1
|
Patz EF, Gottlin EB, Simon GR. Perspective: rethinking therapeutic strategies in oncology. Front Oncol 2024; 13:1335987. [PMID: 38269024 PMCID: PMC10805859 DOI: 10.3389/fonc.2023.1335987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
Immuno-oncology has revolutionized cancer care, drug development, the design of clinical trials, standard treatment paradigms, and the evaluation of response to therapy. These are all areas, however, that have not fully incorporated principles of tumor immunology. Insufficient emphasis is put on the effect drugs have on the immune system, and specifically, the impact that multiple lines of therapy can have on the functioning of the immune system, hindering a robust anti-tumor immune response. A paradigm shift in how we approach the development of novel immunotherapeutic agents is necessary to facilitate the effective improvements in patient outcomes.
Collapse
Affiliation(s)
- Edward F. Patz
- Department of Radiology, Duke University School of Medicine, Durham, NC, United States
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, United States
| | - Elizabeth B. Gottlin
- Department of Radiology, Duke University School of Medicine, Durham, NC, United States
| | - George R. Simon
- Department of Medical Oncology at Advent Health, Moffitt Cancer Center, Tampa, FL, United States
| |
Collapse
|
2
|
Otani T, Ikushima H, Bando Y, Yamashita M, Kuwahara K, Otsuka H, Kondo K, Miyoshi H. Early Prediction of Radiotherapeutic Efficacy in a Mouse Model of Non-Small Cell Lung Carcinoma Using 18F-FLT and 18F-FDG PET/CT. THE JOURNAL OF MEDICAL INVESTIGATION 2023; 70:361-368. [PMID: 37940520 DOI: 10.2152/jmi.70.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
This study investigated the usefulness of [18F]-3'-deoxy-3'-fluorothymidine (18F-FLT) and [18F]-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) imaging for predicting the therapeutic efficacy of non-small cell lung cancer (NSCLC) irradiation at an early stage after radiation treatment. Mice were xenografted with the human lung adenocarcinoma line A549 or large cell lung cancer line FT821. Tumour uptake of 18F-FLT and 18F-FDG was imaged using PET/CT before and 1 week after irradiation. In A549 tumours, 18F-FLT uptake was significantly decreased, and 18F-FDG uptake was unchanged post-irradiation compared with pre-irradiation. In FT821 tumours, uptake of both 18F-FLT and 18F-FDG uptake was substantially decreased post-irradiation compared with pre-irradiation. In both xenografts, tumour volumes in the irradiated groups were significantly decreased compared with those in the control group. 18F-FLT is expected to contribute to individual NSCLC therapy because it accurately evaluates the decrease in tumour activity that cannot be captured by 18F-FDG. 18F-FDG may be useful for evaluating surviving cells without being affected by the inflammatory reaction at an extremely early stage, approximately 1 week after irradiation. Combined use of 18F-FLT and 18F-FDG PET/CT imaging may increase the accurate prediction of radiotherapy efficacy, which may lead to improved patient outcomes and minimally invasive personalised therapy. J. Med. Invest. 70 : 361-368, August, 2023.
Collapse
Affiliation(s)
- Tamaki Otani
- Advance Radiation Research, Education, and Management Center, Tokushima University, Tokushima, Japan
| | - Hitoshi Ikushima
- Department of Therapeutic Radiology, Institute of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Yoshimi Bando
- Department of Pathology and Laboratory Medicine, Institute of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Michiko Yamashita
- Department of Analytical Pathology, Institute of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Kenmei Kuwahara
- Faculty of Health Science, Tokushima University Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Hideki Otsuka
- Department of Medical Imaging/Nuclear Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kazuya Kondo
- Department of Oncological Medical Services, Institute of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Hirokazu Miyoshi
- Advance Radiation Research, Education, and Management Center, Tokushima University, Tokushima, Japan
| |
Collapse
|
3
|
FLT-PET/CT in Non-Small Cell Lung Cancer treated with stereotactic body radiotherapy- A Pilot study. Adv Radiat Oncol 2022; 7:101037. [DOI: 10.1016/j.adro.2022.101037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 11/20/2022] Open
|
4
|
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
|
5
|
Kerner GSMA, Bollineni VR, Hiltermann TJN, Sijtsema NM, Fischer A, Bongaerts AHH, Pruim J, Groen HJM. An exploratory study of volumetric analysis for assessing tumor response with (18)F-FAZA PET/CT in patients with advanced non-small-cell lung cancer (NSCLC). EJNMMI Res 2016; 6:33. [PMID: 27090118 PMCID: PMC4835394 DOI: 10.1186/s13550-016-0187-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypoxia is associated with resistance to chemotherapy and radiotherapy and is randomly distributed within malignancies. Characterization of changes in intratumoral hypoxic regions is possible with specially developed PET tracers such as (18)F-fluoroazomycin arabinoside ((18)F-FAZA) while tumor metabolism can be measured with 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG). The purpose of this study was to study the effects of chemotherapy on (18)F-FAZA and (18)F-FDG uptake simultaneously in non-small-cell lung cancer (NSCLC) patients METHODS At baseline and after the second chemotherapy cycle, both PET/CT with (18)F-FDG and (18)F-FAZA was performed in seven patients with metastasized NSCLC. (18)F-FAZA and (18)F-FDG scans were aligned with deformable image registration using Mirada DBx. The primary tumors were contoured, and on the (18)F-FDG scan, volumes of interest (VOI) were drawn using a 41 % adaptive threshold technique. Subsequently, the resulting VOI was transferred to the (18)F-FAZA scan. (18)F-FAZA maximum tumor-to-background (T/Bgmax) ratio and the fractional hypoxic volume (FHV) were assessed. Measurements were corrected for partial volume effects. Finally, a voxel-by-voxel analysis of the primary tumor was performed to assess regional uptake differences. RESULTS In the primary tumor of all seven patients, median (18)F-FDG standard uptake value (SUVmax) decreased significantly (p = 0.03). There was no significant decrease in (18)F-FAZA uptake as measured with T/Bgmax (p = 0.24) or the FHV (p = 0.35). Additionally, volumetric voxel-by-voxel analysis showed that low hypoxic tumors did not significantly change in hypoxic status between baseline and two cycles of chemotherapy, whereas highly hypoxic tumors did. Individualized volumetric voxel-by-voxel analysis revealed that hypoxia and metabolism were not associated before and after 2 cycles of chemotherapy. CONCLUSIONS Tumor hypoxia and metabolism are independent dynamic events as measured by (18)F-FAZA PET and (18)F-FDG PET, both prior to and after treatment with chemotherapy in NSCLC patients.
Collapse
Affiliation(s)
- Gerald S M A Kerner
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O.Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Vikram R Bollineni
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thijo J N Hiltermann
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O.Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Alphons H H Bongaerts
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Pruim
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Nuclear Medicine, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| | - Harry J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O.Box 30.001, 9700 RB, Groningen, The Netherlands
| |
Collapse
|
6
|
Campa MJ, Moody MA, Zhang R, Liao HX, Gottlin EB, Patz EF. Interrogation of individual intratumoral B lymphocytes from lung cancer patients for molecular target discovery. Cancer Immunol Immunother 2016; 65:171-80. [PMID: 26739486 PMCID: PMC11028467 DOI: 10.1007/s00262-015-1787-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/17/2015] [Indexed: 12/18/2022]
Abstract
Intratumoral B lymphocytes are an integral part of the lung tumor microenvironment. Interrogation of the antibodies they express may improve our understanding of the host response to cancer and could be useful in elucidating novel molecular targets. We used two strategies to explore the repertoire of intratumoral B cell antibodies. First, we cloned VH and VL genes from single intratumoral B lymphocytes isolated from one lung tumor, expressed the genes as recombinant mAbs, and used the mAbs to identify the cognate tumor antigens. The Igs derived from intratumoral B cells demonstrated class switching, with a mean VH mutation frequency of 4%. Although there was no evidence for clonal expansion, these data are consistent with antigen-driven somatic hypermutation. Individual recombinant antibodies were polyreactive, although one clone demonstrated preferential immunoreactivity with tropomyosin 4 (TPM4). We found that higher levels of TPM4 antibodies were more common in cancer patients, but measurement of TPM4 antibody levels was not a sensitive test for detecting cancer. Second, in an effort to focus our recombinant antibody expression efforts on those B cells that displayed evidence of clonal expansion driven by antigen stimulation, we performed deep sequencing of the Ig genes of B cells collected from seven different tumors. Deep sequencing demonstrated somatic hypermutation but no dominant clones. These strategies may be useful for the study of B cell antibody expression, although identification of a dominant clone and unique therapeutic targets may require extensive investigation.
Collapse
Affiliation(s)
- Michael J Campa
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
| | - M Anthony Moody
- Department of Pediatrics, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710, USA
| | - Ruijun Zhang
- Department of Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710, USA
| | - Hua-Xin Liao
- Department of Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Elizabeth B Gottlin
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
| | - Edward F Patz
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA.
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, 27710, USA.
| |
Collapse
|
7
|
Absence of a relationship between tumor ¹⁸F-fluorodeoxyglucose standardized uptake value and survival in patients treated with definitive radiotherapy for non-small-cell lung cancer. J Thorac Oncol 2014; 9:377-82. [PMID: 24518089 PMCID: PMC4132041 DOI: 10.1097/jto.0000000000000096] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction: A recent meta-analysis suggested that patients with non–small-cell lung cancer (NSCLC) whose primary tumors have a higher standardized uptake value (SUV) derived from 18F-fluorodeoxyglucose positron emission tomography (PET) have a worse prognosis in comparison with those with tumors with lower values. However, previous analyses have had methodological weaknesses. Furthermore, the prognostic significance over the full range of SUV values in patients treated nonsurgically remains unclear. The aim of this retrospective study was to investigate the relationship between survival and maximum SUV (SUVmax) analyzed as a continuous variable, in patients with NSCLC, staged using PET/computed tomography (CT) and treated with radiotherapy with or without chemotherapy. Methods: Eligible patients had a histological diagnosis of NSCLC, were treated with radical radiotherapy with or without chemotherapy as their primary treatment, and had pretreatment PET/CT scans. SUVmax, defined as the maximum pixel SUV value retrieved from the primary tumor, was analyzed primarily as a continuous variable for overall survival. Results: Eighty-eight patients met eligibility criteria: stage I, 19; stage II, 10; and stage III, 59. Median SUVmax was 15.0 (range, 2.5–56). Higher stage was associated with higher SUVmax values (p = 0.048). In univariate analysis, there was no evidence of a prognostic effect of SUVmax (hazard ratio per doubling = 0.83; 95% confidence interval, 0.62–1.11; p = 0.22). Analyzing SUVmax as a dichotomous variable (median cut point = 15.0), the hazard ratio (high: low) for risk of death was 0.71, with p = 0.18 (95% confidence interval, 0.44–1.15). Conclusions: In this cohort of patients, increasing SUVmax derived from 18F-fluorodeoxyglucose–PET/CT was associated with increasing tumor, node, metastasis (TNM) stage. We found no evidence of an association of increasing SUVmax with a shorter survival. Previous reports of an association between prognosis and SUVmax may partly be the result of methodological differences between this study and previous reports and an association between stage and SUVmax.
Collapse
|
8
|
Everitt SJ, Ball DL, Hicks RJ, Callahan J, Plumridge N, Collins M, Herschtal A, Binns D, Kron T, Schneider M, MacManus M. Differential 18F-FDG and 18F-FLT Uptake on Serial PET/CT Imaging Before and During Definitive Chemoradiation for Non–Small Cell Lung Cancer. J Nucl Med 2014; 55:1069-74. [DOI: 10.2967/jnumed.113.131631] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 03/10/2014] [Indexed: 11/16/2022] Open
|
9
|
Daly PE, Ball DL. Tumor size and outcomes in non-small-cell lung carcinoma treated with radiotherapy: a critical review. Lung Cancer Manag 2014. [DOI: 10.2217/lmt.14.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY: The relationship between tumor volume and outcome in non-small-cell lung cancer treated with chemoradiotherapy is complex. The tumor node metastasis classification and its inherent prognostic information are based on surgical data. Studies have shown the tumor node metastasis staging to be insufficient in providing prognostic information in patients treated with chemoradiotherapy. For larger lesions, intrinsic tumor composition and radiobiological factors may play a more important role in outcomes, while irradiating larger volumes increases the risk of toxicity. In an attempt to review the conflicting data on this topic, we systematically reviewed published studies that addressed the relationship between tumor volume and outcome in patients with non-small-cell lung cancer treated with chemoradiotherapy.
Collapse
Affiliation(s)
- Patricia E Daly
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - DL Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| |
Collapse
|
10
|
Computed tomography RECIST assessment of histopathologic response and prediction of survival in patients with resectable non-small-cell lung cancer after neoadjuvant chemotherapy. J Thorac Oncol 2013; 8:222-8. [PMID: 23287849 DOI: 10.1097/jto.0b013e3182774108] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION This study's objectives were to determine whether tumor response measured by computed tomography (CT) and evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) correlated with overall survival (OS) in patients with non-small-cell lung cancer (NSCLC) after neoadjuvant chemotherapy and surgical resection. METHODS We measured primary tumor size on CT before and after neoadjuvant chemotherapy in 160 NSCLC patients who underwent surgical resection. The relationship between CT-measured response (RECIST) and histopathologic response (≤ 10% viable tumor) and OS were assessed by Kaplan-Meier survival, univariable, and multivariable Cox proportional hazards regression. RESULTS There was a statistically significant association between CT-measured response (RECIST) and OS (p = 0.03). However, histopathologic response was a stronger predictor of OS (p = 0.002), with a more pronounced separation of the survival curves when compared with CT-measured response. In multivariable Cox regression analysis, only pathologic stage and histopathologic response were significant predictors of OS. A 41% overall discordance rate was noted between CT RECIST response and histopathologic response. CT RECIST classified as nonresponders a subset of patients with histopathologic response (8 out of 30 points, 27%) who demonstrated prolonged survival after neoadjuvant chemotherapy. CONCLUSION We were unable to show that CT RECIST is a reliable predictor of OS in patients with NSCLC undergoing surgical resection after neoadjuvant chemotherapy. The failure of CT RECIST to predict long-term outcome may be because of the inability of CT imaging to consistently identify patients with histopathologic response. CT RECIST may have only a limited role as an efficacy endpoint after neoadjuvant chemotherapy in patients with resectable NSCLC.
Collapse
|
11
|
Koksal D, Demirag F, Bayiz H, Ozmen O, Tatci E, Berktas B, Aydoğdu K, Yekeler E. The correlation of SUVmax with pathological characteristics of primary tumor and the value of Tumor/ Lymph node SUVmax ratio for predicting metastasis to lymph nodes in resected NSCLC patients. J Cardiothorac Surg 2013; 8:63. [PMID: 23557204 PMCID: PMC3622559 DOI: 10.1186/1749-8090-8-63] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 03/26/2013] [Indexed: 12/25/2022] Open
Abstract
Background We aimed to investigate the correlation of maximum standardized uptake value (SUVmax) with pathological characteristics of primary tumor and to determine a Tumor/ Lymph node (T/LN) SUVmax ratio predicting metastasis to lymph nodes in NSCLC patients. Methods Eighty-one NSCLC patients who had PET/CT examination at initial staging and subsequently underwent surgical resection were retrospectively evaluated. There were 100 PET/CT positive mediastinal or hilar lymph node stations. Pathological characteristics of the tumor such as largest tumor diameter, tumor histology, differentiation, number of mitosis, degree of stromal inflammation, necrosis; etiology of PET/CT positive lymph node stations; SUVmax of primary tumor and positive lymph node stations were recorded. A T/LN SUVmax ratio was calculated for each lymph node station. Results SUVmax of the primary tumor was positively correlated with the largest tumor diameter (p = 0.001, r = 0.374), number of mitosis (p < 0.001, r = 0.405), and postoperative pathological stage (p = 0.007, r = 0.298). Patients with squamous cell carcinoma had a statistically significant higher mean SUVmax, number of mitosis and advanced N stages compared to adenocarcinoma. The etiology of 100 PET/CT positive lymph node stations were metastasis in 14, anthracosis in 40, reactive in 39, granulomatous in 4, and silicosis in 3 patients. A T/LN SUVmax ratio of 5 or lower was suggestive for a malignant lymph node with a sensitivity of 92.8% and specificity of 47%. Conclusions SUVmax of a primary tumor is related to certain pathological characteristics, such as largest diameter, histology, and number of mitosis. A T/LN SUVmax ratio lower than 5 predicts the metastasis to lymph nodes with a high sensitivity.
Collapse
Affiliation(s)
- Deniz Koksal
- Chest Diseases Clinic, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Hoshi M, Takada J, Oebisu N, Hata K, Ieguchi M, Nakamura H. Overexpression of hexokinase-2 in giant cell tumor of bone is associated with false positive in bone tumor on FDG-PET/CT. Arch Orthop Trauma Surg 2012; 132:1561-8. [PMID: 22825642 DOI: 10.1007/s00402-012-1588-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of the current study was to evaluate the usefulness of maximum standardized uptake value (SUV(max)) in 2-deoxy-2-F(18)-fluoro-D-glucose positron emission tomography combined with computed tomography (18F-FDG-PET/CT) for preoperative differential diagnosis between benign and malignant bone tumors. MATERIALS AND METHODS Seventy-nine patients with bone tumors were examined by FDG-PET prior to histopathological diagnosis. The SUV(max) was calculated and compared between benign and malignant lesions, and among different histopathological subgroups, to identify false-positive histological subtypes. RESULTS There was a statistically significant difference in the SUV(max) of benign (3.7 ± 3.3; n = 17) and malignant (5.3 ± 3.3; n = 62) bone tumors. However, receiver operating characteristic curve analysis revealed the poor accuracy of this distinction. The cut-off value was determined to be 2.6, while the value of sensitivity and specificity was calculated to be 74.2 and 64.7 %, respectively. Giant cell tumor of bone (9.0 ± 2.0; n = 5) displayed a higher SUV(max) than osteosarcoma (4.2 ± 2.3; n = 18). Immunohistochemical analysis demonstrated that markers of these cancers, hexokinase-2 (HK-2) and glucose transporter type 1 (GLUT-1), supported our findings. CONCLUSION The poor accuracy of SUV(max) in 18F-FDG-PET/CT in distinguishing malignant from benign bone tumors was confirmed; some benign bone tumors showed high FDG uptake. Giant cell tumor of bone was a major false-positive histopathological subtype of bone tumors, showing high FDG accumulation. HK-2 contributed significantly to FDG uptake, whereas GLUT-1 appeared to play no role in FDG uptake in giant cell tumor of bone.
Collapse
Affiliation(s)
- Manabu Hoshi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan.
| | | | | | | | | | | |
Collapse
|
13
|
|
14
|
The Association of Intratumoral Germinal Centers with Early-Stage Non-small Cell Lung Cancer. J Thorac Oncol 2011; 6:1687-90. [DOI: 10.1097/jto.0b013e3182217bec] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
15
|
van Loon J, van Baardwijk A, Boersma L, Ollers M, Lambin P, De Ruysscher D. Therapeutic implications of molecular imaging with PET in the combined modality treatment of lung cancer. Cancer Treat Rev 2011; 37:331-43. [PMID: 21320756 DOI: 10.1016/j.ctrv.2011.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 01/13/2011] [Accepted: 01/21/2011] [Indexed: 12/23/2022]
Abstract
Molecular imaging with PET, and certainly integrated PET-CT, combining functional and anatomical imaging, has many potential advantages over anatomical imaging alone in the combined modality treatment of lung cancer. The aim of the current article is to review the available evidence regarding PET with FDG and other tracers in the combined modality treatment of locally advanced lung cancer. The following topics are addressed: tumor volume definition, outcome prediction and the added value of PET after therapy, and finally its clinical implications and future perspectives. The additional value of FDG-PET in defining the primary tumor volume has been established, mainly in regions with atelectasis or post-treatment effects. Selective nodal irradiation (SNI) of FDG-PET positive nodal stations is the preferred treatment in NSCLC, being safe and leading to decreased normal tissue exposure, providing opportunities for dose escalation. First results in SCLC show similar results. FDG-uptake on the pre-treatment PET scan is of prognostic value. Data on the value of pre-treatment FDG-uptake to predict response to combined modality treatment are conflicting, but the limited data regarding early metabolic response during treatment do show predictive value. The FDG response after radical treatment is of prognostic significance. FDG-PET in the follow-up has potential benefit in NSCLC, while data in SCLC are lacking. Radiotherapy boosting of radioresistant areas identified with FDG-PET is subject of current research. Tracers other than (18)FDG are promising for treatment response assessment and the visualization of intra-tumor heterogeneity, but more research is needed before they can be clinically implemented.
Collapse
Affiliation(s)
- Judith van Loon
- Maastricht University Medical Centre, Department of Radiation Oncology, MAASTRO Clinic, GROW Research Institute, The Netherlands.
| | | | | | | | | | | |
Collapse
|