Sabine Kaltenbach², Matthias Weissinger², Francesco Fiz², Peter Martus³, Maren Pritzkow², Juergen Kupferschlaeger², Christian la Fougère^{2

4}

Affiliations

¹ Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Tuebingen, Germany helmut.dittmann@med.uni-tuebingen.de.
² Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Tuebingen, Germany.
³ Institute for Clinical Epidemiology and Applied Biometry, University of Tuebingen, Tuebingen, Germany; and.
⁴ iFIT Cluster of Excellence, University of Tuebingen, Tuebingen, Germany.

PMID: 32444369
DOI: 10.2967/jnumed.119.240408

Abstract

Radiolabeled bisphosphonates such as ^99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (^99mTc-DPD) typically show intense uptake in skeletal metastases from metastatic castration-resistant prostate cancer (mCRPC). Extensive bone involvement is regarded as a risk factor for mCRPC patients treated with ²²³Ra-dichloride (²²³Ra). The aim of this study was to quantify ^99mTc-DPD uptake by means of SPECT/CT before ²²³Ra and compare the results with the feasibility of treatment and overall survival (OS). Methods: Sixty consecutive mCRPC patients were prospectively included in this study. SPECT/CT of the central skeleton covering the skull to the mid-femoral level was performed before the first cycle of ²²³Ra. The bone compartment was defined by means of low-dose CT. Emission data were corrected for scatter, attenuation, and decay supplemented by resolution recovery using dedicated software. The Kaplan-Meier estimator, U test, and Cox regression analysis were used for statistics. Results: Total ^99mTc-DPD uptake of the central skeleton varied between 11% and 56% of injected dose (%ID) or between 1.8 and 10.5 %ID/1,000 mL of bone volume (%ID/L). SUV_mean ranged from 1.9 to 7.4, whereas the SUV_max range was 18-248. Patients unable to complete ²²³Ra treatment because of progression and/or cytopenia (n = 23) showed significantly higher uptake (31.9 vs. 25.4 %ID and 6.0 vs. 4.7 %ID/L; P < 0.02). OS after ²²³Ra (median, 15.2 mo) was reduced to 7.3 mo in cases of skeletal uptake that was 26 %ID or higher, as compared with 30.8 mo if lower than 26 %ID (P = 0.008). Similar results were obtained for %ID/L and SUV_mean SUV_max did not correlate with survival. %ID/L was identified as an independent prognostic factor for OS (hazard ratio, 1.381 per unit), along with number of previous treatment lines. Conclusion: Quantitative SPECT/CT of bone scans performed at baseline is prognostic for survival in mCRPC patients treated with ²²³Ra.

Keywords: 223Ra; SPECT/CT; bone scan; prostate cancer; quantification.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Bone Neoplasms / diagnostic imaging*
Bone Neoplasms / secondary*
Bone and Bones / diagnostic imaging*
Follow-Up Studies
Humans
Male
Middle Aged
Neoplasm Metastasis
Prognosis
Prostatic Neoplasms, Castration-Resistant / pathology*
Prostatic Neoplasms, Castration-Resistant / radiotherapy
Radium / therapeutic use*
Single Photon Emission Computed Tomography Computed Tomography*

Substances

Radium-223
Radium