Prognostic factors in patients treated with 223Ra: The role of skeletal tumor burden on baseline 18F-fluoride PET/CT in predicting overall survival

Elba C. Etchebehere, John C. Araujo, Patricia S. Fox, Nancy M. Swanston, Homer A. Macapinlac, Eric M. Rohren

Research output: Contribution to journalArticlepeer-review

84 Scopus citations


The purpose of this study was to evaluate outcome after 223Ra dichloride therapy (223Ra) and to determine whether skeletal tumor burden on whole-body 18F-fluoride PET/CT can be used as a predictive biomarker of survival in patients treated with 223Ra. Methods: Forty-two patients with hormone-refractory prostate cancer underwent 223Ra and a baseline fluoride PET/CT scan. Fluoride PET/CT parameters were generated, including maximum standardized uptake value (SUVmax) of the hottest lesion (hSUVmax), average SUV of disease (Mean10), and skeletal tumor burden indices of total fluoride skeletal metastatic lesion uptake (TLF10) and total volume of fluoride avid bone metastases (FTV10). Overall survival (OS) was the primary endpoint. Secondary endpoints were progression-free survival and skeletal-related event (SRE). Results: Skeletal tumor burden indices (TLF10 and FTV10) derived from fluoride PET/CT at baseline were highly correlated and significant independent predictors of OS (P 5 0.0212; hazard ratio 5 5.990; 95% confidence interval 5 1.306-27.475). A TLF10 cutoff value < 8,000 discriminated survivors from nonsurvivors after 223Ra (with TLF10 values < 8,000, the median OS was not estimated, whereas with TLF10 < 8,000, the median OS was 6.67 mo). Visual analysis, Mean10, and hSUVmax were not predictors of OS or progression-free survival. Mean10 was found to be a significant univariate predictor of the odds of having an SRE (P = 0.0445; odds ratio = 1.30; 95% confidence interval = 1.006-1.681), with a Mean10 greater than 19 increasing the risk of SRE. Conclusion: Skeletal tumor burden on baseline fluoride PET/CT is a predictive biomarker of OS and the risk of an SRE in patients treated with 223Ra.

Original languageEnglish (US)
Pages (from-to)1177-1184
Number of pages8
JournalJournal of Nuclear Medicine
Issue number8
StatePublished - Aug 1 2015


  • Fluoride PET/CT
  • NaF PET/CT
  • Prostate cancer
  • Ra
  • Skeletal tumor burden

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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