51
|
Gu J, Zhu J, Qiu Q, Wang Y, Bai T, Duan J, Yin Y. The Feasibility Study of Megavoltage Computed Tomographic (MVCT) Image for Texture Feature Analysis. Front Oncol 2018; 8:586. [PMID: 30568918 PMCID: PMC6290333 DOI: 10.3389/fonc.2018.00586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/21/2018] [Indexed: 11/13/2022] Open
Abstract
Purpose: To determine whether radiomics texture features can be reproducibly obtained from megavoltage computed tomographic (MVCT) images acquired by Helical TomoTherapy (HT) with different imaging conditions. Methods: For each of the 195 textures enrolled, the mean intrapatient difference, which is considered to be the benchmark for reproducibility, was calculated from the MVCT images of 22 patients with early-stage non-small-cell lung cancer. Test–retest MVCT images of an in-house designed phantom were acquired to determine the concordance correlation coefficient (CCC) for these 195 texture features. Features with high reproducibility (CCC > 0.9) in the phantom test–retest set were investigated for sensitivities to different imaging protocols, scatter levels, and motion frequencies using a wood phantom and in-vitro animal tissues. Results: Of the 195 features, 165 (85%) features had CCC > 0.9. For the wood phantom, 124 features were reproducible in two kinds of scatter materials, and further investigations were performed on these features. For animal tissues, 108 features passed the criteria for reproducibility when one layer of scatter was covered, while 106 and 108 features of in-vitro liver and bone passed with two layers of scatter, respectively. Considering the effect of differing acquisition pitch (AcP), 97 features extracted from wood passed, while 103 and 59 features extracted from in-vitro liver and bone passed, respectively. Different reconstruction intervals (RI) had a small effect on the stability of the feature value. When AcP and RI were held consistent without motion, all 124 features calculated from wood passed, and a majority (122 of 124) of the features passed when imaging with a “fine” AcP with different RIs. However, only 55 and 40 features passed with motion frequencies of 20 and 25 beats per minute, respectively. Conclusion: Motion frequency has a significant impact on MVCT texture features, and features from MVCT were more reproducibility in different scatter conditions than those from CBCT. Considering the effects of AcP and RI, the scanning protocols should be kept consistent when MVCT images are used for feature analysis. Some radiomics features from HT MVCT images are reproducible and could be used for creating clinical prediction models in the future.
Collapse
Affiliation(s)
- Jiabing Gu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China.,Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Zhu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Qingtao Qiu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Yungang Wang
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Tong Bai
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Jinghao Duan
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| |
Collapse
|
52
|
van Diessen J, De Ruysscher D, Sonke JJ, Damen E, Sikorska K, Reymen B, van Elmpt W, Westman G, Fredberg Persson G, Dieleman E, Bjorkestrand H, Faivre-Finn C, Belderbos J. The acute and late toxicity results of a randomized phase II dose-escalation trial in non-small cell lung cancer (PET-boost trial). Radiother Oncol 2018; 131:166-173. [PMID: 30327236 DOI: 10.1016/j.radonc.2018.09.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE The PET-boost randomized phase II trial (NCT01024829) investigated dose-escalation to the entire primary tumour or redistributed to regions of high pre-treatment FDG-uptake in inoperable non-small cell lung cancer (NSCLC) patients. We present a toxicity analysis of the 107 patients randomized in the study. MATERIALS AND METHODS Patients with stage II-III NSCLC were treated with an isotoxic integrated boost of ≥72 Gy in 24 fractions, with/without chemotherapy and strict dose limits. Toxicity was scored until death according to the CTCAEv3.0. RESULTS 77 (72%) patients were treated with concurrent chemoradiotherapy. Acute and late ≥G3 occurred in 41% and 25%. For concurrent (C) and sequential or radiotherapy alone (S), the most common acute ≥G3 toxicities were: dysphagia in 14.3% (C) and 3.3% (S), dyspnoea in 2.6% (C) and 6.7% (S), pneumonitis in 0% (C) and 6.7% (S), cardiac toxicity in 6.5% (C) and 3.3% (S). Seventeen patients died of which in 13 patients a possible relation to treatment could not be excluded. In 10 of these 13 patients progressive disease was scored. Fatal pulmonary haemorrhages and oesophageal fistulae were observed in 9 patients. CONCLUSION Personalized dose-escalation in inoperable NSCLC patients results in higher acute and late toxicity compared to conventional chemoradiotherapy. The toxicity, however, was within the boundaries of the pre-defined stopping rules.
Collapse
Affiliation(s)
- Judi van Diessen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO Clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eugène Damen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Karolina Sikorska
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bart Reymen
- Department of Radiation Oncology (MAASTRO Clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO Clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands
| | - Gunnar Westman
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Denmark
| | | | - Edith Dieleman
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Corinne Faivre-Finn
- The University of Manchester, Division of Cancer Sciences, The Christie NHS Foundation Trust, United Kingdom
| | - José Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| |
Collapse
|
53
|
Ma W, Wang M, Li X, Huang H, Zhu Y, Song X, Dai D, Xu W. Quantitative 18F-FDG PET analysis in survival rate prediction of patients with non-small cell lung cancer. Oncol Lett 2018; 16:4129-4136. [PMID: 30214552 PMCID: PMC6126162 DOI: 10.3892/ol.2018.9166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 10/13/2017] [Indexed: 12/19/2022] Open
Abstract
The aim of the present study was to investigate the prognostic value of quantitative [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) parameters for patients with non-small cell lung cancer (NSCLC). The present study conducted a retrospective review of the medical records of 203 patients with NSCLC, of which 193 patients underwent baseline 18F-FDG PET/CT prior to initial therapy. Multivariate analyses using Cox's proportional hazards regression were performed for the assessment of the association between initial PET/CT measurements and overall survival (OS). The multivariate models were adjusted for sex, age, smoking status, disease stage, standardized uptake value (SUV), standardized uptake value corrected for lean body mass (SUL), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and standard deviation of SUV (SD). Kaplan-Meier (K-M) estimator curves were constructed following the formation of three approximately equal-sized groups using tertiles for each PET/CT measurement (n=65, 64 and 64). OS curves were plotted using K-M estimator curves. Results demonstrated significant associations between OS and MTVPET volume computerized assisted reporting (PETVCAR), MTV2.5, MTV25%, MTV42% and TLGPETVCAR; however, no significant associations were identified between OS and MTV50%, MTV75%, TLG2.5, all SUV and SUL. Subgroup analyses according to pathology demonstrated that there were statistically significant associations between OS and stage (P<0.001), MTV50% (P=0.002) and MTV42% (P=0.004) in the adenocarcinoma group, and SULmean (P=0.010), MTV25% (P=0.005) and MTV42% (P=0.001) in the squamous cell carcinoma group; however, no significant differences were identified between any other group. Furthermore, there was a significant association between OS and MTV42% (P=0.02) and MTV50% (P=0.04) in the early-stage group; however, no significant differences were identified in the advanced-stage group. K-M estimator curve analyses demonstrated that the pathology (P=0.01), stage (P<0.001) and all PET metabolic parameters with the exception of SD were significantly associated with OS (P<0.05). No significant associations were demonstrated between SD and OS. In conclusion, 18F-FDG PET/CT MTVPETVCAR, MTV2.5, MTV25%, MTV42% and TLGPETVCAR exhibit prognostic values with regard to OS. Overall, selection of appropriate metabolic parameters may predict NSCLC prognosis.
Collapse
Affiliation(s)
- Wenchao Ma
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Minshu Wang
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Xiaofeng Li
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Hui Huang
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Yanjia Zhu
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Xiuyu Song
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Dong Dai
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| | - Wengui Xu
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
- Tianjin Clinical Research Center for Cancer, Hexi, Tianjin 300060, P.R. China
| |
Collapse
|
54
|
Ercelep O, Alan O, Sahin D, Telli TA, Salva H, Tuylu TB, Babacan NA, Kaya S, Dane F, Ones T, Alkis H, Adli M, Yumuk F. Effect of PET/CT standardized uptake values on complete response to treatment before definitive chemoradiotherapy in stage III non-small cell lung cancer. Clin Transl Oncol 2018; 21:499-504. [PMID: 30229391 DOI: 10.1007/s12094-018-1949-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The standard treatment for patients with stage III non-small cell lung cancer (NSCLC), unsuitable for resection and with good performance, is definitive radiotherapy with cisplatin-based chemotherapy. Our aim is to evaluate the effect of the maximum value of standardized uptake values (SUVmax) of the primary tumor in positron emission tomography-computed tomography (PET/CT) before treatment on complete response (CR) and overall survival. METHODS The data of 73 stage III NSCLC patients treated with concurrent definitive chemoradiotherapy (CRT) between 2008 and 2017 and had PET/CT staging in the pretreatment period were evaluated. ROC curve analysis was performed to determine the ideal cut-off value of pretreatment SUVmax to predict CR. RESULTS Median age was 58 years (range 27-83 years) and 66 patients were male (90.4%). Median follow-up time was 18 months (range 3-98 months); median survival was 23 months. 1-year overall survival (OS) rate and 5-year OS rate were 72 and 19%, respectively. Median progression-free survival (PFS) was 9 months; 1-year PFS rate and 5-year PFS rate were 38 and 19%, respectively. The ideal cut-off value of pretreatment SUVmax that predicted the complete response of CRT was 12 in the ROC analysis [AUC 0.699 (0.550-0.833)/P < 0.01] with a sensitivity of 83%, and specificity of 55%. In patients with SUVmax < 12, CR rate was 60%, while, in patients with SUV ≥ 12, it was only 19% (P = 0.002). Median OS was 26 months in patients with pretreatment SUVmax < 12, and 21 months in patients with SUVmax ≥ 12 (HR = 2.93; 95% CI 17.24-28.75; P = 0.087). CR rate of the whole patient population was 26%, and it was the only factor that showed a significant benefit on survival in both univariate and multivariate analyses. CONCLUSION Pretreatment SUVmax of the primary tumor in PET/CT may predict CR in stage III NSCLC patients who were treated with definitive CRT. Having clinical CR is the only positive predictive factor for prolonged survival.
Collapse
Affiliation(s)
- O Ercelep
- Department of Medical Oncology, Pendik Education and Research Hospital, Marmara University, Istanbul, Turkey.
| | - O Alan
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - D Sahin
- Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - T A Telli
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - H Salva
- Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - T B Tuylu
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - N A Babacan
- Department of Medical Oncology, Pendik Education and Research Hospital, Marmara University, Istanbul, Turkey
| | - S Kaya
- Department of Medical Oncology, Pendik Education and Research Hospital, Marmara University, Istanbul, Turkey
| | - F Dane
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - T Ones
- Department of Nuclear Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - H Alkis
- Department of Radiation Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - M Adli
- Department of Radiation Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - F Yumuk
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| |
Collapse
|
55
|
Zhao XR, Zhang Y, Yu YH. Use of 18F-FDG PET/CT to predict short-term outcomes early in the course of chemoradiotherapy in stage III adenocarcinoma of the lung. Oncol Lett 2018; 16:1067-1072. [PMID: 30061935 DOI: 10.3892/ol.2018.8748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 08/23/2017] [Indexed: 11/06/2022] Open
Abstract
The purpose of the present prospective study was to evaluate the use of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the assessment of therapy response and the prediction of short-term outcomes by maximum and mean standardized uptake values (SUVmax and SUVmean, respectively), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) following chemoradiotherapy (CRT) in patients with stage III adenocarcinoma of the lung. The study included a total of 15 patients, all of whom underwent two serial 18F-FDG PET/CT scans prior to and following 60-Gy radiotherapy with a concurrent cisplatin/pemetrexed combined chemotherapy regimen. SUVmax, SUVmean, MTV and TLG were determined. Short-term outcomes were assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST) and the PET Response Criteria in Solid Tumors (PERCIST). Post-CRT SUVmax, ΔSUVmax, ΔMTV and ΔTLG varied significantly between responders and non-responders (P=0.009, P=0.015, P=0.006 and P=0.004, respectively). The differences in SUVmax, SUVmean, carcinoembryonic antigen, MTV and TLG between the responders and the non-responders at the initial 18F-FDG PET/CT scans were not statistically significant (P>0.05). The overall response rate was significantly higher (P=0.01) when evaluated using PERCIST compared with evaluation using RECIST. It was concluded that post-CRT SUVmax, ΔSUVmax, ΔMTV and ΔTLG may be used to differentiate the responders from the non-responders following CRT for stage III adenocarcinoma of the lung. This would aid in deciding whether or not to increase dosages or to incorporate a boost treatment without the requirement to suspend therapy.
Collapse
Affiliation(s)
- Xiang-Rong Zhao
- Department of Radiation Oncology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Yong Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, P.R. China
| | - Yong-Hua Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, P.R. China
| |
Collapse
|
56
|
Yılmaz U, Batum Ö, Koparal H, Özbilek E, Kıraklı E. Prognostic value of primary tumor SUV max on pre-treatment 18 F-FDG PET/CT imaging in patients with stage III non-small cell lung cancer. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
57
|
Lee JW, Lee SM. Radiomics in Oncological PET/CT: Clinical Applications. Nucl Med Mol Imaging 2018; 52:170-189. [PMID: 29942396 PMCID: PMC5995782 DOI: 10.1007/s13139-017-0500-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/22/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022] Open
Abstract
18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is widely used for staging, evaluating treatment response, and predicting prognosis in malignant diseases. FDG uptake and volumetric PET parameters such as metabolic tumor volume have been used and are still used as conventional PET parameters to assess biological characteristics of tumors. However, in recent years, additional features derived from PET images by computational processing have been found to reflect intratumoral heterogeneity, which is related to biological tumor features, and to provide additional predictive and prognostic information, which leads to the concept of radiomics. In this review, we focus on recent clinical studies of malignant diseases that investigated intratumoral heterogeneity on PET/CT, and we discuss its clinical role in various cancers.
Collapse
Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100 Gil 25, Seo-gu, Incheon, 22711 South Korea
- Institute for Integrative Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| |
Collapse
|
58
|
Nygård L, Vogelius IR, Fischer BM, Kjær A, Langer SW, Aznar MC, Persson GF, Bentzen SM. A Competing Risk Model of First Failure Site after Definitive Chemoradiation Therapy for Locally Advanced Non–Small Cell Lung Cancer. J Thorac Oncol 2018; 13:559-567. [DOI: 10.1016/j.jtho.2017.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/22/2017] [Accepted: 12/24/2017] [Indexed: 12/25/2022]
|
59
|
Yılmaz U, Batum Ö, Koparal H, Özbilek E, Kıraklı E. Prognostic value of primary tumor SUV max on pre-treatment 18F-FDG PET/CT imaging in patients with stage iii non-small cell lung cancer. Rev Esp Med Nucl Imagen Mol 2018; 37:S2253-654X(17)30216-0. [PMID: 29559214 DOI: 10.1016/j.remn.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/10/2017] [Accepted: 11/14/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Concomitant chemoradiotherapy (CCRT) is widely used in the treatment of patients with stage iii non-small cell lung carcinoma (NSCLC). The early identification of patients with poor prognosis is the premise of personalized treatment for patients. The aim of the study was to evaluate the prognostic value of clinical parameters and primary tumor SUVmax on pre-treatment 18F-FDG PET/CT in patients with stage iii NSCLC. MATERIAL AND METHODS Clinical records of 79 stage iii-NSCLC patients with pre-treatment 18F-FDG PET/CT imaging, treated with definitive CCRT were retrospectively reviewed. The clinical endpoints in terms of progression-free survival (PFS) and overall survival (OS) were correlated with the median pre-treatment primary tumor SUVmax. Furthermore, other factors influencing patient outcome were analyzed. RESULTS The median age of patients was 58 years (range, 45-71) with 72 (91%) males. Squamous cell carcinoma (73%) was the most common histologic type. Performance status was very good (ECOG 0) in 64.5% of patients. Sixty (79%) patients had died at the time of this analysis. Median OS and PFS were 22.5 and 12.0 months, respectively. Patients were dichotomized according to pre-treatment primary tumor SUVmax≤15.0 vs.>15.0. There was no statistically significant difference for OS and PFS in both arms. Multivariate analysis showed that pre-treatment SUVmax was not a significant predictor of OS (HR 1.099, P=0.726) and PFS (HR 1.022, P=0.941). CONCLUSIONS SUVmax with threshold value of 15.0 on the primary tumor before treatment had no prognostic value in our patient group with stage iii NSCLC treated with definitive CCRT.
Collapse
Affiliation(s)
- U Yılmaz
- Department of Pulmonology, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turquía.
| | - Ö Batum
- Department of Pulmonology, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turquía
| | - H Koparal
- Department of Nuclear Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turquía
| | - E Özbilek
- Department of Nuclear Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turquía
| | - E Kıraklı
- Department of Radiation Oncology, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turquía
| |
Collapse
|
60
|
Jensen GL, Yost CM, Mackin DS, Fried DV, Zhou S, Court LE, Gomez DR. Prognostic value of combining a quantitative image feature from positron emission tomography with clinical factors in oligometastatic non-small cell lung cancer. Radiother Oncol 2018; 126:362-367. [DOI: 10.1016/j.radonc.2017.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/31/2017] [Accepted: 11/13/2017] [Indexed: 01/24/2023]
|
61
|
Im HJ, Zhang Y, Wu H, Wu J, Daw NC, Navid F, Shulkin BL, Cho SY. Prognostic Value of Metabolic and Volumetric Parameters of FDG PET in Pediatric Osteosarcoma: A Hypothesis-generating Study. Radiology 2018; 287:303-312. [PMID: 29357275 DOI: 10.1148/radiol.2017162758] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To preliminarily assess the potential prognostic value of various fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) parameters before, during, and after neoadjuvant chemotherapy (NCT). Materials and Methods Thirty-four patients with osteosarcoma were enrolled prospectively from 2008 to 2012 and underwent FDG PET/computed tomography (CT) imaging before (baseline scan), during (interim scan) and after NCT (posttherapy scan). The study was approved by the institutional review board and informed consent was received from patients. Maximum and peak standardized uptake value (SUVmax and SUVpeak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured. Predictive value of FDG PET parameters for event-free survival (EFS) and overall survival (OS) were evaluated. Multivariable Cox regression analysis for EFS and OS was performed by using histologic response and initial presence of metastasis as covariates. Results At baseline scan, SUVpeak, MTV, and TLG were predictive of EFS (P = .006-.03) and OS (P = .001-.03) but not associated with histologic response. At interim and posttherapy scan, SUVmax, SUVpeak, MTV, and TLG were associated with histologic response (P = .0002-.04) and predictive of EFS (P = .004-.02) and OS (P = .001-.03). Multivariable Cox regression analysis revealed that the FDG PET parameters either at baseline, interim, or posttherapy were independently predictive of EFS and OS. In particular, baseline MTV was an independent predictor of EFS (hazard ratio, 5.0 [95% confidence interval {CI}: 1.5, 16.8]) and OS (hazard ratio, 29.4 [95% CI: 2.2, 392.2]). Conclusion SUVpeak, MTV, and TLG either at baseline, interim, or posttherapy were predictive of EFS and OS and may be useful prognostic biomarkers for osteosarcoma. © RSNA, 2018 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Hyung-Jun Im
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Yi Zhang
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Huiyun Wu
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Jianrong Wu
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Najat C Daw
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Fariba Navid
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Barry L Shulkin
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Steve Y Cho
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| |
Collapse
|
62
|
Thoracic reirradiation with SBRT for residual/recurrent and new primary NSCLC within or immediately adjacent to a prior high-dose radiation field. Pract Radiat Oncol 2017; 8:e117-e123. [PMID: 29724402 DOI: 10.1016/j.prro.2017.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 10/05/2017] [Accepted: 11/28/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE Local failure following concurrent chemoradiation and in-lobe failures following stereotactic body radiation therapy (SBRT) are common. We evaluated our institutional experience using SBRT as salvage in this setting. METHODS AND MATERIALS Seventy-two patients were reirradiated with SBRT for residual, locally recurrent, or new primary non-small cell lung cancer within or adjacent to a high-dose external beam radiation therapy or SBRT field. Kaplan-Meier analysis with log-rank test were used to estimate endpoints and differentiate cohorts. RESULTS Median follow-up was 17.9 months. Patients had residual or recurrent disease (54.2%); 45.8% had new lung primaries. Median reirradiated T size was 2.5 cm (range, 0.8-7.8 cm). Median pre-retreatment maximum standardized uptake value (SUVmax) was 7.15 (range, 1.2-37.6). The most common SBRT reirradiation regimen was 48 Gy in 4 fractions (range, 17-60 Gy in 1-5 fractions). Median progression-free survival was 15.2 months, and median overall survival was 20.8 months. Two-year local failure was 21.6%. Patients with SUVmax at reirradiation <7.0 had a 2-year local control of 93.1% versus 61.1% above the median (P < .001). The 2-year rate of distant metastases was 10.4% versus 54.1% in patients treated for a new primary versus residual or recurrent disease (P < .001). Median progression-free survival was 31.9 months versus 8.4 months, respectively (P = .037). Median survival of patients treated for new primary was 25.2 months versus 16.2 months with residual or recurrent disease (P = .049), and median survival for patients with reirradiation SUVmax below the median was 42.0 months versus 9.8 months above the median (P < .001). Acute any-grade toxicity was seen in 29.2% of patients, acute grade 3 toxicity in 11.1%, and late grade 3 toxicity in 1.4% with no treatment-related deaths. CONCLUSIONS SBRT appears to be a safe and effective means of salvaging recurrent, residual, or new primary NSCLC in or adjacent to a previous high-dose radiation field.
Collapse
|
63
|
Roengvoraphoj O, Wijaya C, Eze C, Li M, Dantes M, Taugner J, Tufman A, Huber RM, Belka C, Manapov F. Analysis of primary tumor metabolic volume during chemoradiotherapy in locally advanced non-small cell lung cancer. Strahlenther Onkol 2017; 194:107-115. [PMID: 29116336 DOI: 10.1007/s00066-017-1229-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/13/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Positron emission tomography with 2‑deoxy-2-[fluorine-18] fluoro-d-glucose integrated with computed tomography (18F-FDG-PET/CT) has an established role in the initial diagnosis and staging of lung cancer. However, a prognostic value of PET/CT during multimodality treatment has not yet been fully clarified. This study evaluated the role of primary tumor metabolic volume (PT-MV) changes on PET/CT before, during, and after chemoradiotherapy (CRT). METHODS A total of 65 patients with non-small-cell lung cancer (NSCLC) UICC stage IIIA/B (TNM 7th Edition) were treated with definitive chemoradiotherapy (sequential or concurrent setting). PET/CT was acquired before the start, at the end of the third week, and 6 weeks following CRT. RESULTS Median overall survival (OS) for the entire cohort was 16 months (95% confidence interval [CI]: 12-20). In all, 60 (92.3%) patients were eligible for pre-treatment (pre-PT-MV), 28 (43%) for mid-treatment (mid-PT-MV), and 53 (81.5%) for post-treatment (post-PT-MV) volume analysis. Patients with pre-PT-MV >63 cm3 had worse OS (p < 0.0001). A reduction from mid-PT-MV to post-PT-MV of >15% improved OS (p = 0.001). In addition, patients with post-PT-MV > 25 cm3 had significantly worse outcome (p = 0.001). On multivariate analysis, performance status (p = 0.002, hazard ratio [HR] 0.007; 95% CI 0.00-0.158), pre-PT-MV1 < 63 cm3 (p = 0.027, HR 3.98; 95% CI 1.17-13.49), post-PT-MV < 25 cm3 (p = 0.013, HR 11.90; 95% CI 1.70-83.27), and a reduction from mid-PT-MV to post-PT-MV > 15% (p = 0.004, HR 0.25; 95% CI 0.02-0.31) correlated with improved OS. CONCLUSIONS Our results demonstrated that pre- and post-treatment PT-MV, as well as an at least 15% reduction in mid- to post-PT-MV, significantly correlates with OS in patients with inoperable locally advanced NSCLC.
Collapse
Affiliation(s)
- Olarn Roengvoraphoj
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Cherylina Wijaya
- Department of Pulmonology, Asklepios Fachkliniken München-Gauting, Munich, Germany
| | - Chukwuka Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Maurice Dantes
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Julian Taugner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Amanda Tufman
- Respiratory Medicine and Thoracic Oncology, Internal Medicine V, Ludwig-Maximilians-University of Munich and Thoracic Oncology Centre Munich, Ziemssenstraße 1, 80336, Munich, Germany
- members of the German Centre for Lung Research (DZL CPC-M), -, Germany
| | - Rudolf Maria Huber
- Respiratory Medicine and Thoracic Oncology, Internal Medicine V, Ludwig-Maximilians-University of Munich and Thoracic Oncology Centre Munich, Ziemssenstraße 1, 80336, Munich, Germany
- members of the German Centre for Lung Research (DZL CPC-M), -, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- members of the German Centre for Lung Research (DZL CPC-M), -, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- members of the German Centre for Lung Research (DZL CPC-M), -, Germany
| |
Collapse
|
64
|
The Warburg effect and glucose-derived cancer theranostics. Drug Discov Today 2017; 22:1637-1653. [DOI: 10.1016/j.drudis.2017.08.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 07/16/2017] [Accepted: 08/14/2017] [Indexed: 12/20/2022]
|
65
|
Ohri N, Bodner WR, Kabarriti R, Shankar V, Cheng H, Abraham T, Halmos B, Gucalp R, Perez-Soler R, Kalnicki S, Garg M. Positron Emission Tomography-Adjusted Intensity Modulated Radiation Therapy for Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017; 102:709-715. [PMID: 29249527 DOI: 10.1016/j.ijrobp.2017.10.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/18/2017] [Accepted: 10/17/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To perform a prospective trial examining positron emission tomography (PET)-based, dose-painted intensity modulated radiation therapy (IMRT) in the setting of locally advanced non-small cell lung cancer (NSCLC). METHODS AND MATERIALS Patients with stage IIB-III NSCLC were treated with 25 fractions of dose-painted IMRT. Tumors or lymph nodes with metabolic tumor volume exceeding 25 cm3 were deemed "high risk" and received 65 Gy. Smaller lesions were treated with 57 Gy or 52.5 Gy (after November 2014). Patients received concurrent weekly carboplatin (area under the curve = 2) and paclitaxel (45 mg/m2). The primary study endpoint was the absence of high residual metabolic activity (maximum standardized uptake value > 6) in treated lesions on PET 12 to 16 weeks after completion of IMRT. RESULTS Thirty-five subjects with 116 hypermetabolic lesions were eligible for analysis. The primary endpoint was met for 24 of 30 patients (80%) who underwent posttreatment PET, satisfying our efficacy objective. With a median follow-up duration of 23.8 months for living patients, progression in a lesion targeted with radiation therapy has been observed in 5 patients (14%). Treating progression in other sites and death without progression as competing risks, 2-year cumulative incidence rates of local disease progression in high-risk lesions (n=24) and low-risk lesions (n=92) are 9% and 3%, respectively. The actuarial rate of overall survival at 2 years is 52%. CONCLUSIONS Dose-painted IMRT based on pretreatment PET metrics with concurrent chemotherapy yields high rates of metabolic response and local disease control for locally advanced NSCLC. Future trials should test this approach to maximize the therapeutic ratio of thoracic radiation therapy.
Collapse
Affiliation(s)
- Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | - William R Bodner
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Viswanathan Shankar
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Haiying Cheng
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Tony Abraham
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Balazs Halmos
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Rasim Gucalp
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Roman Perez-Soler
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Shalom Kalnicki
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Madhur Garg
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
66
|
Cheng G, Huang H. Prognostic Value of 18F-Fluorodeoxyglucose PET/Computed Tomography in Non-Small-Cell Lung Cancer. PET Clin 2017; 13:59-72. [PMID: 29157386 DOI: 10.1016/j.cpet.2017.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related death with a poor prognosis. Numerous factors contribute to treatment outcome. 18F-fluorodeoxyglucose (FDG) uptake reflects tumor metabolic activity and is an important prognosticator in patients with NSCLC. Volume-based FDG-PET parameters reflect the metabolic status of a malignancy more accurately than maximum standardized uptake value and thus are better prognostic markers in lung cancer. FDG-avid tumor burden parameters may help clinicians to predict treatment outcomes before and during therapy so that treatment can be adjusted to achieve the best possible outcomes while avoiding side effects.
Collapse
Affiliation(s)
- Gang Cheng
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - He Huang
- Department of Nuclear Medicine, Luzhou People's Hospital, Luzhou, Sichuan Province, People's Republic of China
| |
Collapse
|
67
|
Santana-Davila R, Martins R. Treatment of Stage IIIA Non-Small-Cell Lung Cancer: A Concise Review for the Practicing Oncologist. J Oncol Pract 2017; 12:601-6. [PMID: 27407154 DOI: 10.1200/jop.2016.013052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Stage IIIA non-small-cell lung cancer occurs in a heterogenous group of patients for whom the best treatment is multimodality therapy with chemotherapy, radiation, and surgery in a select group of individuals. This clinical review intends to answer the most common questions that clinicians face in the decision about the best management in this group.
Collapse
|
68
|
Gensheimer MF, Hong JC, Chang-Halpenny C, Zhu H, Eclov NCW, To J, Murphy JD, Wakelee HA, Neal JW, Le QT, Hara WY, Quon A, Maxim PG, Graves EE, Olson MR, Diehn M, Loo BW. Mid-radiotherapy PET/CT for prognostication and detection of early progression in patients with stage III non-small cell lung cancer. Radiother Oncol 2017; 125:338-343. [PMID: 28830717 DOI: 10.1016/j.radonc.2017.08.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 05/22/2017] [Accepted: 08/05/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Pre- and mid-radiotherapy FDG-PET metrics have been proposed as biomarkers of recurrence and survival in patients treated for stage III non-small cell lung cancer. We evaluated these metrics in patients treated with definitive radiation therapy (RT). We also evaluated outcomes after progression on mid-radiotherapy PET/CT. MATERIAL AND METHODS Seventy-seven patients treated with RT with or without chemotherapy were included in this retrospective study. Primary tumor and involved nodes were delineated. PET metrics included metabolic tumor volume (MTV), total lesion glycolysis (TLG), and SUVmax. For mid-radiotherapy PET, both absolute value of these metrics and percentage decrease were analyzed. The influence of PET metrics on time to death, local recurrence, and regional/distant recurrence was assessed using Cox regression. RESULTS 91% of patients had concurrent chemotherapy. Median follow-up was 14months. None of the PET metrics were associated with overall survival. Several were positively associated with local recurrence: pre-radiotherapy MTV, and mid-radiotherapy MTV and TLG (p=0.03-0.05). Ratio of mid- to pre-treatment SUVmax was associated with regional/distant recurrence (p=0.02). 5/77 mid-radiotherapy scans showed early out-of-field progression. All of these patients died. CONCLUSIONS Several PET metrics were associated with risk of recurrence. Progression on mid-radiotherapy PET/CT was a poor prognostic factor.
Collapse
Affiliation(s)
- Michael F Gensheimer
- Department of Radiation Oncology, Stanford University, USA; Stanford Cancer Institute, Stanford University School of Medicine, USA.
| | - Julian C Hong
- Department of Radiation Oncology, Stanford University, USA; Department of Radiation Oncology, Duke University, Durham, USA
| | - Christine Chang-Halpenny
- Department of Radiation Oncology, Stanford University, USA; Department of Radiation Oncology, cCARE, Fresno, USA
| | - Hui Zhu
- Department of Radiation Oncology, Stanford University, USA; Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Neville C W Eclov
- Department of Radiation Oncology, Stanford University, USA; University of Chicago, USA
| | - Jacqueline To
- Department of Radiation Oncology, Stanford University, USA; University of Colorado, USA
| | - James D Murphy
- Department of Radiation Oncology, Stanford University, USA; Department of Radiation Medicine and Applied Sciences, University of California San Diego, USA
| | - Heather A Wakelee
- Stanford Cancer Institute, Stanford University School of Medicine, USA; Department of Medicine, Division of Oncology, Stanford University, USA
| | - Joel W Neal
- Stanford Cancer Institute, Stanford University School of Medicine, USA; Department of Medicine, Division of Oncology, Stanford University, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, USA; Stanford Cancer Institute, Stanford University School of Medicine, USA
| | - Wendy Y Hara
- Department of Radiation Oncology, Stanford University, USA; Stanford Cancer Institute, Stanford University School of Medicine, USA
| | - Andrew Quon
- Department of Nuclear Medicine, University of California Los Angeles, USA
| | - Peter G Maxim
- Department of Radiation Oncology, Stanford University, USA; Stanford Cancer Institute, Stanford University School of Medicine, USA
| | - Edward E Graves
- Department of Radiation Oncology, Stanford University, USA; Stanford Cancer Institute, Stanford University School of Medicine, USA
| | - Michael R Olson
- Department of Radiation Oncology, Stanford University, USA; Florida Radiation Oncology Group, Baptist Medical Center, Jacksonville, USA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University, USA; Stanford Cancer Institute, Stanford University School of Medicine, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, USA.
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University, USA; Stanford Cancer Institute, Stanford University School of Medicine, USA.
| |
Collapse
|
69
|
Abstract
Facilitative carbohydrate transporters-Gluts-have received wide attention over decades due to their essential role in nutrient uptake and links with various metabolic disorders, including diabetes, obesity, and cancer. Endeavors directed towards understanding the mechanisms of Glut-mediated nutrient uptake have resulted in a multidisciplinary research field spanning protein chemistry, chemical biology, organic synthesis, crystallography, and biomolecular modeling. Gluts became attractive targets for cancer research and medicinal chemistry, leading to the development of new approaches to cancer diagnostics and providing avenues for cancer-targeting therapeutics. In this review, the current state of knowledge of the molecular interactions behind Glut-mediated sugar uptake, Glut-targeting probes, therapeutics, and inhibitors are discussed.
Collapse
Affiliation(s)
- Marina Tanasova
- Department of Chemistry, Michigan Technological University, 1400 Townsend Drive, Houghton, MI, 49931, USA
| | - Joseph R Fedie
- Department of Chemistry, Michigan Technological University, 1400 Townsend Drive, Houghton, MI, 49931, USA
| |
Collapse
|
70
|
Wang Y, Zhao M, Liu J, Sun Z, Ni J, Liu H. miRNA-125b regulates apoptosis of human non-small cell lung cancer via the PI3K/Akt/GSK3β signaling pathway. Oncol Rep 2017; 38:1715-1723. [PMID: 28713974 DOI: 10.3892/or.2017.5808] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 06/21/2017] [Indexed: 11/05/2022] Open
Abstract
The present investigation demonstrated that regulation of microRNA (miR)-125b affected the apoptosis of human non-small cell lung cancer (NSCLC) through targeting of the PI3K/Akt and Wnt/β-catenin signaling pathways. The expression of miR-125b was assessed in patients with NSCLC, which demonstrated that miR-125b expression in NSCLC tissue was higher than that in para-carcinoma tissue. Furthermore, survival analysis of patients with NSCLC over 3 years indicated that the overall survival (OS) and disease-free survival (DFS) rates of patients with low miR-125b expression were higher than those of patients with high miR-125b expression. Proliferation and apoptosis assays were subsequently conducted in the human NSCLC cell line A549 using MTT assay and Annexin V-FITC/PI kits, respectively. Caspase-3 activity ELISA and western blot analysis were also used to assess caspase-3 activity and the protein expression of Bax, Akt, phosphorylated (p)-Akt, p-GSK3β, Wnt and β-catenin. It was observed that downregulation of miR-125b inhibited the proliferation and induced the apoptosis of A549 cells. Downregulation of miR-125b also suppressed the protein expression of p-Akt, Wnt and β-catenin, and increased caspase-3 activity and Bax protein expression in A549 cells. In addition, downregulation of miR-125b combined with the PI3K inhibitor LY294002 enhanced cell growth inhibition, suppression of p-GSK3β, Wnt and β-catenin protein expression and promotion of caspase-3 activity in A549 cells. These results revealed that the downregulation of miR-125b regulates apoptosis in human NSCLC through the suppression of the PI3K/Akt/GSK3β and Wnt/β-catenin signaling pathways.
Collapse
Affiliation(s)
- Yingyi Wang
- Oncology Department of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Dongcheng, Beijing 100730, P.R. China
| | - Ming Zhao
- Thoracic Surgery Department of China PLA General Hospital, Haidian, Beijing 100853, P.R. China
| | - Jieying Liu
- Oncology Department of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Dongcheng, Beijing 100730, P.R. China
| | - Zhao Sun
- Oncology Department of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Dongcheng, Beijing 100730, P.R. China
| | - Jianjiao Ni
- Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng, Beijing 100730, P.R. China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng, Beijing 100730, P.R. China
| |
Collapse
|
71
|
Salavati A, Duan F, Snyder BS, Wei B, Houshmand S, Khiewvan B, Opanowski A, Simone CB, Siegel BA, Machtay M, Alavi A. Optimal FDG PET/CT volumetric parameters for risk stratification in patients with locally advanced non-small cell lung cancer: results from the ACRIN 6668/RTOG 0235 trial. Eur J Nucl Med Mol Imaging 2017; 44:1969-1983. [PMID: 28689281 DOI: 10.1007/s00259-017-3753-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE In recent years, multiple studies have demonstrated the value of volumetric FDG-PET/CT parameters as independent prognostic factors in patients with non-small cell lung cancer (NSCLC). We aimed to determine the optimal cut-off points of pretreatment volumetric FDG-PET/CT parameters in predicting overall survival (OS) in patients with locally advanced NSCLC and to recommend imaging biomarkers appropriate for routine clinical applications. METHODS Patients with inoperable stage IIB/III NSCLC enrolled in ACRIN 6668/RTOG 0235 were included. Pretreatment FDG-PET scans were quantified using semiautomatic adaptive contrast-oriented thresholding and local-background partial-volume-effect-correction algorithms. For each patient, the following indices were measured: metabolic tumor volume (MTV), total lesion glycolysis (TLG), SUVmax, SUVmean, partial-volume-corrected TLG (pvcTLG), and pvcSUVmean for the whole-body, primary tumor, and regional lymph nodes. The association between each index and patient outcome was assessed using Cox proportional hazards regression. Optimal cut-off points were estimated using recursive binary partitioning in a conditional inference framework and used in Kaplan-Meier curves with log-rank testing. The discriminatory ability of each index was examined using time-dependent receiver operating characteristic (ROC) curves and corresponding area under the curve (AUC(t)). RESULTS The study included 196 patients. Pretreatment whole-body and primary tumor MTV, TLG, and pvcTLG were independently prognostic of OS. Optimal cut-off points were 175.0, 270.9, and 35.5 cm3 for whole-body TLG, pvcTLG, and MTV, and were 168.2, 239.8, and 17.4 cm3 for primary tumor TLG, pvcTLG, and MTV, respectively. In time-dependent ROC analysis, AUC(t) for MTV and TLG were uniformly higher than that of SUV measures over all time points. Primary tumor and whole-body parameters demonstrated similar patterns of separation for those patients above versus below the optimal cut-off points in Kaplan-Meier curves and in time-dependent ROC analysis. CONCLUSION We demonstrated that pretreatment whole-body and primary tumor volumetric FDG-PET/CT parameters, including MTV, TLG, and pvcTLG, are strongly prognostic for OS in patients with locally advanced NSCLC, and have similar discriminatory ability. Therefore, we believe that, after validation in future trials, the derived optimal cut-off points for primary tumor volumetric FDG-PET/CT parameters, or their more refined versions, could be incorporated into routine clinical practice, and may provide more accurate prognostication and staging based on tumor metabolic features.
Collapse
Affiliation(s)
- Ali Salavati
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. .,Department of Radiology, University of Minnesota, Minneapolis, MN, USA.
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Bradley S Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Bo Wei
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sina Houshmand
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Benjapa Khiewvan
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Adam Opanowski
- American College of Radiology, ACR Center for Research and Innovation, Philadelphia, PA, USA
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Barry A Siegel
- Mallinckrodt Institute of Radiology and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St, Louis, MO, USA
| | - Mitchell Machtay
- Department of Radiation Oncology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
72
|
Cremonesi M, Gilardi L, Ferrari ME, Piperno G, Travaini LL, Timmerman R, Botta F, Baroni G, Grana CM, Ronchi S, Ciardo D, Jereczek-Fossa BA, Garibaldi C, Orecchia R. Role of interim 18F-FDG-PET/CT for the early prediction of clinical outcomes of Non-Small Cell Lung Cancer (NSCLC) during radiotherapy or chemo-radiotherapy. A systematic review. Eur J Nucl Med Mol Imaging 2017; 44:1915-1927. [PMID: 28681192 DOI: 10.1007/s00259-017-3762-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/14/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Non-Small Cell Lung Cancer (NSCLC) is characterized by aggressiveness and includes the majority of thorax malignancies. The possibility of early stratification of patients as responsive and non-responsive to radiotherapy with a non-invasive method is extremely appealing. The distribution of the Fluorodeoxyglucose (18F-FDG) in tumours, provided by Positron-Emission-Tomography (PET) images, has been proved to be useful to assess the initial staging of the disease, recurrence, and response to chemotherapy and chemo-radiotherapy (CRT). OBJECTIVES In the last years, particular efforts have been focused on the possibility of using ad interim 18F-FDG PET (FDGint) to evaluate response already in the course of radiotherapy. However, controversial findings have been reported for various malignancies, although several results would support the use of FDGint for individual therapeutic decisions, at least in some pathologies. The objective of the present review is to assemble comprehensively the literature concerning NSCLC, to evaluate where and whether FDGint may offer predictive potential. METHODS Several searches were completed on Medline and the Embase database, combining different keywords. Original papers published in the English language from 2005 to 2016 with studies involving FDGint in patients affected by NSCLC and treated with radiation therapy or chemo-radiotherapy only were chosen. RESULTS Twenty-one studies out of 970 in Pubmed and 1256 in Embase were selected, reporting on 627 patients. CONCLUSION Certainly, the lack of univocal PET parameters was identified as a major drawback, while standardization would be required for best practice. In any case, all these papers denoted FDGint as promising and a challenging examination for early assessment of outcomes during CRT, sustaining its predictivity in lung cancer.
Collapse
Affiliation(s)
- Marta Cremonesi
- Radiation Research Unit, European Institute of Oncology, Milano, Italy.
| | - Laura Gilardi
- Division of Nuclear Medicine, European Institute of Oncology, Milano, Italy
| | | | - Gaia Piperno
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | | | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Francesca Botta
- Medical Physics Unit, European Institute of Oncology, Milano, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano University, Milano, Italy
| | - Chiara Maria Grana
- Division of Nuclear Medicine, European Institute of Oncology, Milano, Italy
| | - Sara Ronchi
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | | | - Roberto Orecchia
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy.,Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milano, Italy
| |
Collapse
|
73
|
Kalman NS, Weiss E, Walker PR, Rosenman JG. Local Radiotherapy Intensification for Locally Advanced Non-small-cell Lung Cancer - A Call to Arms. Clin Lung Cancer 2017; 19:17-26. [PMID: 28712978 DOI: 10.1016/j.cllc.2017.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/24/2017] [Accepted: 05/30/2017] [Indexed: 12/25/2022]
Abstract
Chemoradiotherapy, the standard of care for locally advanced non-small-cell lung cancer (NSCLC), often fails to eradicate all known disease. Despite advances in chemotherapeutic regimens, locally advanced NSCLC remains a difficult disease to treat, and locoregional failure remains common. Improved radiographic detection can identify patients at significant risk of locoregional failure after definitive treatment, and newer methods of escalating locoregional treatment may allow for improvements in locoregional control with acceptable toxicity. This review addresses critical issues in escalating local therapy, focusing on using serial positron emission tomography-computed tomography to select high-risk patients and employing stereotactic radiotherapy to intensify treatment. We further propose a clinical trial concept that incorporates the review's findings.
Collapse
Affiliation(s)
- Noah S Kalman
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA.
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA
| | - Paul R Walker
- Division of Hematology/Oncology, Department of Internal Medicine, East Carolina University, Greenville, NC
| | - Julian G Rosenman
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
74
|
Verma V, Simone CB, Krishnan S, Lin SH, Yang J, Hahn SM. The Rise of Radiomics and Implications for Oncologic Management. J Natl Cancer Inst 2017; 109:3573848. [PMID: 28423406 DOI: 10.1093/jnci/djx055] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/07/2017] [Indexed: 12/28/2022] Open
Abstract
Clinical medicine, particularly oncology, is progressing toward personalized care. Whereas the terms genomics, proteomics, transcriptomics, and metabolomics have dominated personalized medicine for the past couple decades, the concept of radiomics was first described in 2012. This nascent concept has major implications for personalized cancer care and involves extracting hundreds of standardized and quantifiable imaging characteristics from diagnostic computed tomography/magnetic resonance imaging images. The central hypothesis of radiomics is that these libraries of quantitative individual voxel-based variables are more sensitively associated with various clinical endpoints compared with the more qualitative radiologic, histopathologic, and clinical data more commonly utilized today. Because radiomics offers immense potential but has not reached a mainstream oncologic audience, the authors discuss herein the role of radiomics in cancer care in the future.
Collapse
Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven H Lin
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jinzhong Yang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen M Hahn
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
75
|
Prior JO, Gillessen S, Wirth M, Dale W, Aapro M, Oyen WJ. Radiopharmaceuticals in the elderly cancer patient: Practical considerations, with a focus on prostate cancer therapy. Eur J Cancer 2017; 77:127-139. [DOI: 10.1016/j.ejca.2017.01.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/12/2017] [Accepted: 01/29/2017] [Indexed: 11/24/2022]
|
76
|
Dong M, Liu J, Sun X, Xing L. Prognositc significance of SUVmax
on pretreatment 18
F-FDG PET/CT in early-stage non-small cell lung cancer treated with stereotactic body radiotherapy: A meta-analysis. J Med Imaging Radiat Oncol 2017; 61:652-659. [PMID: 28266166 DOI: 10.1111/1754-9485.12599] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 01/27/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Min Dong
- Department of Radiation Oncology, Shandong Key Laboratory of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University; Shandong Academic of Medicine Science; Jinan Shandong China
- Department of Oncology; Pingyi County People's Hospital; Linyi Shandong China
| | - Jing Liu
- Department of Radiation Oncology, Shandong Key Laboratory of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University; Shandong Academic of Medicine Science; Jinan Shandong China
| | - Xiaorong Sun
- Department of Radiology, Shandong Key Laboratory of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University; Shandong Academic of Medicine Science; Jinan Shandong China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Key Laboratory of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University; Shandong Academic of Medicine Science; Jinan Shandong China
| |
Collapse
|
77
|
Rosenzweig KE, Gomez JE. Concurrent Chemotherapy and Radiation Therapy for Inoperable Locally Advanced Non–Small-Cell Lung Cancer. J Clin Oncol 2017; 35:6-10. [DOI: 10.1200/jco.2016.69.9678] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 72-year-old man with a 40-pack-year tobacco history developed a cough and decreased exercise tolerance. A chest x-ray demonstrated a right-upper-lobe opacity. Chest computed tomography (CT) scan revealed a 2.5-cm mass in the right upper lobe with multiple mediastinal lymph node disease ( Fig 1 ). A positron emission tomography (PET) scan confirmed the lung lesion and the mediastinal lymphadenopathy without distant metastases. Brain magnetic resonance imaging results were negative. The biopsy specimen revealed adenocarcinoma with no actionable mutations present. Cervical mediastinoscopy was positive for carcinoma in level 2, 3, 4R, and 7 lymph nodes; level 4L was negative. The patient’s stage was T1bN2M0, stage IIIA. His medical history was significant for hyperlipidemia and hypothyroidism. He had smoked one pack a day for 40 years and had quit 15 years earlier. Physical examination was unrevealing, and the patient had an Eastern Cooperative Oncology Group performance status of 0. Because of the extent of lung cancer in the mediastinum, the patient’s cancer was deemed inoperable, and he was referred for consideration of concurrent chemotherapy and radiation.
Collapse
Affiliation(s)
- Kenneth E. Rosenzweig
- Kenneth E. Rosenzweig and Jorge E. Gomez, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jorge E. Gomez
- Kenneth E. Rosenzweig and Jorge E. Gomez, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
78
|
Bazan JG, Duan F, Snyder BS, Horng D, Graves EE, Siegel BA, Machtay M, Loo BW. Metabolic tumor volume predicts overall survival and local control in patients with stage III non-small cell lung cancer treated in ACRIN 6668/RTOG 0235. Eur J Nucl Med Mol Imaging 2017; 44:17-24. [PMID: 27645692 PMCID: PMC5121029 DOI: 10.1007/s00259-016-3520-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine whether higher pre-treatment metabolic tumor volume (tMTV-pre) is associated with worse overall survival (OS) in patients with inoperable NSCLC treated with definitive chemoradiation (CRT). METHODS This is a secondary analysis of the American College of Radiology Imaging Network (ACRIN) 6668/Radiation Therapy Oncology Group 0235 trial. Pre-treatment PET scans were performed on ACRIN-qualified scanners. Computer-aided MTV measurement was performed using RT_Image. Kaplan-Meier curves and Cox proportional hazards regression models were used to assess the association between tMTV and OS. RESULTS Of the 250 patients enrolled on the study, 230 were evaluable for tMTV-pre. Patients with MTV-pre >32 mL (median value) vs. ≤32 mL had worse median OS (14.8 vs. 29.7 months, p < 0.001). As a continuous variable, higher tMTV-pre (per 10-mL increase) remained associated with worse OS (HR = 1.03, p < 0.001) after controlling for other variables. A significant interaction between radiation dose and tMTV-pre occurred for OS (p = 0.002), demonstrating that the negative prognostic impact of tMTV-pre decreased as radiotherapy dose increased. Among patients with tMTV-pre ≤32 mL, there was no difference in survival according to radiotherapy dose delivered (p = 0.694). However, median OS was inferior in patients with tMTV-pre >32 mL who received ≤60 Gy compared with those who received 61-69 Gy or ≥70 Gy (p = 0.001). CONCLUSIONS Higher tMTV-pre is associated with significantly worse OS in inoperable stage III NSCLC treated with definitive CRT. Our findings suggest that for patients with large tMTV-pre, achieving a therapeutic radiation dose may help maximize OS. Prospective studies are needed to confirm this finding.
Collapse
Affiliation(s)
- Jose G Bazan
- Department of Radiation Oncology, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA.
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Bradley S Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Dunstan Horng
- ECOG-ACRIN Cancer Research Group, Philadelphia, PA, USA
| | - Edward E Graves
- Department of Radiation Oncology, Stanford Cancer Institute, School of Medicine, Stanford University, 875 Blake Wilbur Drive, Stanford, CA, 94305-5847, USA
| | - Barry A Siegel
- Mallinckrodt Institute of Radiology and the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Mitchell Machtay
- Case Comprehensive Cancer Center and Case Western Reserve University, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford Cancer Institute, School of Medicine, Stanford University, 875 Blake Wilbur Drive, Stanford, CA, 94305-5847, USA.
| |
Collapse
|
79
|
Reddy JP, Tang C, Shih T, Kim B, Kim C, Nguyen QN, Welsh J, Benveniste M, Zhang J, Liao Z, Gomez DR. Influence of Surveillance PET/CT on Detection of Early Recurrence After Definitive Radiation in Stage III Non-small-cell Lung Cancer. Clin Lung Cancer 2016; 18:141-148. [PMID: 27913215 DOI: 10.1016/j.cllc.2016.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/24/2016] [Accepted: 11/01/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are few data to support the use of varying imaging modalities in evaluating recurrence in non-small-cell lung cancer (NSCLC). We compared the efficacy of surveillance positron emission tomography (PET)/computed tomography (CT) versus CT scans of the chest in detecting recurrences after definitive radiation for NSCLC. MATERIALS AND METHODS We retrospectively analyzed 200 patients treated between 2000 and 2011 who met the inclusion criteria of stage III NSCLC, completion of definitive radiation treatment, and absence of recurrence within the initial 6 months. These patients were then grouped on the basis of the use of PET/CT imaging during postradiation surveillance. Patients who received ≥ 1 PET/CT scans within 6 months of the end of radiation treatment were placed in the PET group whereas all others were placed in the CT group. We compared survival times from the end of treatment to the date of death or last follow-up using log rank tests. Multivariate analysis was conducted to identify factors associated with decreased survival. RESULTS In the entire cohort, median event-free survival (EFS) was 26.7 months, and median overall survival (OS) was 41.2 months. The CT group had a median EFS of 21.4 months versus 29.4 months for the PET group (P = .59). There was no difference in OS between the CT and PET groups (median OS of 41.2 and 41.3 months, respectively; P = .59). There was also no difference in local recurrence-free survival or distant metastases-free survival between the CT-only and PET/CT groups (P = .92 and P = .30, respectively). Similarly, in multivariate analysis, stratification into the PET group was not associated with improved EFS (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.61-1.34; P = .60) or OS (HR, 1.2; 95% CI, 0.83-1.7; P = .34). CONCLUSIONS In stage III NSCLC patients treated with definitive radiation and without early recurrence, PET/CT scan surveillance did not result in decreased time to detection of locoregional or distant recurrence or improved survival.
Collapse
Affiliation(s)
- Jay P Reddy
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Tina Shih
- Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Bumyang Kim
- Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX; School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Charissa Kim
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - James Welsh
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Marcelo Benveniste
- Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Jianjun Zhang
- Department of Thoracic Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Daniel R Gomez
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
| |
Collapse
|
80
|
Ohno Y, Fujisawa Y, Koyama H, Kishida Y, Seki S, Sugihara N, Yoshikawa T. Dynamic contrast-enhanced perfusion area-detector CT assessed with various mathematical models: Its capability for therapeutic outcome prediction for non-small cell lung cancer patients with chemoradiotherapy as compared with that of FDG-PET/CT. Eur J Radiol 2016; 86:83-91. [PMID: 28027771 DOI: 10.1016/j.ejrad.2016.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To directly compare the capability of dynamic first-pass contrast-enhanced (CE-) perfusion area-detector CT (ADCT) and PET/CT for early prediction of treatment response, disease progression and overall survival of non-small cell carcinoma (NSCLC) patients treated with chemoradiotherapy. MATERIALS AND METHODS Fifty-three consecutive Stage IIIB NSCLC patients who had undergone PET/CT, dynamic first-pass CE-perfusion ADCT, chemoradiotherapy, and follow-up examination were enrolled in this study. They were divided into two groups: 1) complete or partial response (CR+PR) and 2) stable or progressive disease (SD+PD). Pulmonary arterial and systemic arterial perfusions and total perfusion were assessed at targeted lesions with the dual-input maximum slope method, permeability surface and distribution volume with the Patlak plot method, tumor perfusion with the single-input maximum slope method, and SUVmax, and results were averaged to determine final values for each patient. Next, step-wise regression analysis was used to determine which indices were the most useful for predicting therapeutic effect. Finally, overall survival of responders and non-responders assessed by using the indices that had a significant effect on prediction of therapeutic outcome was statistically compared. RESULTS The step-wise regression test showed that therapeutic effect (r2=0.63, p=0.01) was significantly affected by the following three factors in order of magnitude of impact: systemic arterial perfusion, total perfusion, and SUVmax. Mean overall survival showed a significant difference for total perfusion (p=0.003) and systemic arterial perfusion (p=0.04). CONCLUSION Dynamic first-pass CE-perfusion ADCT as well as PET/CT are useful for treatment response prediction in NSCLC patients treated with chemoradiotherapy.
Collapse
Affiliation(s)
- Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan; Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan.
| | | | - Hisanobu Koyama
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuji Kishida
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichiro Seki
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Takeshi Yoshikawa
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan; Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
81
|
FDG PET-CT for solitary pulmonary nodule and lung cancer: Literature review. Diagn Interv Imaging 2016; 97:1003-1017. [DOI: 10.1016/j.diii.2016.06.020] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 12/17/2022]
|
82
|
Sharma RA, Plummer R, Stock JK, Greenhalgh TA, Ataman O, Kelly S, Clay R, Adams RA, Baird RD, Billingham L, Brown SR, Buckland S, Bulbeck H, Chalmers AJ, Clack G, Cranston AN, Damstrup L, Ferraldeschi R, Forster MD, Golec J, Hagan RM, Hall E, Hanauske AR, Harrington KJ, Haswell T, Hawkins MA, Illidge T, Jones H, Kennedy AS, McDonald F, Melcher T, O'Connor JPB, Pollard JR, Saunders MP, Sebag-Montefiore D, Smitt M, Staffurth J, Stratford IJ, Wedge SR. Clinical development of new drug-radiotherapy combinations. Nat Rev Clin Oncol 2016; 13:627-42. [PMID: 27245279 DOI: 10.1038/nrclinonc.2016.79] [Citation(s) in RCA: 213] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In countries with the best cancer outcomes, approximately 60% of patients receive radiotherapy as part of their treatment, which is one of the most cost-effective cancer treatments. Notably, around 40% of cancer cures include the use of radiotherapy, either as a single modality or combined with other treatments. Radiotherapy can provide enormous benefit to patients with cancer. In the past decade, significant technical advances, such as image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic radiotherapy, and proton therapy enable higher doses of radiotherapy to be delivered to the tumour with significantly lower doses to normal surrounding tissues. However, apart from the combination of traditional cytotoxic chemotherapy with radiotherapy, little progress has been made in identifying and defining optimal targeted therapy and radiotherapy combinations to improve the efficacy of cancer treatment. The National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group (CTRad) formed a Joint Working Group with representatives from academia, industry, patient groups and regulatory bodies to address this lack of progress and to publish recommendations for future clinical research. Herein, we highlight the Working Group's consensus recommendations to increase the number of novel drugs being successfully registered in combination with radiotherapy to improve clinical outcomes for patients with cancer.
Collapse
Affiliation(s)
- Ricky A Sharma
- UCL Cancer Institute, University College London, 72 Huntley Street, London WC1E 6DD, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Martin D Forster
- UCL Cancer Institute, University College London, 72 Huntley Street, London WC1E 6DD, UK
| | - Julian Golec
- Vertex Pharmaceuticals (Europe) Ltd, Abingdon, UK
| | | | - Emma Hall
- The Institute of Cancer Research/The Royal Marsden NIHR Biomedical Research Centre, London, UK
| | | | - Kevin J Harrington
- The Institute of Cancer Research/The Royal Marsden NIHR Biomedical Research Centre, London, UK
| | | | | | | | | | | | - Fiona McDonald
- The Institute of Cancer Research/The Royal Marsden NIHR Biomedical Research Centre, London, UK
| | | | | | | | | | | | | | - John Staffurth
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | | | | |
Collapse
|
83
|
Fave X, Mackin D, Yang J, Zhang J, Fried D, Balter P, Followill D, Gomez D, Jones AK, Stingo F, Fontenot J, Court L. Can radiomics features be reproducibly measured from CBCT images for patients with non-small cell lung cancer? Med Phys 2016; 42:6784-97. [PMID: 26632036 DOI: 10.1118/1.4934826] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Increasing evidence suggests radiomics features extracted from computed tomography (CT) images may be useful in prognostic models for patients with nonsmall cell lung cancer (NSCLC). This study was designed to determine whether such features can be reproducibly obtained from cone-beam CT (CBCT) images taken using medical Linac onboard-imaging systems in order to track them through treatment. METHODS Test-retest CBCT images of ten patients previously enrolled in a clinical trial were retrospectively obtained and used to determine the concordance correlation coefficient (CCC) for 68 different texture features. The volume dependence of each feature was also measured using the Spearman rank correlation coefficient. Features with a high reproducibility (CCC > 0.9) that were not due to volume dependence in the patient test-retest set were further examined for their sensitivity to differences in imaging protocol, level of scatter, and amount of motion by using two phantoms. The first phantom was a texture phantom composed of rectangular cartridges to represent different textures. Features were measured from two cartridges, shredded rubber and dense cork, in this study. The texture phantom was scanned with 19 different CBCT imagers to establish the features' interscanner variability. The effect of scatter on these features was studied by surrounding the same texture phantom with scattering material (rice and solid water). The effect of respiratory motion on these features was studied using a dynamic-motion thoracic phantom and a specially designed tumor texture insert of the shredded rubber material. The differences between scans acquired with different Linacs and protocols, varying amounts of scatter, and with different levels of motion were compared to the mean intrapatient difference from the test-retest image set. RESULTS Of the original 68 features, 37 had a CCC >0.9 that was not due to volume dependence. When the Linac manufacturer and imaging protocol were kept consistent, 4-13 of these 37 features passed our criteria for reproducibility more than 50% of the time, depending on the manufacturer-protocol combination. Almost all of the features changed substantially when scatter material was added around the phantom. For the dense cork, 23 features passed in the thoracic scans and 11 features passed in the head scans when the differences between one and two layers of scatter were compared. Using the same test for the shredded rubber, five features passed the thoracic scans and eight features passed the head scans. Motion substantially impacted the reproducibility of the features. With 4 mm of motion, 12 features from the entire volume and 14 features from the center slice measurements were reproducible. With 6-8 mm of motion, three features (Laplacian of Gaussian filtered kurtosis, gray-level nonuniformity, and entropy), from the entire volume and seven features (coarseness, high gray-level run emphasis, gray-level nonuniformity, sum-average, information measure correlation, scaled mean, and entropy) from the center-slice measurements were considered reproducible. CONCLUSIONS Some radiomics features are robust to the noise and poor image quality of CBCT images when the imaging protocol is consistent, relative changes in the features are used, and patients are limited to those with less than 1 cm of motion.
Collapse
Affiliation(s)
- Xenia Fave
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030 and The University of Texas Graduate School of Biomedical Sciences at Houston, 6767 Bertner Avenue, Houston, Texas 77030
| | - Dennis Mackin
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030
| | - Joy Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030
| | - David Fried
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030 and The University of Texas Graduate School of Biomedical Sciences at Houston, 6767 Bertner Avenue, Houston, Texas 77030
| | - Peter Balter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030
| | - David Followill
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030
| | - Daniel Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030
| | - A Kyle Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030
| | - Francesco Stingo
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030
| | - Jonas Fontenot
- Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, Louisiana 70809
| | - Laurence Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030 and Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030
| |
Collapse
|
84
|
Abstract
Precision medicine allows tailoring of preventive or therapeutic interventions to avoid the expense and toxicity of futile treatment given to those who will not respond. Lung cancer is a heterogeneous disease functionally and morphologically. PET is a sensitive molecular imaging technique with a major role in the precision medicine algorithm of patients with lung cancer. It contributes to the precision medicine of lung neoplasia by interrogating tumor heterogeneity throughout the body. It provides anatomofunctional insight during diagnosis, staging, and restaging of the disease. It is a biomarker of tumoral heterogeneity that helps direct selection of the most appropriate treatment, the prediction of early response to cytotoxic and cytostatic therapies, and is a prognostic biomarker in patients with lung cancer.
Collapse
Affiliation(s)
- Katherine A Zukotynski
- Division of Nuclear Medicine and Molecular Imaging, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, Ontario L9G 4X5, Canada; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, McMaster University, 1200 Main Street West, Hamilton, Ontario L9G 4X5, Canada
| | - Victor H Gerbaudo
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| |
Collapse
|
85
|
Simone CB, Houshmand S, Kalbasi A, Salavati A, Alavi A. PET-Based Thoracic Radiation Oncology. PET Clin 2016; 11:319-32. [DOI: 10.1016/j.cpet.2016.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
86
|
Suzuki H, Nishio M, Nakanishi H, Hanai N, Hirakawa H, Kodaira T, Tamaki T, Hasegawa Y. Impact of total lesion glycolysis measured by 18F-FDG-PET/CT on overall survival and distant metastasis in hypopharyngeal cancer. Oncol Lett 2016; 12:1493-1500. [PMID: 27446459 DOI: 10.3892/ol.2016.4765] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/06/2016] [Indexed: 11/05/2022] Open
Abstract
The present study investigated the possible correlation between 18F-2-fluorodeoxyglucose (18F-FDG)-uptake parameters and clinicopathological parameters in hypopharyngeal squamous cell carcinoma (HPSCC). A total of 53 patients, newly diagnosed with HPSCC, received pretreatment 18F-FDG-positron emission tomography/computed tomography (PET/CT). Metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum and peak standardized uptake values (SUVmax and SUVpeak) were calculated as 18F-FDG-uptake parameters of the primary tumor. Tumor thickness, depth of invasion and pathological tumor volume were pathologically measured. Upon univariate survival analysis, SUVmax ≥28.5, SUVpeak ≥19, MTV ≥12 and TLG ≥42 were significantly associated with a shorter overall survival (OS) time, and MTV ≥12 and TLG ≥42 were significantly associated with a shorter distant metastasis-free survival (DMFS) time. Upon multivariate analysis with adjustment for clinical T category and treatment group, patients with SUVmax ≥28.5 exhibited a significantly shorter OS time, while TLG ≥42 was significantly correlated with shorter OS and DMFS times. Upon simple regression analysis, TLG was found to be significantly associated with tumor thickness and depth of invasion, while MTV was found to be closely associated with pathological tumor volume. In conclusion, pretreatment 18F-FDG-PET/CT is likely to provide valuable prognostic parameters in HPSCC.
Collapse
Affiliation(s)
- Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Masami Nishio
- Department of Radiology, Nagoya Positron Emission Tomography Imaging Center, Nagoya, Aichi 454-0933, Japan
| | - Hayao Nakanishi
- Department of Pathology, Aichi Cancer Center Aichi Hospital, Okazaki, Aichi 444-0011, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Hitoshi Hirakawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Tsuneo Tamaki
- Department of Radiology, East Nagoya Positron Emission Tomography Imaging Center, Nagoya, Aichi 464-0044, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| |
Collapse
|
87
|
Dong X, Sun X, Sun L, Maxim PG, Xing L, Huang Y, Li W, Wan H, Zhao X, Xing L, Yu J. Early Change in Metabolic Tumor Heterogeneity during Chemoradiotherapy and Its Prognostic Value for Patients with Locally Advanced Non-Small Cell Lung Cancer. PLoS One 2016; 11:e0157836. [PMID: 27322376 PMCID: PMC4913903 DOI: 10.1371/journal.pone.0157836] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/06/2016] [Indexed: 12/25/2022] Open
Abstract
Introduction To observe the early change of metabolic tumor heterogeneity during chemoradiotherapy and to determine its prognostic value for patients with locally advanced non-small cell lung cancer (NSCLC). Methods From January 2007 to March 2010, 58 patients with NSCLC were included who were received 18F-fluorodeoxyglucose (18F-FDG) PET/CT before and following 40 Gy radiotherapy with the concurrent cisplatin-based chemotherapy (CCRT). Primary tumor FDG uptake heterogeneity was determined using global and local scale textural features extracted from standardized uptake value (SUV) histogram analysis (coefficient of variation [COV], skewness, kurtosis, area under the curve of the cumulative SUV histogram [AUC-CSH]) and normalized gray-level co-occurrence matrix (contrast, dissimilarity, entropy, homogeneity). SUVmax and metabolic tumor volume (MTV) were also evaluated. Correlations were analyzed between parameters on baseline or during treatments with tumor response, progression-free survival (PFS), and overall survival (OS). Results Compared with non-responders, responders showed significantly greater pre-treatment COV, contrast and MTV (AUC = 0.781, 0.804, 0.686, respectively). Receiver-operating-characteristic curve analysis showed that early change of tumor textural analysis serves as a response predictor with higher sensitivity (73.2%~92.1%) and specificity (80.0%~83.6%) than baseline parameters. Change in AUC-CSH and dissimilarity during CCRT could also predict response with optimal cut-off values (33.0% and 28.7%, respectively). The patients with greater changes in contrast and AUC-CSH had significantly higher 5-year OS (P = 0.008, P = 0.034) and PFS (P = 0.007, P = 0.039). In multivariate analysis, only change in contrast was found as the independent prognostic factor of PFS (HR 0.476, P = 0.021) and OS (HR 0.519, P = 0.015). Conclusions The metabolic tumor heterogeneity change during CCRT characterized by global and local scale textural features may be valuable for predicting treatment response and survival for patients with locally advanced NSCLC.
Collapse
Affiliation(s)
- Xinzhe Dong
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Xiaorong Sun
- Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Lu Sun
- Jinan University, Jinan, Shandong, China
| | - Peter G. Maxim
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Lei Xing
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Yong Huang
- Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Wenwu Li
- Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Honglin Wan
- College of Physics and Electronic Science, Shandong Normal University, Jinan, Shandong, China
| | - Xianguang Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
- * E-mail: (XZ); (LX)
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
- * E-mail: (XZ); (LX)
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| |
Collapse
|
88
|
Pöttgen C, Gauler T, Bellendorf A, Guberina M, Bockisch A, Schwenzer N, Heinzelmann F, Cordes S, Schuler MH, Welter S, Stamatis G, Friedel G, Darwiche K, Jöckel KH, Eberhardt W, Stuschke M. Standardized Uptake Decrease on [18F]-Fluorodeoxyglucose Positron Emission Tomography After Neoadjuvant Chemotherapy Is a Prognostic Classifier for Long-Term Outcome After Multimodality Treatment: Secondary Analysis of a Randomized Trial for Resectable Stage IIIA/B Non-Small-Cell Lung Cancer. J Clin Oncol 2016; 34:2526-33. [PMID: 27247220 DOI: 10.1200/jco.2015.65.5167] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A confirmatory analysis was performed to determine the prognostic value of metabolic response during induction chemotherapy followed by bimodality/trimodality treatment of patients with operable locally advanced non-small-cell lung cancer. PATIENTS AND METHODS Patients with potentially operable stage IIIA(N2) or selected stage IIIB non-small-cell lung cancer received three cycles of cisplatin/paclitaxel (induction chemotherapy) followed by neoadjuvant radiochemotherapy (RCT) to 45 Gy (1.5 Gy twice per day concurrent cisplatin/vinorelbine) within the ESPATUE (Phase III Study of Surgery Versus Definitive Concurrent Chemoradiotherapy Boost in Patients With Resectable Stage IIIA[N2] and Selected IIIB Non-Small-Cell Lung Cancer After Induction Chemotherapy and Concurrent Chemoradiotherapy) trial. Positron emission tomography scans were recommended before (t0) and after (t2) induction chemotherapy. Patients who were eligible for surgery after neoadjuvant RCT were randomly assigned to definitive RCT or surgery. The prognostic value of percentage of maximum standardized uptake value (%SUVmax) remaining in the primary tumor after induction chemotherapy-%SUVremaining = SUVmax(t2)/SUVmax(t0)-was assessed by proportional hazard analysis and receiver operating characteristic analysis. RESULTS Overall, 161 patients were randomly assigned (155 from the Essen and Tübingen centers), and 124 of these received positron emission tomography scans at t0 and t2. %SUVremaining as a continuous variable was prognostic for the three end points of overall survival, progression-free survival, and freedom from extracerebral progression in univariable and multivariable analysis (P < .016). The respective hazard ratios per 50% increase in %SUVremaining from multivariable analysis were 2.3 (95% CI, 1.5 to 3.4; P < .001), 1.8 (95% CI, 1.3 to 2.5; P < .001), and 1.8 (95% CI, 1.2 to 2.7; P = .006) for the three end points. %SUVremaining dichotomized at a cut point of maximum sum of sensitivity and specificity from receiver operating characteristic analysis at 36 months was also prognostic. Exploratory analysis revealed that %SUVremaining was likewise prognostic for overall survival in both treatment arms and was more closely associated with extracerebral distant metastases (P = .016) than with isolated locoregional relapses (P = .97). CONCLUSION %SUVremaining is a predictor for survival and other end points after multimodality treatment and can serve as a parameter for treatment stratification after induction chemotherapy or for evaluation of adjuvant new systemic treatment options for high-risk patients.
Collapse
Affiliation(s)
- Christoph Pöttgen
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Thomas Gauler
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Alexander Bellendorf
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Maja Guberina
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Andreas Bockisch
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Nina Schwenzer
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Frank Heinzelmann
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Sebastian Cordes
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Martin H Schuler
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Stefan Welter
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Georgios Stamatis
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Godehard Friedel
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Kaid Darwiche
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Karl-Heinz Jöckel
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Wilfried Eberhardt
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany
| | - Martin Stuschke
- Christoph Pöttgen, Thomas Gauler, Alexander Bellendorf, Maja Guberina, Andreas Bockisch, Sebastian Cordes, Martin H. Schuler, Karl-Heinz Jöckel, Wilfried Eberhardt, and Martin Stuschke, University Hospital Essen; University of Duisburg-Essen; Stefan Welter, Georgios Stamatis, and Kaid Darwiche, Ruhrlandklinik, Essen; Nina Schwenzer and Frank Heinzelmann, University Hospital Tübingen; University of Tübingen, Tübingen; and Godehard Friedel, Robert-Bosch-Krankenhaus; Klinikum Schillerhöhe, Gerlingen, Germany.
| |
Collapse
|
89
|
Jin F, Zhu H, Fu Z, Kong L, Yu J. Prognostic value of the standardized uptake value maximum change calculated by dual-time-point (18)F-fluorodeoxyglucose positron emission tomography imaging in patients with advanced non-small-cell lung cancer. Onco Targets Ther 2016; 9:2993-9. [PMID: 27284249 PMCID: PMC4881733 DOI: 10.2147/ott.s104919] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of this study was to investigate the prognostic value of the standardized uptake value maximum (SUVmax) change calculated by dual-time-point 18F-fluorodeoxyglucose positron emission tomography (PET) imaging in patients with advanced non-small-cell lung cancer (NSCLC). Patients and methods We conducted a retrospective review of 115 patients with advanced NSCLC who underwent pretreatment dual-time-point 18F-fluorodeoxyglucose PET acquired at 1 and 2 hours after injection. The SUVmax from early images (SUVmax1) and SUVmax from delayed images (SUVmax2) were recorded and used to calculate the SUVmax changes, including the SUVmax increment (ΔSUVmax) and percent change of the SUVmax (%ΔSUVmax). Progression-free survival (PFS) and overall survival (OS) were determined by the Kaplan–Meier method and were compared with the studied PET parameters, and the clinicopathological prognostic factors in univariate analyses and multivariate analyses were constructed using Cox proportional hazards regression. Results One hundred and fifteen consecutive patients were reviewed, and the median follow-up time was 12.5 months. The estimated median PFS and OS were 3.8 and 9.6 months, respectively. In univariate analysis, SUVmax1, SUVmax2, ΔSUVmax, %ΔSUVmax, clinical stage, and Eastern Cooperative Oncology Group (ECOG) scores were significant prognostic factors for PFS. Similar results were significantly correlated with OS, except %ΔSUVmax. In multivariate analysis, ΔSUVmax and %ΔSUVmax were significant factors for PFS. On the other hand, ECOG scores were only identified as independent predictors of OS. Conclusion Our results demonstrated the prognostic value of the SUVmax change in predicting the PFS of patients with advanced NSCLC. However, SUVmax change could not predict OS.
Collapse
Affiliation(s)
- Feng Jin
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, People's Republic of China; Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Zheng Fu
- Department of Nuclear Medicine, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Li Kong
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| |
Collapse
|
90
|
Zhang L, Fried DV, Fave XJ, Hunter LA, Yang J, Court LE. IBEX: an open infrastructure software platform to facilitate collaborative work in radiomics. Med Phys 2016; 42:1341-53. [PMID: 25735289 DOI: 10.1118/1.4908210] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Radiomics, which is the high-throughput extraction and analysis of quantitative image features, has been shown to have considerable potential to quantify the tumor phenotype. However, at present, a lack of software infrastructure has impeded the development of radiomics and its applications. Therefore, the authors developed the imaging biomarker explorer (IBEX), an open infrastructure software platform that flexibly supports common radiomics workflow tasks such as multimodality image data import and review, development of feature extraction algorithms, model validation, and consistent data sharing among multiple institutions. METHODS The IBEX software package was developed using the MATLAB and c/c++ programming languages. The software architecture deploys the modern model-view-controller, unit testing, and function handle programming concepts to isolate each quantitative imaging analysis task, to validate if their relevant data and algorithms are fit for use, and to plug in new modules. On one hand, IBEX is self-contained and ready to use: it has implemented common data importers, common image filters, and common feature extraction algorithms. On the other hand, IBEX provides an integrated development environment on top of MATLAB and c/c++, so users are not limited to its built-in functions. In the IBEX developer studio, users can plug in, debug, and test new algorithms, extending IBEX's functionality. IBEX also supports quality assurance for data and feature algorithms: image data, regions of interest, and feature algorithm-related data can be reviewed, validated, and/or modified. More importantly, two key elements in collaborative workflows, the consistency of data sharing and the reproducibility of calculation result, are embedded in the IBEX workflow: image data, feature algorithms, and model validation including newly developed ones from different users can be easily and consistently shared so that results can be more easily reproduced between institutions. RESULTS Researchers with a variety of technical skill levels, including radiation oncologists, physicists, and computer scientists, have found the IBEX software to be intuitive, powerful, and easy to use. IBEX can be run at any computer with the windows operating system and 1GB RAM. The authors fully validated the implementation of all importers, preprocessing algorithms, and feature extraction algorithms. Windows version 1.0 beta of stand-alone IBEX and IBEX's source code can be downloaded. CONCLUSIONS The authors successfully implemented IBEX, an open infrastructure software platform that streamlines common radiomics workflow tasks. Its transparency, flexibility, and portability can greatly accelerate the pace of radiomics research and pave the way toward successful clinical translation.
Collapse
Affiliation(s)
- Lifei Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - David V Fried
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas 77030
| | - Xenia J Fave
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas 77030
| | - Luke A Hunter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas 77030
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas 77030
| |
Collapse
|
91
|
Kanzaki H, Kataoka M, Nishikawa A, Uwatsu K, Nagasaki K, Nishijima N, Ochi T, Mochizuki T. Impact of early tumor reduction on outcome differs by histological subtype in stage III non-small-cell lung cancer treated with definitive radiotherapy. Int J Clin Oncol 2016; 21:853-861. [PMID: 27125214 DOI: 10.1007/s10147-016-0982-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/13/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND We retrospectively investigated the impact on survival of early tumor reduction during definitive radiotherapy for inoperable stage III non-small cell lung cancer (NSCLC) patients, according to their histological subtypes. METHODS Between November 2006 and December 2012, 152 consecutive patients with inoperable stage III NSCLC who underwent definitive radiotherapy were reviewed retrospectively. Forty-one patients were excluded for not satisfying the inclusion criteria. Forty-five (40.5 %) and 48 (43.2 %) patients were diagnosed with squamous cell carcinoma (SQC) and adenocarcinoma (ADC), respectively. The tumor reduction rate (TRR) was defined as follows: TRR = 1-[gross tumor volume (GTV) on computed tomography at shrinking irradiation field planning]/(GTV on computed tomography at the initial treatment planning). The Cox proportional hazard model was used to identify significant prognostic factors for overall survival (OS) and progression-free survival (PFS). RESULTS We evaluated 111 patients, with a median follow-up time of 52.2 months in surviving patients. The median TRR was 45.9 %. In all patients, there were significant associations between TRR and PFS (P = 0.036) on multivariate analysis, although TRR had no correlation with OS (P = 0.141). With respect to histological subtype, multivariate analyses revealed that a higher TRR showed significant associations with better OS and PFS in the SQC group (P = 0.013 and 0.040, respectively). In contrast, a higher TRR was associated with poorer OS in the ADC group (P = 0.030); there was no association between TRR and PFS. CONCLUSION We found that a higher TRR is a promising prognostic factor for better survival and disease control in SQC patients.
Collapse
Affiliation(s)
- Hiromitsu Kanzaki
- Department of Radiation Oncology, Shikoku Cancer Center Hospital, National Hospital Organization, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan. .,Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon-City, Ehime, 791-0295, Japan.
| | - Masaaki Kataoka
- Department of Radiation Oncology, Shikoku Cancer Center Hospital, National Hospital Organization, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Atsushi Nishikawa
- Department of Radiation Oncology, Shikoku Cancer Center Hospital, National Hospital Organization, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Kotaro Uwatsu
- Department of Radiation Oncology, Shikoku Cancer Center Hospital, National Hospital Organization, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Kei Nagasaki
- Department of Radiation Oncology, Shikoku Cancer Center Hospital, National Hospital Organization, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Noriko Nishijima
- Department of Radiation Oncology, Shikoku Cancer Center Hospital, National Hospital Organization, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Takashi Ochi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon-City, Ehime, 791-0295, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon-City, Ehime, 791-0295, Japan
| |
Collapse
|
92
|
Sawada S, Suehisa H, Ueno T, Sugimoto R, Yamashita M. Monitoring and management of lung cancer patients following curative-intent treatment: clinical utility of 2-deoxy-2-[fluorine-18]fluoro-d-glucose positron emission tomography/computed tomography. LUNG CANCER-TARGETS AND THERAPY 2016; 7:45-51. [PMID: 28210160 PMCID: PMC5310700 DOI: 10.2147/lctt.s83644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A large number of studies have demonstrated that 2-deoxy-2-[fluorine-18]fluoro-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) is superior to conventional modalities for the diagnosis of lung cancer and the evaluation of the extent of the disease. However, the efficacy of PET/CT in a follow-up surveillance setting following curative-intent treatments for lung cancer has not yet been established. We reviewed previous papers and evaluated the potential efficacy of PET-CT in the setting of follow-up surveillance. The following are our findings: 1) PET/CT is considered to be superior or equivalent to conventional modalities for the detection of local recurrence. However, inflammatory changes and fibrosis after treatments in local areas often result in false-positive findings; 2) the detection of asymptomatic distant metastasis is considered to be an advantage of PET/CT in a follow-up setting. However, it should be noted that detection of brain metastasis with PET/CT has some limitation, similar to its use in pretreatment staging; 3) additional radiation exposure and higher medical cost arising from the use of PET/CT should be taken into consideration, particularly in patients who might not have cancer after curative-intent treatment and are expected to have a long lifespan. The absence of any data regarding survival benefits and/or improvements in quality of life is another critical issue. In summary, PET/CT is considered to be more accurate and sensitive than conventional modalities for the detection of asymptomatic recurrence after curative-intent treatments. These advantages could modify subsequent management in patients with suspected recurrence and might contribute to the selection of appropriate treatments for recurrence. Therefore, PET/CT may be an alternative to conventional follow-up modalities. However, several important issues remain to be solved. PET/CT in a follow-up surveillance setting is generally not recommended in clinical practice at the moment.
Collapse
Affiliation(s)
- Shigeki Sawada
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Hiroshi Suehisa
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Tsuyoshi Ueno
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Ryujiro Sugimoto
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Motohiro Yamashita
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| |
Collapse
|
93
|
Kitajima K, Doi H, Kanda T, Yamane T, Tsujikawa T, Kaida H, Tamaki Y, Kuribayashi K. Present and future roles of FDG-PET/CT imaging in the management of lung cancer. Jpn J Radiol 2016; 34:387-99. [PMID: 27121156 DOI: 10.1007/s11604-016-0546-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/12/2016] [Indexed: 12/19/2022]
Abstract
Integrated positron emission tomography/computed tomography (PET/CT) using 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) has emerged as a powerful tool for combined metabolic and anatomic evaluation in clinical oncologic imaging. This review discusses the utility of (18)F-FDG PET/CT as a tool for managing patients with lung cancer. We discuss different patient management stages, including diagnosis, initial staging, therapy planning, early treatment response assessment, re-staging, and prognosis.
Collapse
Affiliation(s)
- Kazuhiro Kitajima
- Division of Nuclear Medicine and PET Center, Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tomonori Kanda
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Tomohiko Yamane
- Department of Nuclear Medicine, Saitama International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tetsuya Tsujikawa
- Department of Biomedical Imaging Research Center, Fukui University, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Hayato Kaida
- Department of Radiology, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yukihisa Tamaki
- Department of Radiation Oncology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Kozo Kuribayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| |
Collapse
|
94
|
Wu J, Aguilera T, Shultz D, Gudur M, Rubin DL, Loo BW, Diehn M, Li R. Early-Stage Non-Small Cell Lung Cancer: Quantitative Imaging Characteristics of (18)F Fluorodeoxyglucose PET/CT Allow Prediction of Distant Metastasis. Radiology 2016; 281:270-8. [PMID: 27046074 DOI: 10.1148/radiol.2016151829] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose To identify quantitative imaging biomarkers at fluorine 18 ((18)F) positron emission tomography (PET) for predicting distant metastasis in patients with early-stage non-small cell lung cancer (NSCLC). Materials and Methods In this institutional review board-approved HIPAA-compliant retrospective study, the pretreatment (18)F fluorodeoxyglucose PET images in 101 patients treated with stereotactic ablative radiation therapy from 2005 to 2013 were analyzed. Data for 70 patients who were treated before 2011 were used for discovery purposes, while data from the remaining 31 patients were used for independent validation. Quantitative PET imaging characteristics including statistical, histogram-related, morphologic, and texture features were analyzed, from which 35 nonredundant and robust features were further evaluated. Cox proportional hazards regression model coupled with the least absolute shrinkage and selection operator was used to predict distant metastasis. Whether histologic type provided complementary value to imaging by combining both in a single prognostic model was also assessed. Results The optimal prognostic model included two image features that allowed quantification of intratumor heterogeneity and peak standardized uptake value. In the independent validation cohort, this model showed a concordance index of 0.71, which was higher than those of the maximum standardized uptake value and tumor volume, with concordance indexes of 0.67 and 0.64, respectively. The prognostic model also allowed separation of groups with low and high risk for developing distant metastasis (hazard ratio, 4.8; P = .0498, log-rank test), which compared favorably with maximum standardized uptake value and tumor volume (hazard ratio, 1.5 and 2.0, respectively; P = .73 and 0.54, log-rank test, respectively). When combined with histologic types, the prognostic power was further improved (hazard ratio, 6.9; P = .0289, log-rank test; and concordance index, 0.80). Conclusion PET imaging characteristics associated with distant metastasis that could potentially help practitioners to tailor appropriate therapy for individual patients with early-stage NSCLC were identified. (©) RSNA, 2016 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Jia Wu
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - Todd Aguilera
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - David Shultz
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - Madhu Gudur
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - Daniel L Rubin
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - Billy W Loo
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - Maximilian Diehn
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - Ruijiang Li
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| |
Collapse
|
95
|
Padovani L, Baret A, Ciccolini J, Taieb D, Bardia F, Teissonnier L, Muracciole X, Barlesi F, Barbolosi D. An alternative parameter for early forecasting clinical response in NSCLC patients during radiotherapy: proof of concept study. Br J Radiol 2016; 89:20160061. [PMID: 27043244 DOI: 10.1259/bjr.20160061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Positron emission tomography with (18)F fludeoxyglucose integrated with CT ((18)F-FDG PET/CT) is a recommended imaging procedure in the evaluation of non-small-cell lung cancers (NSCLCs). Radiochemotherapy (RCT) is a mainstay for treatment of locally advanced NSCLC, for which overall survival still remains poor. Early evaluation of treatment response may help in decision-making to complete radiotherapy (RT) or to switch to other treatment modalities. The present study aimed to evaluate the performance of new metabolic parameters based on a simplified kinetic analysis on a single time point (SKA-S)-derived mathematical method, as compared with standardized uptake value (SUV) measurement during RT. METHODS Four patients treated with RT or RCT for NSCLC were evaluated using (18)F-FDG PET/CT during RT and after treatment completion. Whole-body (18)F-FDG PET/CT was performed followed by four additional list-mode acquisitions centered over the target lesion. Response was evaluated at four times (i.e. PET1-PET4) by calculating standard SUV values and T80%, the time taken to reach 80% of (18)F-FDG metabolized fraction using a SKA-S-derived mathematical method. RESULTS Data from SUV and T80% calculations were found to be controversial. T80% was found to be more predictive of clinical outcome. CONCLUSION Although results from this pilot study should be further confirmed in a large prospective study, the data suggest that T80% is a promising metabolic biomarker for assessing early response to RT. ADVANCES IN KNOWLEDGE In this proof of concept study, we show that T80% defined from a mathematic model taking into account the net influx rate constant and vascular volume could be consider as a promising biomarker as compared with the maximum SUV.
Collapse
Affiliation(s)
- Laetitia Padovani
- 1 SMARTc, INSERM, UMR 911 CRO2, Aix Marseille Université, Marseille, France.,2 Assistance Publique des Hôpitaux de Marseille, Radiotherapy Department, Marseille, France
| | - Aurelie Baret
- 2 Assistance Publique des Hôpitaux de Marseille, Radiotherapy Department, Marseille, France
| | - Joseph Ciccolini
- 1 SMARTc, INSERM, UMR 911 CRO2, Aix Marseille Université, Marseille, France
| | - David Taieb
- 3 Aix Marseille Université; Assistance Publique Hôpitaux de Marseille, Nuclear Medical Department, Marseille, France
| | - Farman Bardia
- 3 Aix Marseille Université; Assistance Publique Hôpitaux de Marseille, Nuclear Medical Department, Marseille, France
| | - Laetitia Teissonnier
- 3 Aix Marseille Université; Assistance Publique Hôpitaux de Marseille, Nuclear Medical Department, Marseille, France
| | - Xavier Muracciole
- 1 SMARTc, INSERM, UMR 911 CRO2, Aix Marseille Université, Marseille, France.,2 Assistance Publique des Hôpitaux de Marseille, Radiotherapy Department, Marseille, France
| | - Fabrice Barlesi
- 1 SMARTc, INSERM, UMR 911 CRO2, Aix Marseille Université, Marseille, France.,4 Aix Marseille Université; Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Department, Marseille, France
| | | |
Collapse
|
96
|
Wu J, Gensheimer MF, Dong X, Rubin DL, Napel S, Diehn M, Loo BW, Li R. Robust Intratumor Partitioning to Identify High-Risk Subregions in Lung Cancer: A Pilot Study. Int J Radiat Oncol Biol Phys 2016; 95:1504-1512. [PMID: 27212196 DOI: 10.1016/j.ijrobp.2016.03.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/16/2016] [Accepted: 03/12/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To develop an intratumor partitioning framework for identifying high-risk subregions from (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) and computed tomography (CT) imaging and to test whether tumor burden associated with the high-risk subregions is prognostic of outcomes in lung cancer. METHODS AND MATERIALS In this institutional review board-approved retrospective study, we analyzed the pretreatment FDG-PET and CT scans of 44 lung cancer patients treated with radiation therapy. A novel, intratumor partitioning method was developed, based on a 2-stage clustering process: first at the patient level, each tumor was over-segmented into many superpixels by k-means clustering of integrated PET and CT images; next, tumor subregions were identified by merging previously defined superpixels via population-level hierarchical clustering. The volume associated with each of the subregions was evaluated using Kaplan-Meier analysis regarding its prognostic capability in predicting overall survival (OS) and out-of-field progression (OFP). RESULTS Three spatially distinct subregions were identified within each tumor that were highly robust to uncertainty in PET/CT co-registration. Among these, the volume of the most metabolically active and metabolically heterogeneous solid component of the tumor was predictive of OS and OFP on the entire cohort, with a concordance index or CI of 0.66-0.67. When restricting the analysis to patients with stage III disease (n=32), the same subregion achieved an even higher CI of 0.75 (hazard ratio 3.93, log-rank P=.002) for predicting OS, and a CI of 0.76 (hazard ratio 4.84, log-rank P=.002) for predicting OFP. In comparison, conventional imaging markers, including tumor volume, maximum standardized uptake value, and metabolic tumor volume using threshold of 50% standardized uptake value maximum, were not predictive of OS or OFP, with CI mostly below 0.60 (log-rank P>.05). CONCLUSION We propose a robust intratumor partitioning method to identify clinically relevant, high-risk subregions in lung cancer. We envision that this approach will be applicable to identifying useful imaging biomarkers in many cancer types.
Collapse
Affiliation(s)
- Jia Wu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Michael F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Xinzhe Dong
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Daniel L Rubin
- Department of Radiology, Stanford University School of Medicine, Stanford, California; Department of Medicine (Biomedical Informatics Research), Stanford University School of Medicine, Stanford, California
| | - Sandy Napel
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Ruijiang Li
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
97
|
Early lesion-specific 18F-FDG PET response to chemotherapy predicts time to lesion progression in locally advanced non-small cell lung cancer. Radiother Oncol 2016; 118:460-4. [DOI: 10.1016/j.radonc.2016.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/07/2016] [Accepted: 01/10/2016] [Indexed: 01/19/2023]
|
98
|
Update on F-18-fluoro-deoxy-glucose-PET/computed tomography in nonsmall cell lung cancer. Curr Opin Pulm Med 2016; 21:314-21. [PMID: 25978629 DOI: 10.1097/mcp.0000000000000182] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an outline of current evidence for the use of F-18-fluoro-deoxy-glucose PET computed tomography (FDG-PET/CT) in nonsmall cell lung cancer (NSCLC) for diagnosis, staging, radiotherapy planning, response assessment and response monitoring. RECENT FINDINGS Management of patients with NSCLC requires a multimodality approach to accurately diagnose and stage patients. In this approach, FDG-PET/CT has become a standard staging instrument in lung cancer. FDG-PET/CT is, in addition to staging, also valuable for the characterization of the solitary pulmonary nodule. An increased uptake in the nodule as compared with mediastinal blood pool is suspected for malignancy. In radiotherapy planning, FDG-PET/CT can assist the radiation oncologist for optimal dose delivery to the tumour, while sparing healthy tissues. Evidence of the prognostic and predictive implications of FDG-PET/CT is accumulating. Volumetric parameters of PET, such as metabolic active tumour volume and total lesion glycolysis, are promising predictive and prognostic biomarkers. However, for implementation of metabolic response parameters in clinical practice, more randomized, PET-based, multicentre trials are necessary. The introduction of integrated PET and MRI scanners did not change the pivotal role of standard FDG-PET/CT yet, as with current technology, PET/MRI did not show superior performance in thoracic staging. SUMMARY The role of PET is described for diagnosis, staging and response assessment.
Collapse
|
99
|
Detection of bladder metabolic artifacts in (18)F-FDG PET imaging. Comput Biol Med 2016; 71:77-85. [PMID: 26897070 DOI: 10.1016/j.compbiomed.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 12/18/2022]
Abstract
Positron emission tomography using (18)F-fluorodeoxyglucose ((18)F-FDG-PET) is a widely used imaging modality in oncology. It enables significant functional information to be included in analyses of anatomical data provided by other image modalities. Although PET offers high sensitivity in detecting suspected malignant metabolism, (18)F-FDG uptake is not tumor-specific and can also be fixed in surrounding healthy tissue, which may consequently be mistaken as cancerous. PET analyses may be particularly hampered in pelvic-located cancers by the bladder׳s physiological uptake potentially obliterating the tumor uptake. In this paper, we propose a novel method for detecting (18)F-FDG bladder artifacts based on a multi-feature double-step classification approach. Using two manually defined seeds (tumor and bladder), the method consists of a semi-automated double-step clustering strategy that simultaneously takes into consideration standard uptake values (SUV) on PET, Hounsfield values on computed tomography (CT), and the distance to the seeds. This method was performed on 52 PET/CT images from patients treated for locally advanced cervical cancer. Manual delineations of the bladder on CT images were used in order to evaluate bladder uptake detection capability. Tumor preservation was evaluated using a manual segmentation of the tumor, with a threshold of 42% of the maximal uptake within the tumor. Robustness was assessed by randomly selecting different initial seeds. The classification averages were 0.94±0.09 for sensitivity, 0.98±0.01 specificity, and 0.98±0.01 accuracy. These results suggest that this method is able to detect most (18)F-FDG bladder metabolism artifacts while preserving tumor uptake, and could thus be used as a pre-processing step for further non-parasitized PET analyses.
Collapse
|
100
|
Ohri N, Duan F, Snyder BS, Wei B, Machtay M, Alavi A, Siegel BA, Johnson DW, Bradley JD, DeNittis A, Werner-Wasik M, El Naqa I. Pretreatment 18F-FDG PET Textural Features in Locally Advanced Non-Small Cell Lung Cancer: Secondary Analysis of ACRIN 6668/RTOG 0235. J Nucl Med 2016; 57:842-8. [PMID: 26912429 DOI: 10.2967/jnumed.115.166934] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/13/2016] [Indexed: 12/25/2022] Open
Abstract
UNLABELLED In a secondary analysis of American College of Radiology Imaging Network (ACRIN) 6668/RTOG 0235, high pretreatment metabolic tumor volume (MTV) on (18)F-FDG PET was found to be a poor prognostic factor for patients treated with chemoradiotherapy for locally advanced non-small cell lung cancer (NSCLC). Here we utilize the same dataset to explore whether heterogeneity metrics based on PET textural features can provide additional prognostic information. METHODS Patients with locally advanced NSCLC underwent (18)F-FDG PET prior to treatment. A gradient-based segmentation tool was used to contour each patient's primary tumor. MTV, maximum SUV, and 43 textural features were extracted for each tumor. To address overfitting and high collinearity among PET features, the least absolute shrinkage and selection operator (LASSO) method was applied to identify features that were independent predictors of overall survival (OS) after adjusting for MTV. Recursive binary partitioning in a conditional inference framework was utilized to identify optimal thresholds. Kaplan-Meier curves and log-rank testing were used to compare outcomes among patient groups. RESULTS Two hundred one patients met inclusion criteria. The LASSO procedure identified 1 textural feature (SumMean) as an independent predictor of OS. The optimal cutpoint for MTV was 93.3 cm(3), and the optimal SumMean cutpoint for tumors above 93.3 cm(3) was 0.018. This grouped patients into three categories: low tumor MTV (n = 155; median OS, 22.6 mo), high tumor MTV and high SumMean (n = 23; median OS, 20.0 mo), and high tumor MTV and low SumMean (n = 23; median OS, 6.2 mo; log-rank P < 0.001). CONCLUSION We have described an appropriate methodology to evaluate the prognostic value of textural PET features in the context of established prognostic factors. We have also identified a promising feature that may have prognostic value in locally advanced NSCLC patients with large tumors who are treated with chemoradiotherapy. Validation studies are warranted.
Collapse
Affiliation(s)
- Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Bradley S Snyder
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Bo Wei
- Emory University, Atlanta, Georgia
| | - Mitchell Machtay
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center and Case Western Reserve University, Cleveland, Ohio
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Barry A Siegel
- Mallinckrodt Institute of Radiology and the Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Douglas W Johnson
- Department of Radiation Oncology, Baptist Cancer Institute, Jacksonville, Florida
| | - Jeffrey D Bradley
- Mallinckrodt Institute of Radiology and the Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Albert DeNittis
- Department of Radiation Oncology, Lankenau Hospital and Lankenau Institute for Medical Research, Lower Merion, Pennsylvania
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Issam El Naqa
- University of Michigan Ann Arbor, Ann Arbor, Michigan
| |
Collapse
|