Contents lists available at ScienceDirect European Journal of Radiology journal homepage: www.elsevier.com/locate/ejrad Research paper F-18 FDG PET/CT metabolic tumor volume predicts overall survival in patients with disseminated epithelial ovarian cancer Rosj Gallicchio a , Anna Nardelli b , Angela Venetucci a , Daniela Capacchione a , Alessandra Pelagalli b , Cesare Sirignano b , Pierpaolo Mainenti b , Piernicola Pedicini a , Giuseppe Guglielmi c , Giovanni Storto ⁎ ,a a Medicina Nucleare, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro di Riferimento Oncologico della Basilicata (CROB), Rionero in Vulture, Italy b Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche (CNR), Naples, Italy, c Dipartimento di Radiologia, Università di Foggia, Italy ARTICLE INFO Keywords: Epithelial ovarian cancer Carcinomatosis PET/CT Survival ABSTRACT Objective: We evaluated the prognostic impact of quantitative assessment by maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV) and tumour lesion glycolysis (TLG) on [F-18] FDG PET/CT for patients with peritoneal carcinomatosis from epithelial ovarian cancer (EOC). Methods: Thirty-one patients with EOC underwent PET/CT for an early restaging after cytoreductive surgery, having been diagnosed with carcinomatosis (before chemotherapy). The SUVmax, MTV (cm 3 ; 42% threshold) and TLG (g) were registered on residual peritoneal lesions. The patients were followed up 20 ± 12 months thereafter. The PET/CT results were compared to overall survival (OS). Results: The Kaplan-Meier survival analysis for the SUVmax did not reveal significant differences in OS (p = 0.48). The MTV survival analysis showed a significant higher OS in patients presenting with a higher tumour burden than those with less tumour burden (p = 0.01; 26 vs. 14 months), whereas TLG exhibited a similar trend though not significant (p = 0.06). Apart from chemo-resistance, the higher the MTV, the better will be the response to chemotherapy. Conclusions: Quantitative assessment by MTV rather than by SUVmax and TLG on PET/CT may be helpful for stratifying patients who present with peritoneal carcinomatosis from EOC, in order to implement the appropriate therapeutic regimen. 1. Introduction Epithelial ovarian cancer (EOC) is the most fatal gynaecological malignancy. Almost 22,000 cases are being diagnosed in the United States annually, and 14,240 estimated deaths are expected in 2016. [1]. The number of cases is similar in other developed countries, with an age-standardised rate per 100,000 women of 9.1 [2]. This disease is frequently diagnosed at advanced stages, because EOC spreads in- traperitoneally through seeding, via direct invasion or via the lym- phatic or vascular circulation [3]. This stage, called peritoneal carci- nomatosis, represents a clinical challenge. Although primary cytoreductive surgery (CRS) followed by taxane/ platinum-based chemotherapy (CHTx) is considered the standard approach [4], unfortunately patients have a high death rate following this ineffective and somewhat life-threatening therapy. Several authors have suggested that maximal cytoreduction after surgery is one of the most powerful prognostic factors [5–7]. Nevertheless, the presence of residual large-volume disease after surgery does not preclude benefits from subsequent treatments. The prognostic impact of the residual (loco-regional/peritoneal) tumour burden assessed by positron emission tomography/computed tomography (PET/CT) has not yet been completely investigated. In fact, the appraisal of the peritoneal involvement is usually performed by contrast-enhanced CT and magnetic resonance imaging, but sensitivity is reduced because the anatomical imaging considers only size criteria and does not distinguish the functional alterations that may occur http://dx.doi.org/10.1016/j.ejrad.2017.05.036 Received 26 May 2016; Received in revised form 24 May 2017; Accepted 25 May 2017 ⁎ Corresponding author at: Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro di Riferimento Oncologico della Basilicata (CROB), Via P. Pio 1, 85028 Rionero in Vulture, Italy. E-mail address: giosto24@hotmail.com (G. Storto). Abbreviations: EOC, epithelial ovarian cancer; CRS, cytoreductive surgery; PET/CT, positron emission tomography/computed tomography; MTV, metabolic tumour volume; TLG, total lesion glycolysis; SUVmax, standardized uptake value; [18F]FDG, fluorine18 fluorodeoxyglucose; FIGO, International Federation of Gynaecology and Obstetrics; GOG, Gynaecologic Oncology Group European Journal of Radiology 93 (2017) 107–113 0720-048X/ © 2017 Elsevier B.V. All rights reserved. MARK