Cervical cancer histology and tumor differentiation affect 18F‐fluorodeoxyglucose uptake

BACKGROUND:

This study aimed to evaluate the variation in cervical cancer glucose metabolism for different tumor histologies and levels of differentiation, as measured by the uptake of ¹⁸F‐fluorodeoxyglucose (FDG) by positron emission tomography (PET).

METHODS:

The study population consisted of 240 patients with International Federation of Gynecology and Obstetrics stages Ib1 through IVb cervical cancer, who underwent a pretreatment FDG‐PET. Tumor histology included 221 squamous cell (SC), 4 adenosquamous (AS), and 15 adenocarcinoma (AC) tumors. There were 14 well, 145 moderately, and 81 poorly differentiated tumors. The stage distribution was as follows: 70 stage I tumors (9 AC, 2 AS, and 59 SC), 102 stage II tumors (3 AC, 1 AS, and 98 SC), 64 stage III tumors (3 AC, 1 AS, and 60 SC), and 4 stage IV tumors (4 SC). From the FDG‐PET, maximal standardized uptake value (SUV_max) was determined. The variation in SUV_max was analyzed for differences based on tumor histology and differentiation.

RESULTS:

For all patients, the mean SUV_max was 11.62 (range, 2.50‐50.39). The mean SUV_max by histology was as follows: SC, 11.91 (range, 2.50‐50.39); AS, 8.85 (range, 6.53‐11.26); and AC, 8.05 (range, 2.83‐13.92). Squamous versus nonsquamous tumors demonstrated a significant difference in SUV_max (P = .0153). SUV_max and tumor volume were not found to be correlated (R² = 0.013). The mean SUV_max was 8.58 for well‐differentiated, 11.56 for moderately differentiated, and 12.23 for poorly differentiated tumors. The mean SUV_max was significantly different for well?differentiated versus poorly differentiated cervical tumors (P = .0474).

CONCLUSIONS:

Cervical tumor FDG uptake varied by histology and differentiation. SC tumors demonstrated a significantly higher SUV_max compared with nonsquamous cell tumors, and poorly differentiated tumors also had a higher SUV_max. Cancer 2009. © 2009 American Cancer Society.     

NF-κB protein expression associates with F-FDG PET tumor uptake in non-small cell lung cancer: A radiogenomics validation study to understand tumor metabolism

Introduction

We previously demonstrated that NF-κB may be associated with ¹⁸F-FDG PET uptake and patient prognosis using radiogenomics in patients with non-small cell lung cancer (NSCLC). To validate these results, we assessed NF-κB protein expression in an extended cohort of NSCLC patients.

Methods

We examined NF-κBp65 by immunohistochemistry (IHC) using a Tissue Microarray. Staining intensity was assessed by qualitative ordinal scoring and compared to tumor FDG uptake (SUV_max and SUV_mean), lactate dehydrogenase A (LDHA) expression (as a positive control) and outcome using ANOVA, Kaplan Meier (KM), and Cox-proportional hazards (CPH) analysis.

Results

365 tumors from 355 patients with long-term follow-up were analyzed. The average age for patients was 67 ± 11 years, 46% were male and 67% were ever smokers. Stage I and II patients comprised 83% of the cohort and the majority had adenocarcinoma (73%). From 88 FDG PET scans available, average SUV_max and SUV_mean were 8.3 ± 6.6, and 3.7 ± 2.4 respectively. Increasing NF-κBp65 expression, but not LDHA expression, was associated with higher SUV_max and SUV_mean (p = 0.03 and 0.02 respectively). Both NF-κBp65 and positive FDG uptake were significantly associated with more advanced stage, tumor histology and invasion. Higher NF-κBp65 expression was associated with death by KM analysis (p = 0.06) while LDHA was strongly associated with recurrence (p = 0.04). Increased levels of combined NF-κBp65 and LDHA expression were synergistic and associated with both recurrence (p = 0.04) and death (p = 0.03).

Conclusions

NF-κB IHC was a modest biomarker of prognosis that associated with tumor glucose metabolism on FDG PET when compared to existing molecular correlates like LDHA, which was synergistic with NF-κB for outcome. These findings recapitulate radiogenomics profiles previously reported by our group and provide a methodology for studying tumor biology using computational approaches.     

Quantitative F18‐fluorodeoxyglucose positron emission tomography accurately characterizes peripheral nerve sheath tumors as malignant or benign

BACKGROUND:

Correct pretreatment classification is critical for optimizing diagnosis and treatment of patients with peripheral nerve sheath tumors (PNSTs). The aim of this study was to evaluate whether F18‐fluorodeoxyglucose positron emission tomography (FDG PET) can differentiate malignant (MPNST) from benign PNSTs.

METHODS:

Thirty‐four adult patients presenting with PNST who underwent a presurgical FDG PET/computed tomography (CT) scan between February 2005 and November 2008 were included in the study. Tumors were characterized histologically, by FDG maximum standardized uptake value (SUV_max [g/mL]), and by CT size (tumor maximal diameter [cm]). The accuracy of FDG PET for differentiating MPNSTs from benign PNSTs (neurofibroma and schwannoma) was evaluated by receiver operating characteristic (ROC) curve analysis.

RESULTS:

SUV_max was measured in 34 patients with 40 tumors (MPNSTs: n = 17; neurofibromas: n = 9; schwannomas: n = 14). SUV_max was significantly higher in MPNST compared with benign PNST (12.0 ± 7.1 vs 3.4 ± 1.8; P < .001). An SUV_max cutoff point of ≥6.1 separated MPNSTs from BPSNTs with a sensitivity of 94% and a specificity of 91% (P < .001). By ROC curve analysis, SUV_max reliably differentiated between benign and malignant PNSTs (area under the ROC curve of 0.97). Interestingly, the difference between MPNSTs and schwannomas was less prominent than that between MPNSTs and neurofibromas.

CONCLUSIONS:

Quantitative FDG PET imaging distinguished between MPNSTs and neurofibromas with high accuracy. In contrast, MPNSTs and schwannomas were less reliably distinguished. Given the difficulties in clinically evaluating PNST and in distinguishing benign PNST from MPNST, FDG PET imaging should be used for diagnostic intervention planning and for optimizing treatment strategies. Cancer 2010. © 2010 American Cancer Society.     

Pelvic lymph node F‐18 fluorodeoxyglucose uptake as a prognostic biomarker in newly diagnosed patients with locally advanced cervical cancer

BACKGROUND:

The objective of the current study was to evaluate the prognostic significance of the maximum standardized uptake value (SUV_max) of F‐18 fluorodeoxyglucose (FDG) as measured by positron emission tomography (PET) in pelvic lymph nodes in patients with cervical cancer.

METHODS:

The authors studied cervical cancer patients with pelvic lymph node metastasis, as evidenced on FDG‐PET, who were treated between November 2003 and October 2008. The maximum dimension and SUV_max for the most FDG‐avid pelvic lymph node (SUV_PLN) and the SUV_max of the primary cervical tumor (SUV_cervix) were recorded from the FDG‐PET/computed tomography (CT) scan. The SUV_PLN was analyzed for its association with treatment response, pelvic disease recurrence, disease‐specific survival, and overall survival.

RESULTS:

The population was comprised of 83 women with International Federation of Gynecology and Obstetrics (FIGO) stages IB1 to IIIB cervical cancer. The average SUV_PLN was 6.9 (range, 2.1‐33.0), whereas the average SUV_cervix was 14.0 (range, 3.2‐38.4). The SUV_cervix and SUV_PLN were found to be weakly correlated (correlation coefficient [R²] = 0.301). The average size of the pelvic lymph nodes was 2.1 cm (range, 0.6‐7.9 cm), and was also found to be only weakly associated with the SUV_PLN (R² = 0.225). The SUV_PLN was found to be correlated with an increased risk of persistent disease after treatment (P = .0025), specifically within the pelvic lymph node region (P = .0003). The SUV_PLN was found to be predictive of an increased risk of ever developing pelvic disease recurrence (P = .0035). Patients with a higher SUV_PLN were found to have significantly worse disease‐specific (P = .0230) and overall survival (P = .0378) using Kaplan?Meier evaluation. A Cox proportional hazards model for the risk of pelvic disease recurrence was performed including SUV_PLN, patient age, and tumor stage, and found only an increased SUV_PLN to be an independent predictor.

CONCLUSIONS:

SUV_PLN is a prognostic biomarker, predicting treatment response, pelvic recurrence risk, and disease‐specific survival in patients with cervical cancer. Cancer 2010. © 2010 American Cancer Society.     

Limited prognostic value of dual time point F-18 FDG PET/CT in patients with early stage (stage I & II) non-small cell lung cancer (NSCLC)

Objective

The aim of the current study was to investigate the prognostic value of dual time point F-18 FDG PET/CT in patients with early stage (stage I & II) NSCLC.

Methods

A retrospective review identified 66 patients with surgically resected early (stage I & II) NSCLC who received dual time point F-18 FDG PET/CT at diagnosis of cancer. Survival analysis was conducted using Kaplan-Meier analysis, and survival curves stratified by age, sex, mediastinal lymph node involvement, TNM staging, SUV_maxE, SUV_maxD, and %ΔSUV_max were generated for estimation of overall survival and disease-free survival (DFS). Independent predictive factors for survival were determined using Cox proportional hazard model.

Results

The overall survival and DFS were better in patients with tumor SUV_maxE ? 5.75 than the patients with tumor SUV_maxE ? 5.75. Seventeen patients (18.2%) with a tumor SUV_maxD ? 6.8 and 4 of 33 patients with tumor SUV_maxD ? 6.8 recurred during follow-up period. The median disease-free survival of the patients with tumor SUV_maxD ? 6.8 was 31.7 months and was significantly worse than the patients with tumor SUV_maxD ? 6.8 (Log rank test, Χ² = 10.45, p = 0.0012). The %ΔSUV_max did not have prognostic values for overall survival and disease-free survival. The SUV_maxE and SUV_maxD were the potent predictors for overall survival. Also, the potent predictor of DFS was the SUV_maxE.

Conclusion

In conclusion, %ΔSUV_max measured by dual time point F-18 FDG PET/CT might not have a prognostic value for overall survival and DFS in surgically resected early stage (stage I & II) NSCLC.     

Metabolic activity measured by FDG PET predicts pathological response in locally advanced superior sulcus NSCLC

Objectives

Pathological complete response and tumor regression to less than 10% vital tumor cells after induction chemoradiotherapy have been shown to be prognostically important in non-small cell lung cancer (NSCLC). Predictive imaging biomarkers could help treatment decision-making. The purpose of this study was to assess whether postinduction changes in tumor FDG uptake could predict pathological response and to evaluate the correlation between residual vital tumor cells and post-induction FDG uptake.

Methods

NSCLC patients with sulcus superior tumor (SST), planned for trimodality therapy, routinely undergo FDG PET/CT scans before and after induction chemoradiotherapy in our institute. Metabolic end-points based on standardized uptake values (SUV) were calculated, including SUV_max (maximum SUV), SUV_TTL (tumor-to-liver ratio), SUV_peak (SUV within 1 cc sphere with highest activity), and SUV_PTL (peak-to-liver ratio). Pathology specimens were assessed for residual vital tumor cell percentages and scored as no (grade 3), <10% (grade 2b) and >10% vital tumor cells (grade 2a/1).

Results

19 and 23 patients were evaluated for (1) metabolic change and (2) postinduction PET-pathology correlation, respectively. Changes in all parameters were predictive for grade 2b/3 response. ΔSUV_TTL and ΔSUV_PTL were also predictive for grade 3 response. Remaining vital tumor cells correlated with post-induction SUV_peak (R = 0.55; P = 0.007) and postinduction SUV_PTL (R = 0.59; P = 0.004). Postinduction SUV_PTL could predict both grades 3 and 2b/3 response.

Conclusion

In NSCLC patients treated with chemoradiotherapy, changes in SUV_max, SUV_TTL, SUV_peak, and SUV_PTL were predictive for pathological response (grade 2b/3 and for SUV_TTL and SUV_PTL grade 3 as well). Postinduction SUV_PTL correlated with residual tumor cells.     

The prognostic value of volume-based parameters using <Superscript>18</Superscript>F-FDG PET/CT in gastric cancer according to HER2 status

Background

We aimed to find the clinical value of metastatic tumor burden evaluated with F18-FDG PET/CT in gastric cancer patients, considering the human epidermal growth factor receptor 2 (HER2) status.

Methods

We retrospectively reviewed 124 patients with locally advanced or metastatic gastric cancer at Yonsei Cancer Center between January 2006 and December 2014 who had undergone baseline FDG PET/CT before first-line chemotherapy. We measured the maximum standardized uptake value from the primary tumor (SUV_max) and whole-body (WB) PET/CT parameters, including WB SUV_max, WB SUV_mean, WB metabolic tumor volume (WB MTV), and WB total lesion glycolysis (WB TLG), in all metabolically active metastatic lesions (SUV threshold ≥2.5 or 40% isocontour for ≤2.5), and we determined their association with patient survival outcomes.

Results

SUV_max was higher in HER2-positive gastric cancers (median 12.1, range 3.4–34.6) compared to HER-2 negative (7.4, 1.6–39.1, P < 0.001). Among all patients, WB TLG > 600, which is indicative of a high metastatic tumor burden, showed worse progression-free survival (PFS) [hazard ratio (HR), 2.003; 95% CI, 1.300–3.086; P = 0.002] and overall survival (OS) (HR, 3.001; 95% CI, 1.950–4.618; P < 0.001) than did WB TLG ≤ 600. Among HER2-positive gastric cancer patients treated with trastuzumab, higher metabolic tumor burden predicted worse OS, but not PFS.

Conclusions

HER2-positive gastric cancers had higher SUV_max compared to HER2-negative gastric cancers. In both HER2-negative patients and -positive patients receiving trastuzumab, FDG PET/CT volume-based parameters may have a role in further stratifying the prognosis of stage IV gastric cancer.

     

A SUV<Subscript>max</Subscript>-based propensity matched analysis of stereotactic body radiotherapy versus surgery in stage I non-small cell lung cancer: unveiling the role of 18F-FDG PET/CT in clinical decision-making

Background

The value of maximum standard uptake value (SUV_max) was overlooked in current studies comparing stereotactic body radiotherapy (SBRT) versus surgery for stage I non-small cell lung cancer (NSCLC). Herein, we aimed to compare the 3-year outcomes based on patients for whom SUV_max were available, and to explore the role of SUV_max in clinical decision-making.

Methods

From January 2010 to June 2016, data of eligible patients were collected. Patient variables and clinical outcomes were compared in both unmatched and matched groups using propensity score matching (PSM). Multivariate analysis was performed for predictors of poor outcome. The relationship between treatment approach and survival outcome was also evaluated in subgroup patients stratified by SUV_max level.

Results

A total of 425 patients treated with either surgery (325) or SBRT (100) were included. Patients receiving SBRT were significantly older, had a higher level of SUV_max and were more likely to have tumor of centrally located. Multivariate analysis showed that SUV_max and tumor size were significant predictors for 3-year OS, LRC, and PFS, while better PFS was also related to peripheral tumor and surgery. The result of PSM analysis also showed that compared to SBRT, surgery could only achieve better PFS. Subgroup analysis indicated that surgery had added advantage of 3-year LRC and PFS for patients in high SUV_max group (SUV_max > 8), but not in low SUV_max group.

Conclusions

The study found a superior PFS after surgery while OS and LRC did not differ between SBRT and surgery. Surgery should be recommended for tumor of high SUV_max.

     

Total lesion glycolysis in oral squamous cell carcinoma as a biomarker derived from pre-operative FDG PET/CT outperforms established prognostic factors in a newly developed multivariate prediction model

Purpose: Retrospective study to investigate the impact of image derived biomarkers from [¹⁸F]FDG PET/CT prior to surgical resection in patients with initial diagnosis of oral squamous cell carcinoma (OSCC), namely SUV_max, SUV_mean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary tumor to predict overall survival (OS).Materials and Methods: 127 subsequent patients with biopsy-proven OSCC were included who underwent [¹⁸F]FDG PET/CT before surgery. SUV_max, SUV_mean, MTV and TLG of the primary tumor were measured. OS was estimated according to Kaplan-Meier and compared between median-splitted groups by the log-rank test. Prognostic parameters were analyzed by uni-/multivariate Cox-regression.Results: During follow-up 52 (41%) of the patients died. Median OS was longer for patients with lower MTV or lower TLG. SUV_max and SUV_mean failed to be significant predictors for OS. Univariate Cox-regression identified MTV, TLG, lymph node status and UICC stage as prognostic factors. By multivariate Cox-regression MTV and TLG turned out to be independent prognostic factors for OS.Conclusions: The pre-therapeutic [¹⁸F]FDG PET/CT parameters MTV and TLG in the primary tumor are prognostic for OS of patients with an initial diagnosis of OSCC. TLG is the strongest independent prognostic factor for OS and outperforms established prognostic parameters in OSCC.     

Early prediction of triple negative breast cancer response to cisplatin treatment using diffusion-weighted MRI and <Superscript>18</Superscript>F-FDG-PET

Background

We evaluated the potential of diffusion-weighted MRI (DW-MRI) and ¹⁸F-FDG-PET for the early prediction of a triple negative breast cancer (TNBC) response to cisplatin.

Methods

Cisplatin-treated TNBC tumor-bearing mice were categorized as responders or non-responders based on the tumor growth rate. DW-MRI and ¹⁸F-FDG-PET were performed before and after treatment (day 0 and days 3 and 7, respectively). The average apparent diffusion coefficient value (ADC_mean), the highest standardized uptake value (SUV_max), and the metabolic tumor volume (MTV) were measured. The ratios of each parameter relative to day 0 were calculated [ΔADC_mean (day 3) and (day 7), ΔSUV_max (day 3) and (day 7), and ΔMTV (day 3) and (day 7), respectively]. Overall survival rates were compared based on the thresholds determined by these parameters.

Results

Both the day 3 and day 7 ratios of ADC_mean and MTV showed significant differences between the responder and non-responder groups, whereas the ratios of SUV_max did not. Mice with ΔADC_mean (day 3) exceeding the threshold showed a longer overall survival rate. Mice with ΔSUV_max (day 7), ΔMTV (day 3), and ΔMTV (day 7) below the respective thresholds showed a longer overall survival rate.

Conclusions

The ratios of ADC_mean, SUV_max, and MTV have the potential to predict the therapeutic response and to screen non-responders in the ultra-early phase following cisplatin treatment in patients with TNBC.

     

Evaluation of children with craniopharyngioma using carbon-11 methionine PET prior to proton therapy

Background

Fluorine-18 (¹⁸F) fluorodeoxyglucose (FDG) positron emission tomography (PET) is limited in its evaluation of brain tumors due to the high basal activity of the cerebral cortex and white matter. Carbon-11 methionine (¹¹C MET) has little uptake under normal conditions. We prospectively investigated the uptake of ¹⁸F FDG and ¹¹C MET PET in patients with craniopharyngioma prior to proton therapy.

Methods

Ten patients newly diagnosed with craniopharyngioma underwent PET imaging using ¹⁸F FDG and ¹¹C MET. PET and MRI studies were registered to help identify tumor volume. Measurements of maximum standardized uptake value (SUV_max) were taken of the tumor and compared with noninvolved left frontal background white matter using a paired t-test. Uptake was graded using a 4-point scale.

Results

Median patient age was 9 years (range 5–19). Seven patients were diagnosed by pathology, 1 by cyst fluid aspiration, and 2 by neuroimaging. Median FDG SUV_max for tumor and background were 2.65 and 3.2, respectively. Median MET SUV_max for tumor and background were 2.2 and 1, respectively. There was a significant difference between MET tumor SUV_max and MET background SUV_max (P = .0001). The difference between FDG tumor SUV_max and FDG background SUV_max was not significant (P = .3672).

Conclusion

¹¹C MET PET uptake is significantly greater within the tumor compared with noninvolved background white matter, making it more useful than FDG PET in identifying active tumor in patients with craniopharyngioma. Future work will focus on using ¹¹C MET PET to discriminate between active and inactive tumor after irradiation.     

Metabolic tumor burden predicts prognosis of ovarian cancer patients who receive platinum‐based adjuvant chemotherapy

Volumetric parameters of positron emission tomography–computed tomography using 18F‐fludeoxyglucose (¹⁸F‐FDG PET/CT) that comprehensively reflect both metabolic activity and tumor burden are capable of predicting survival in several cancers. The aim of this study was to investigate the predictive performance of metabolic tumor burden measured by ¹⁸F‐FDG PET/CT in ovarian cancer patients who received platinum‐based adjuvant chemotherapy after cytoreductive surgery. Included in this study were 37 epithelial ovarian cancer patients. Metabolic tumor burden in terms of metabolic tumor volume (MTV) and total lesion glycolysis (TLG), clinical stage, histological type, residual tumor after primary cytoreductive surgery, baseline serum carbohydrate antigen 125 (CA125) level, and the maximum standardized uptake value (SUV_max) were determined, and compared for their performance in predicting progression‐free survival (PFS). Metabolic tumor volume correlated with CA125 (r = 0.547, P < 0.001), and TLG correlated with SUV_max and CA125 (SUV_max, r = 0.437, P = 0.007; CA125, r = 0.593, P < 0.001). Kaplan–Meier analysis showed a significant difference in PFS between the groups categorized by TLG (P = 0.043; log–rank test). Univariate analysis indicated that TLG was a statistically significant risk factor for poor PFS. Multivariate analysis adjusted according to the clinicopathological features was carried out for MTV, TLG, SUV_max, tumor size, and CA125. Only TLG showed a significant difference (P = 0.038), and a 3.915‐fold increase in the hazard ratio of PFS. Both MTV and TLG (especially TLG) could serve as potential surrogate biomarkers for recurrence in patients who undergo primary cytoreductive surgery followed by platinum‐based chemotherapy, and could identify patients at high risk of recurrence who need more aggressive treatment.     

Significance of 18F-FDG PET Parameters According to Histologic Subtype in the Treatment Outcome of Stage III Non–small-cell Lung Cancer Undergoing Definitive Concurrent Chemoradiotherapy

Purpose

We analyzed positron emission tomography-computed tomography (PET-CT) in patients with stage III non–small-cell lung cancer (NSCLC) undergoing concurrent chemoradiotherapy (CRT) to examine the prognostic value of PET-CT parameters according to histologic subtypes (squamous cell carcinoma [SqCC] and adenocarcinoma [ADC]).

Anal cancer maximum F-18 fluorodeoxyglucose uptake on positron emission tomography is correlated with prognosis

Purpose

To evaluate anal cancer uptake of F-18 fluorodeoxyglucose (FDG) measured as the maximum standardized uptake value (SUV_max) by positron emission tomography (PET) and its correlation with prognostic factors.

Patients and methods

The study population consisted of 77 patients with stages 0-IIIB anal cancer who underwent pre-treatment FDG-PET. Tumor histology included 65 squamous cell, 11 basaloid, and 1 small cell cancers. SUV_max and sites of lymph node metastasis were recorded. We analyzed the association between SUV_max and prognostic factors.

Results

The mean SUV_max was 10.0 (range 1.0-43.1). The stage distribution included: 2 stage 0, 7 stage I, 49 stage II, 10 stage IIIA, 9 stage IIIB. SUV_max and clinical tumor size were not associated (R² = 0.338). Histology did not significantly influence SUV_max (mean SUV_max 10.0 for squamous versus 9.90 for basaloid). Higher SUV_max was associated with an increased risk of nodal metastasis at diagnosis (p < 0.0001). Higher SUV_max was associated with worse disease-free survival (p = 0.05). Patients with high anal tumor SUV_max at diagnosis were at an increased risk of persistent or recurrent disease on post-therapy FDG-PET performed less than 4 months after completing therapy (p = 0.0402).

Conclusions

SUV_max is a valuable biomarker of anal cancer prognosis, predicting increased risk of lymph node metastasis and worse disease-free survival.     

DW MRI at 3.0 T versus FDG PET/CT for detection of malignant pulmonary tumors

Emerging evidence suggests that diffusion‐weighted magnetic resonance imaging (DW MRI) could be useful for tumor detection with N and M staging of lung cancer in place of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT). DW MRI at 3.0 T and FDG PET/CT were performed before therapy in 113 patients with pulmonary nodules. Mean apparent diffusion coefficient (ADC), maximal standardized uptake value (SUV_max) and Ki‐67 scores were assessed. Quantitatively, specificity and accuracy of ADC (91.7 and 92.9%, respectively) were significantly higher than those of SUV_max (66.7 and 77.9% respectively, p < 0.05), although sensitivity was not significantly different between them (93.5 and 83.1%, p > 0.05). Qualitatively, sensitivity, specificity and accuracy of DW MRI (96.1, 83.3 and 92.0%, respectively) were also not significantly different from that of FDG PET/CT (88.3, 83.3 and 86.7%, respectively, p > 0.05). Significant negative correlation was found between Ki‐67 score and ADC (r = ?0.66, p < 0.05), ADC and SUV_max (r = ?0.37, p < 0.05), but not between Ki‐67 score and SUV_max (r = ?0.11, p > 0.05). In conclusion, quantitative and qualitative assessments for detection of malignant pulmonary tumors with DW MRI at 3.0 T are superior to those with FDG PET/CT. Furthermore, ADC could predict the malignancy of lung cancer.     

18F‐fluorodeoxyglucose and 11C‐acetate positron emission tomography are useful modalities for diagnosing the histologic type of thymoma

BACKGROUND:

The objective of this study was to clarify the usefulness of positron emission tomography (PET) using¹⁸F‐fluorodeoxyglucose (FDG) and carbon 11‐labeled acetate (AC) for predicting the histologic types and tumor invasiveness of thymoma in a multicenter study.

METHODS:

Forty thymomas were examined using both FDG‐PET and AC‐PET before surgery. The histologic types were type A in 1 thymoma, type AB in 12 thymomas, type B1 in 11 thymomas, type B2 in 7 thymomas, type B3 in 6 thymomas, and type C in 3 thymomas. Tumor invasiveness was assessed by pathologic tumor stage and was identified as stage I in 17 tumors, stage II in 17 tumors, stage III in 4 tumors, and stage IV in 2 tumors. FDG and AC uptake was measured as the maximum standard uptake value (SUV).

RESULTS:

The FDG‐SUV in type C thymomas was significantly higher than that in the other types (A‐B3; P = .001 – P = .048). The AC‐SUV in type A/AB thymomas was significantly higher than that in the other tumor types (B1‐C; P < .001 – P = .002). All 3 type C tumors had an FDG‐SUV ≥6.3, and all 13 type A/AB tumors had an FDG‐SUV <6.3 and an AC‐SUV ≥5.7. All 17 thymomas that had an FDG‐SUV <6.3 and an AC‐SUV <5.7 were type B1, B2, or B3. Neither the FDG‐SUV nor the AC‐SUV differed significantly between the stages I/II tumors and stage III/IV tumors.

CONCLUSIONS:

Although neither the FDG‐SUV nor the AC‐SUV can predict the invasiveness of thymomas assessed by tumor stage, they are useful for predicting histologic types of thymoma. Thymomas with an FDG‐SUV <6.3 and an AC‐SUV ≥5.7 almost certainly are types A/AB, which is of considerable prognostic and management significance. Cancer 2009. © 2009 American Cancer Society.     

应用根治性IMRT结合降低预防照射区剂量治疗Ⅲ期SCLC研究

目的 分析应用根治性IMRT结合降低预防照射区剂量治疗Ⅲ期SCLC的疗效和不良反应。方法 回顾分析2010—2012年间收治的40例Ⅲ期SCLC患者资料。PGTV总剂量60 Gy分30次,PTV总剂量54 Gy分30次。全部接受了铂类联合依托泊苷或替尼泊苷方案的诱导化疗,31例辅助化疗,22例同期放化疗。17例患者接受了脑预防照射(25 Gy分10次)。采用RECIST 1.0和CTCAE 4.0 标准分别评价近期疗效和不良反应。采用Kaplan-Meier法计算生存率。结果 近期有效率98%。随访率100%,随访时间满2年者22例。1、2年OS分别为84%、48%,LRFS分别为89%、85%,PFS分别为61%、41%。治疗相关性肺炎发生率0~1级65%、2级 25%、3级5%、5级5%,治疗相关性食管炎发生率0~1级53%、2级43%、3级5%。结论 初步结果显示根治性IMRT结合降低预防照射区剂量治疗Ⅲ期SCLC是安全有效的,值得进一步大样本前瞻性随机分组研究。     

[18F]‐Fluorodeoxyglucose Positron Emission Tomography Standardized Uptake Value as a Predictor of Adjuvant Chemotherapy Benefits in Patients With Nasopharyngeal Carcinoma

Background.

The role of adjuvant chemotherapy for the treatment of nasopharyngeal carcinoma (NPC) is controversial, and the identification of adequate predictive factors is warranted. Therefore, we aimed to investigate whether the mean standardized uptake value (SUV) measured on [¹⁸F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) could predict the survival benefits for NPC patients that receive adjuvant chemotherapy.

Materials and Methods.

The data for 174 NPC patients who underwent PET/computed tomography before chemoradiation between January 2004 and January 2012 were reviewed. The SUV_75% was recorded for primary tumors. All patients received intensity-modulated radiotherapy and cisplatin-based chemotherapy. Adjuvant chemotherapy consisted of 3 cycles of 75 mg/m² cisplatin and 1,000 mg/m² fluorouracil for 4 days.

Results.

The optimal cutoff value was 8.35 for SUV_75%, with 112 (64.4%) patients having lower SUV_75% and 62 (35.6%) having higher SUV_75%. Patients with lower SUV_75% had significantly better 5-year overall survival (OS) and distant metastasis-free survival. Multivariate analysis revealed that tumor stage, SUV_75%, and adjuvant chemotherapy were significant prognostic factors for OS. Patients with higher SUV_75% had significantly higher 5-year OS rates with adjuvant chemotherapy than without adjuvant chemotherapy (84.3% vs. 32.4%, respectively; p < .001). However, in the lower SUV_75% group, no differences in 5-year OS were observed between patients who received and those who did not receive adjuvant chemotherapy (92.4% vs. 93.3%, respectively; p = .682).

Conclusion.

The SUV_75% on FDG PET for primary tumors could successfully identify NPC patients who may benefit from adjuvant chemotherapy.     

Axillary Lymph Node-to-Primary Tumor Standard Uptake Value Ratio on Preoperative 18F-FDG PET/CT: A Prognostic Factor for Invasive Ductal Breast Cancer

Purpose

This study assessed the axillary lymph node (ALN)-to-primary tumor maximum standard uptake value (SUV_max) ratio (ALN/T SUV ratio) in invasive ductal breast cancer (IDC) on preoperative ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) to determine the effectiveness in predicting recurrence-free survival (RFS).

Methods

One hundred nineteen IDC patients (mean age, 50.5±10.5 years) with pathologically proven ALN involvement without distant metastasis and preoperative FDG PET/CT were enrolled in the study. SUV_max values of the ALN and primary tumor were obtained on FDG PET/CT, and ALN/T SUV ratio was calculated. Several factors were evaluated for their effectiveness in predicting RFS. These included several parameters on FDG PET/CT as well as several clinicopathological parameters: pathologic tumor/node stage; nuclear and histological grade; hormonal state; status with respect to human epidermal growth factor receptor 2, mindbomb E3 ubiquitin protein ligase 1 (MIB-1), and p53; primary tumor size; and ALN size.

Results

Among 119 patients with breast cancer, 17 patients (14.3%) experienced relapse during follow-up (mean follow-up, 28.4 months). The ALN/T SUV ratio of the group with disease recurrence was higher than that of the group without recurrence (0.97±1.60 and 0.45±0.40, respectively, p=0.005). Univariate analysis showed that the primary tumor SUV_max, ALN SUV_max, ALN/T SUV ratio, ALN status, nuclear and histological grade, estrogen receptor (ER) status, and MIB-1 status were predictors for RFS. Among these variables, ALN/T SUV ratio with hazard ratio of 4.20 (95% confidence interval [CI], 1.74-10.13) and ER status with hazard ratio of 4.33 (95% CI, 1.06-17.71) were predictors for RFS according to multivariate analysis (p=0.002 and p=0.042, respectively).

Conclusion

Our study demonstrated that ALN/T SUV ratio together with ER status was an independent factor for predicting relapse in IDC with metastatic ALN. ALN/T SUV ratio on preoperative FDG PET/CT may be a useful marker for selecting IDC patients that need adjunct treatment to prevent recurrence.     

High rates of tumor growth and disease progression detected on serial pretreatment fluorodeoxyglucose‐positron emission tomography/computed tomography scans in radical radiotherapy candidates with nonsmall cell lung cancer

BACKGROUND:

The authors studied growth and progression of untreated nonsmall cell lung cancer (NSCLC) by comparing diagnostic and radiotherapy (RT) planning fluorodeoxyglucose (FDG)‐positron emission tomography (PET)/computed tomography (CT) scans before proposed radical chemo‐RT.

METHODS:

Patients enrolled on a prospective clinical trial were eligible for this analysis if they underwent 2 pretreatment whole body FDG‐PET/CT scans, >7 days apart. Scan 1 was performed for diagnosis/disease staging and scan 2 for RT planning. Interscan comparisons included disease stage, metabolic characteristics, tumor doubling times, and change in treatment intent.

RESULTS:

Eighty‐two patients underwent planning PET/CT scans between October 2004 and February 2007. Of these, 28 patients (61% stage III, 18% stage II) had undergone prior staging PET/CT scans. The median interscan period was 24 days (range, 8‐176 days). Interscan disease progression (TNM stage) was detected in 11 (39%) patients. The probability of upstaging within 24 days was calculated to be 32% (95% confidence interval [CI], 18%‐49%). Treatment intent changed from curative to palliative in 8 (29%) cases, in 7 because of PET. For 17 patients who underwent serial PET/CT scans under standardized conditions, there was a mean relative interscan increase of 19% in tumor maximum standardized uptake value (SUV) (P = .022), 16% in average SUV (P = .004), and 116% in percentage injected dose (P = .002). Estimated doubling time of FDG avid tumor was 66 days (95% CI, 51‐95 days).

CONCLUSIONS:

Rapid tumor progression was detected in patients with untreated, predominantly stage III, NSCLC on serial FDG‐PET/CT imaging, highlighting the need for prompt diagnosis, staging, and initiation of therapy in patients who are candidates for potentially curative therapy. Cancer 2010. © 2010 American Cancer Society.