Prognostic significance of total lesion glycolysis in patients with advanced non-small cell lung cancer receiving chemotherapy

Background

[¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET) imaging has been employed as a non-invasive diagnostic tool for malignant tumors. Total lesion glycolysis (TLG) on FDG-PET is calculated by multiplying the mean standardized uptake value (SUVmean) by the tumor volume. Unlike the maximum standardized uptake value (SUVmax), which represents the point of greatest metabolic activity within tumors, TLG has been suggested to reflect global metabolic activity in whole tumors.

Methods

We retrospectively examined whether or not FDG-PET measurements, including SUVmean, SUVmax, and TLG, could predict progression-free survival (PFS) or overall survival (OS) in patients with non-small cell lung cancer (NSCLC) receiving chemotherapy.

Results

This study involved 81 consecutive patients with NSCLC who received chemotherapy. All of the patients underwent FDG-PET examination before treatment. SUVmean, SUVmax, and TLG on FDG-PET were significantly associated with gender, smoking status, and tumor histology. With adjustment for several other variables, Cox regression analysis showed that TLG was significantly prognostic for both PFS [hazard ratio = 2.34; 95% confidence interval, 1.18–4.64; P = 0.015] and OS (hazard ratio = 2.80; 95% confidence interval, 1.12–6.96; P = 0.003), whereas SUVmean and SUVmax had no significant association with PFS (P = 0.693 and P = 0.322, respectively) or OS (P = 0.587 and P = 0.214, respectively).

Conclusions

Our findings suggest that TLG may be more useful than SUVmean and SUVmax for predicting PFS and OS in NSCLC patients receiving chemotherapy. The TLG measurement on FDG-PET imaging could be routinely recommended to advanced NSCLC patients.     

18F-FDG PET-CT不同SUV阈值法与胰腺癌GTV靶区相关性研究

目的：随着精确放疗技术在胰腺癌治疗中应用越来越广泛,精确的图像引导技术也逐渐被关注。本研究旨在探讨不同标准化摄取值（standardized uptake values,SUV）阈值法勾画18氟-脱氧葡萄糖正电子发射断层扫描 CT（18 F-flu-orodeoxyglucose positron emission tomography CT,18 F-FDG PET-CT）图像上大体肿瘤体积（gross tumor volume,GTV）靶区与定位扫描增强 CT（contrast-enhanced CT,CECT）图像上 GTV 靶区的一致性,进一步明确 PET-CT 用于胰腺癌靶区勾画的最适方法,为胰腺癌精确放射治疗提供更多图像信息。方法选取2014-07-01—2015-06-30中国人民解放军空军总医院放疗科收治的39例经病理或临床确诊的胰腺恶性肿瘤患者。所有患者放疗前行18 F-FDG PET-CT 检查及腹部 CECT 扫描。依据不同阈值法测量出 PET-CT 图像显示肿块大小（GTV on PET-CT,PET／CT-GTV）。1）SUV相对百分比法：基于最大 SUV（maximum SUV,SUVmax ）,百分活性曲线所包绕的体素范围,包括 GTVpet15％、GTV-pet20％、GTVpet25％、GTVpet30％、GTVpet35％、GTVpet40％、GTVpet45％和 GTVpet50％;2）SUV 绝对值法：指 SUV 值超过预设值2．5所包绕的体素范围 GTVpet2．5）。测量出 CECT 上可见肿块大小（GTV on CT,CT-GTV）。将不同阈值法测出的 PET／CT-GTV 与相应 CT-GTV 进行对比分析。采用配对 t 检验对计量资料进行统计学分析。结果GTVpet 组随着百分比值增加体积在逐渐缩小。GTVpet25％、GTVpet30％和 GTVpet35％平均体积分别为（95．52±43．97）、（77．92±42.97）和（64．24±40．64）cm3;GTVpet2．5的平均体积为（18．6±26．56）cm3;而 GTVct 组平均体积为（80．09±46．07）cm3。对比分析 GTVpet 同 GTVct 体积间的一致性,结果显示 GTVpet30％与 GTVct 体积最为接近,P ＝0．996。同时基于 SUVmax30％阈值法勾画的 GTVpet30％体积较 GTVct 体积稍大,GTVpet30％组平均体积较 GTVct 体积大（0．22±5．2）cm3,95％ CI 为－10．31～10．77 cm3。GTVpet30％与 GTVct 间存在相关性,r ＝0．632,P ＜0．01;GTVpet2．5与GTVct 间不存在明显相关性,r＝0．257,P ＝0．21。胰腺癌18 F-FDG 代谢摄取普遍较低,采用 SUV2．5阈值法勾画 GTV-pet2．5普遍体积较小,甚至由于 SUVmax 都＜2．5而无法采用此方法勾画 GTV。结论采用 SUVmax30％阈值法勾画的GTVpet30％同 CECT 勾画的 GTVct 体积大小最为接近。但具体应用时根据个体代谢高低适度调整百分比一致性更好。     

18F-FDG PET/CT SUV值与胰腺癌预后的相关性研究

目的 探讨胰腺癌组织18F-FDG PET/CT SUV摄取值与肿瘤预后的关系.方法 回顾性分析我院2009年10月～2011年12月期间接受18F-FDG PET/CT 检查的37例胰腺癌患者资料,测量其SUVmax摄取值.以SUVmax值3.5为分界点,将患者分为两组.采用Kaplan-Meier法绘制生存曲线并判断SUVmax值对胰腺癌预后的影响.结果 SUVmax ≥3.5患者的生存时间明显低于SUVmax＜3.5患者（P〈0.001）.结论胰腺癌组织的18F-FDG PET/CT SUV摄取值与肿瘤的预后密切相关.     

PET/CT显像高密度物质对CTAC的影响

目的评价在PET/CT显像中,高密度物质对CTA（CCT衰减校正）的影响。方法采集4个放射性活度相同、体积相同但密度不同的放射源,对比其NAC（非衰减校正）图像的放射性计数和CTAC图像的SUV（标准摄取值）。结果 NAC图像的放射性计数相同而CTAC图像的SUV随物质密度升高而升高。结论高密度物质使CTAC图像SUV偏高、产生伪影。     

Prognostic evaluation of PET/CT in residual post-chemotherapy masses in patients with diffuse large B-cell lymphoma and its impact on survival

Aim of the work

To evaluate the prognostic value and accuracy of PET/CT in DLBCL patients with post-treatment CT-residual masses with concern in overall (OAS) and progression-free survival (PFS).

Materials and methods

We retrospectively studied 62 patients with DLBCL who had CT documented residual masses (CRu) after completion of chemotherapy.

Results

Forty-four patients with negative PET scan were free of relapse while 4 out of 18 patients with positive scan showed CR, the other 14 patients had developed relapse. PET attained a sensitivity of 100%, a specificity of 91%, a NPV of 100% and a PPV of 77.8% and an accuracy of 93.5%. The median OAS time was 33.59 months in patients with negative scan and 19.00 months in patients with positive scan with highly significant correlation (P value 0.0001) and the median PFS time was 29.53 months in patients with negative scan versus only 4.00 months in patients with positive scan with highly significant correlation (P value 0.0000).

Conclusion

PET/CT plays helpful part in evaluation of therapy response in DLBCL patients with CT residual mass and post-chemotherapy PET could be used as an accurate and good predictor of OAS and PFS.     

Evaluation of the SUV values calculation and 4D PET integration in the radiotherapy treatment planning system

Background and Purpose

To evaluate the SUV calculation and integration of the gated (4D) PET in the iPlan 4.0 treatment planning software (BrainLAB).

Materials and Methods

Phantom and patient data for different tracers were used. Two comparisons were performed for each patient: for the delineated VOI, the maximum value of SUV in iPlan was compared with the results from TrueD software. For 10 patients lesion volumes were defined in both systems for a given SUV threshold and differences were calculated. For four patients examined with respiratory gated PET, SUV_max and volume analysis was performed in each phase of the breathing cycle in the gated and the ungated PET.

Results

Maximum differences of 6% and 10% were found for phantom and patient measurements of SUV_max. For patient data, maximal differences in delineated volume of 10% for ungated and up to 27% for gated PET were found in both systems.

Conclusion

This study suggests that for the safe implementation of PET data and delineation algorithms in the radiotherapy planning system, one has to be aware of the differences in SUVs and volumes found in the two systems.     

Prognostic value of SUVmax measurements obtained by FDG-PET in patients with non-small cell lung cancer receiving chemotherapy

[¹⁸F]Fluorodeoxyglucose (FDG) uptake has been shown to correlate well with tumor proliferation rates. In patients with non-small cell lung cancer (NSCLC) receiving chemotherapy, we analyzed the relationships between the maximum standardized uptake value (SUVmax) obtained by FDG positron emission tomography (FDG-PET) and other clinical factors, and examined whether or not SUVmax could predict progression-free survival (PFS) and/or overall survival (OS). This retrospective study involved 62 consecutive NSCLC patients (35 male and 27 female: median age, 65 years). All patients underwent FDG-PET examination before treatment. As the first-line treatment, the patients received chemotherapy with (n = 15) or without (n = 47) radiotherapy. Survival curves were obtained by the Kaplan-Meier method, and differences in survival between subgroups were analyzed by the log-rank test and the Cox proportional hazards model. Significant correlations were observed between SUVmax and gender (P = 0.006), histology (P < 0.001), smoking status (P = 0.049), stage (P = 0.015), and treatment modality (P = 0.008), but not other factors, including age (P = 0.402) and performance status (P = 0.421). The median SUVmax was 5.1 (25-75th percentile: 3.45-7.0) in patients with adenocarcinoma and 8.3 (25-75th percentile: 6.9-9.9) in those with other types of NSCLC. Adenocarcinomas showed significantly lower SUVmax than the other tumor types (P < 0.001). Cox analysis adjusting for possible confounding factors, including gender, smoking status, histology and stage, demonstrated that the hazard ratios increased as the SUVmax increased in terms of both PFS (P = 0.008) and OS (P = 0.045), indicating that SUVmax predicts outcome independently of other clinical factors, such as histology and stage. Our findings indicate that FDG-PET examination can provide information useful for prognostication in NSCLC.     

The value of pre operative S-100B and SUV in clinically stage III melanoma patients undergoing therapeutic lymph node dissection

Introduction

High preoperative serum S-100B values and Standardized Uptake Values (SUV) of Fluorodeoxyglucose (FDG) in PET for clinically stage III melanoma patients could be indicators of recurrence after surgical treatment. Aim was to assess the correlation and the prognostic value of these markers.

Methods

All melanoma patients with palpable nodal metastases, without distant metastases, were included from February 2004 to December 2007. Preoperative SUV and S-100B was determined. The correlation between SUV and S-100B and their relations with DFS and DSS were calculated by Cox Proportional Hazard Analysis.

Results

62 Patients, median age 56.9 years, were included in the study. An elevated S-100B was found in 31 patients (50%) and elevated SUV in 24 patients (38.7%). No relation was found between S-100B and SUV. DFS was reduced (31.1%) for patients with an elevated S-100B (HR = 3.1; p = 0.02) in comparison to a normal S-100B (44.6%). The DFS was 42.0% for patients with a SUV below the cut-off point and 29.0% for patients with an elevated SUV (HR = 1.1; p = 0.8). DSS was 60.7% in a normal S-100B and 44.7% for patients with an elevated S-100B (HR = 2.2; p = 0.07). DSS was 59.1% for patients with a normal SUV and 43.5% for patients with elevated SUV (HR = 1.1; p = 0.8).

Conclusion

S-100B and SUV in stage III melanoma are not correlated and each have different associations with various histopathological factors. S-100B, in contrast with SUV, is associated with nodal tumor load, and when elevated, predicts a shorter DFS.

Synopsis

Preoperative serum S-100B and Fluorodeoxyglucose (FDG) Standardized Uptake Value (SUV) in clinically stage III melanoma are not correlated. S-100B is a strong predictor for Disease Free Survival (DFS) in stage III melanoma.     

Association between 18F-fluorodeoxyglucose-PET/CT and histological grade of uterine endometrial carcinoma

Objective

The incidence of endometrial adenocarcinoma of the uterine corpus has increased in Japan. This study aimed to clarify the relationships between this type of cancer and various data provided by 18F-fluorodeoxyglucose (FDG) accumulation in positron emission tomography/computed tomography (PET/CT).