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Lee EYP, Ip PPC, Tse KY, Chiu KWH, Chu MMY, Chai YK, Wu PY, Law JYP, Kwok ST, Chiu WK, Ngan HYS. Prospective validation of the role of PET/CT in detecting disease after neoadjuvant chemotherapy in advanced ovarian cancer. Eur Radiol 2024; 34:5911-5922. [PMID: 38460014 PMCID: PMC11364794 DOI: 10.1007/s00330-024-10674-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/22/2024] [Accepted: 02/14/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES The study aimed to compare the diagnostic accuracies of 2-[18F]FDG PET/CT and contrast-enhanced CT (ceCT) after neoadjuvant chemotherapy (NACT) in advanced ovarian cancer (OC). MATERIALS AND METHODS This study consisted historical observational cohort and prospective validation cohort. Patients with newly diagnosed stage III-IV OC scheduled for NACT were recruited, with imaging performed after three to six cycles of NACT before interval debulking surgery. Nineteen regions in the abdominopelvic cavity were scored for the presence and absence of disease, referenced to the intra-operative findings or histological specimens. Diagnostic metrics were compared using McNemar's test. RESULTS In the historical cohort (23 patients, age 58 ± 13), 2-[18F]FDG PET had an overall accuracy (Acc) 82%, sensitivity (Sen) 38%, specificity (Spe) 97%, positive predictive value (PPV) 79% and negative predictive value (NPV) 82%; ceCT had an overall Acc 86%, Sen 64%, Spe 93%, PPV 75% and NPV 89%. In the prospective cohort (46 patients, age 59 ± 9), 2-[18F] FDG PET had an overall Acc 87%, Sen 48%, Spe 98%, PPV 84% and NPV 88%; ceCT had an overall Acc 89%, Sen 66%, Spe 95%, PPV 77% and NPV 91%. No significant difference was demonstrated between the two imaging modalities (p > 0.05). High false-negative rates were observed in the right subdiaphragmatic space, omentum, bowel mesentery and serosa. High omental metabolic uptake after NACT was associated with histological non-responders (p < 0.05). CONCLUSION 2-[18F]FDG PET/CT had no additional value over ceCT with comparable diagnostic accuracy in detecting disease after NACT in advanced OC. CLINICAL RELEVANCE STATEMENT 2-[18F]FDG PET/CT is not superior to contrast-enhanced CT in determining disease after neoadjuvant chemotherapy in advanced ovarian cancer; contrast-enhanced CT should be suffice for surgical planning before interval debulking surgery. KEY POINTS • Additional value of 2-[18F]FDG PET/CT over contrast-enhanced CT is undefined in detecting disease after neoadjuvant chemotherapy. • 2-[18F]FDG PET/CT has comparable diagnostic accuracy compared to contrast-enhanced CT. • Contrast-enhanced CT will be suffice for surgical planning after neoadjuvant chemotherapy.
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Affiliation(s)
- Elaine Yuen Phin Lee
- Department of Diagnostic Radiology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Room 406, Block K, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
| | - Philip Pun Ching Ip
- Department of Pathology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Ka Yu Tse
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Keith Wan Hang Chiu
- Department of Diagnostic Radiology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Room 406, Block K, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
| | - Mandy Man Yee Chu
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Yu Ka Chai
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong, China
| | - Philip Yuguang Wu
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Jessica Yun Pui Law
- Department of Obstetrics and Gynecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Shuk Tak Kwok
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Wan Kam Chiu
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong, China
| | - Hextan Yuen Sheung Ngan
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
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Ebrahimi S, Lundström E, Batasin SJ, Hedlund E, Stålberg K, Ehman EC, Sheth VR, Iranpour N, Loubrie S, Schlein A, Rakow-Penner R. Application of PET/MRI in Gynecologic Malignancies. Cancers (Basel) 2024; 16:1478. [PMID: 38672560 PMCID: PMC11048306 DOI: 10.3390/cancers16081478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/23/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
The diagnosis, treatment, and management of gynecologic malignancies benefit from both positron emission tomography/computed tomography (PET/CT) and MRI. PET/CT provides important information on the local extent of disease as well as diffuse metastatic involvement. MRI offers soft tissue delineation and loco-regional disease involvement. The combination of these two technologies is key in diagnosis, treatment planning, and evaluating treatment response in gynecological malignancies. This review aims to assess the performance of PET/MRI in gynecologic cancer patients and outlines the technical challenges and clinical advantages of PET/MR systems when specifically applied to gynecologic malignancies.
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Affiliation(s)
- Sheida Ebrahimi
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Elin Lundström
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
- Department of Surgical Sciences, Radiology, Uppsala University, 751 85 Uppsala, Sweden
- Center for Medical Imaging, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Summer J. Batasin
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Elisabeth Hedlund
- Department of Surgical Sciences, Radiology, Uppsala University, 751 85 Uppsala, Sweden
| | - Karin Stålberg
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Eric C. Ehman
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vipul R. Sheth
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA; (V.R.S.)
| | - Negaur Iranpour
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA; (V.R.S.)
| | - Stephane Loubrie
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Alexandra Schlein
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Rebecca Rakow-Penner
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
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Khessib T, Jha P, Davidzon GA, Iagaru A, Shah J. Nuclear Medicine and Molecular Imaging Applications in Gynecologic Malignancies: A Comprehensive Review. Semin Nucl Med 2024; 54:270-292. [PMID: 38342655 DOI: 10.1053/j.semnuclmed.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/13/2024]
Abstract
Gynecologic malignancies, consisting of endometrial, cervical, ovarian, vulvar, and vaginal cancers, pose significant diagnostic and management challenges due to their complex anatomic location and potential for rapid progression. These tumors cause substantial morbidity and mortality, often because of their delayed diagnosis and treatment. An estimated 19% of newly diagnosed cancers among women are gynecologic in origin. In recent years, there has been growing evidence supporting the integration of nuclear medicine imaging modalities in the diagnostic work-up and management of gynecologic cancers. The sensitivity of fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) combined with the anatomical specificity of computed tomography (CT) and magnetic resonance imaging (MRI) allows for the hybrid evaluation of metabolic activity and structural abnormalities that has become an indispensable tool in oncologic imaging. Lymphoscintigraphy, using technetium 99m (99mTc) based radiotracers along with single photon emission computed tomography/ computed tomography (SPECT/CT), holds a vital role in the identification of sentinel lymph nodes to minimize the surgical morbidity from extensive lymph node dissections. While not yet standard for gynecologic malignancies, promising therapeutic nuclear medicine agents serve as specialized treatment options for patients with advanced or recurrent disease. This article aims to provide a comprehensive review on the nuclear medicine applications in gynecologic malignancies through the following objectives: 1) To describe the role of nuclear medicine in the initial staging, lymph node mapping, response assessment, and recurrence/surveillance imaging of common gynecologic cancers, 2) To review the limitations of 18F-FDG PET/CT and promising applications of 18F-FDG PET/MRI in gynecologic malignancy, 3) To underscore the promising theragnostic applications of nuclear medicine, 4) To highlight the current role of nuclear medicine imaging in gynecologic cancers as per the National Comprehensive Cancer Network (NCCN), European Society of Surgical Oncology (ESGO), and European Society of Medical Oncology (ESMO) guidelines.
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Affiliation(s)
- Tasnim Khessib
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford Health Care; 300 Pasteur Drive, Palo Alto, CA 94305
| | - Priyanka Jha
- Division of Body Imaging, Department of Radiology, Stanford Health Care; 300 Pasteur Drive, Palo Alto, CA 94035
| | - Guido A Davidzon
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford Health Care; 300 Pasteur Drive, Palo Alto, CA 94305
| | - Andrei Iagaru
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford Health Care; 300 Pasteur Drive, Palo Alto, CA 94305
| | - Jagruti Shah
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford Health Care; 300 Pasteur Drive, Palo Alto, CA 94305.
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Predicting Complete Cytoreduction in Ovarian Cancer Patients by RECIST 1.1 Criteria Following Neoadjuvant Chemotherapy. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00575-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chung YS, Kim HS, Lee JY, Kang WJ, Nam EJ, Kim S, Kim SW, Kim YT. Early Assessment of Response to Neoadjuvant Chemotherapy with 18F-FDG-PET/CT in Patients with Advanced-Stage Ovarian Cancer. Cancer Res Treat 2020; 52:1211-1218. [PMID: 32599990 PMCID: PMC7577806 DOI: 10.4143/crt.2019.506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 04/27/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose The aim of this study was to evaluate the ability of sequential 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) after one cycle of neoadjuvant chemotherapy (NAC) to predict chemotherapy response before interval debulking surgery (IDS) in advanced-stage ovarian cancer patients. Materials and Methods Forty consecutive patients underwent 18F-FDG-PET/CT at baseline and after one cycle of NAC. Metabolic responses were assessed by quantitative decrease in the maximum standardized uptake value (SUVmax) with PET/CT. Decreases in SUVmax were compared with cancer antigen 125 (CA-125) level before IDS, response rate by Response Evaluation Criteria in Solid Tumors criteria before IDS, residual tumor at IDS, and I chemotherapy response score (CRS) at IDS. Results A 40% cut-off for the decrease in SUVmax provided the best performance to predict CRS 3 (compete or near-complete pathologic response), with sensitivity, specificity, and accuracy of 81.8%, 72.4%, and 72.4%, respectively. According to this 40% cut-off, there were 17 (42.5%) metabolic responders (≥ 40%) and 23 (57.5%) metabolic non-responders (< 40%). Metabolic responders had higher rate of CRS 3 (52.9% vs. 8.7%, p=0.003), CA-125 normalization (< 35 U/mL) before IDS (76.5% vs. 39.1%, p=0.019), and no residual tumor at IDS (70.6% vs. 31.8%, p=0.025) compared with metabolic non-responders. There were significant associations with progression-free survival (p=0.021) between metabolic responders and non-responders, but not overall survival (p=0.335). Conclusion Early assessment with 18F-FDG-PET/CT after one cycle of NAC can be useful to predic response to chemotherapy before IDS in patients with advanced-stage ovarian cancer.
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Affiliation(s)
- Young Shin Chung
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Soo Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jun Kang
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
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7
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Abstract
Combined PET/computed tomography is used for oncological indications. PET/computed tomography benefits from the metabolic information of PET and the anatomic localization of computed tomography. The integrated scanner provides data with accurate registration of anatomy and molecular information. Many physiologic conditions, normal variants, and benign lesions within the pelvis and the body can cause confusion and uncertainty. False-negative results owing to low 18F-fluorodeoxyglucose uptake from the tumor can produce diagnostic challenges and inaccurate conclusions. This article reviews normal variants and potential pitfalls encountered in PET assessment of gynecologic malignancies to provide useful information for the referring and reporting physicians.
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8
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Tsuyoshi H, Yoshida Y. Diagnostic imaging using positron emission tomography for gynecological malignancy. J Obstet Gynaecol Res 2017; 43:1687-1699. [DOI: 10.1111/jog.13436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/28/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Hideaki Tsuyoshi
- Department of Obstetrics and Gynecology; University of Fukui; Fukui Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology; University of Fukui; Fukui Japan
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9
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Comparison of 18F-FDG PET/MRI and MRI for pre-therapeutic tumor staging of patients with primary cancer of the uterine cervix. Eur J Nucl Med Mol Imaging 2017; 45:67-76. [DOI: 10.1007/s00259-017-3809-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/10/2017] [Indexed: 12/17/2022]
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10
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El Bairi K, Amrani M, Kandhro AH, Afqir S. Prediction of therapy response in ovarian cancer: Where are we now? Crit Rev Clin Lab Sci 2017; 54:233-266. [PMID: 28443762 DOI: 10.1080/10408363.2017.1313190] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Therapy resistance is a major challenge in the management of ovarian cancer (OC). Advances in detection and new technology validation have led to the emergence of biomarkers that can predict responses to available therapies. It is important to identify predictive biomarkers to select resistant and sensitive patients in order to reduce important toxicities, to reduce costs and to increase survival. The discovery of predictive and prognostic biomarkers for monitoring therapy is a developing field and provides promising perspectives in the era of personalized medicine. This review article will discuss the biology of OC with a focus on targetable pathways; current therapies; mechanisms of resistance; predictive biomarkers for chemotherapy, antiangiogenic and DNA-targeted therapies, and optimal cytoreductive surgery; and the emergence of liquid biopsy using recent studies from the Medline database and ClinicalTrials.gov.
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Affiliation(s)
- Khalid El Bairi
- a Faculty of Medicine and Pharmacy , Mohamed Ist University , Oujda , Morocco
| | - Mariam Amrani
- b Equipe de Recherche ONCOGYMA, Faculty of Medicine, Pathology Department , National Institute of Oncology, Université Mohamed V , Rabat , Morocco
| | - Abdul Hafeez Kandhro
- c Department of Biochemistry , Healthcare Molecular and Diagnostic Laboratory , Hyderabad , Pakistan
| | - Said Afqir
- d Department of Medical Oncology , Mohamed VI University Hospital , Oujda , Morocco
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11
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Kim TH, Kim J, Kang YK, Lee M, Kim HS, Cheon GJ, Chung HH. Identification of Metabolic Biomarkers Using Serial 18F-FDG PET/CT for Prediction of Recurrence in Advanced Epithelial Ovarian Cancer. Transl Oncol 2017; 10:297-303. [PMID: 28314183 PMCID: PMC5361859 DOI: 10.1016/j.tranon.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/31/2017] [Accepted: 02/06/2017] [Indexed: 11/02/2022] Open
Abstract
PURPOSE To evaluate the prognostic value of metabolic parameters derived from serial 18F fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with advanced epithelial ovarian cancer (EOC). METHODS Thirteen patients with advanced EOC who received surgical staging and adjuvant platinum-based combination chemotherapy were prospectively enrolled. 18F-FDG PET/CT was performed before and after the surgical staging, and after third cycle of chemotherapy. Tumor glucose metabolism at baseline and its change after operation and third cycle of chemotherapy such as changes of maximum standardized uptake values (ΔSUVmax) via 18F-FDG PET/CT were measured, and assessed regarding their ability to predict recurrence. RESULTS Median duration of progression-free survival (PFS) was 25 months (range, 13-34), and although optimal debulking was performed in 10 patients, 5 (38.5%) patients experienced recurrence. Univariate analyses showed significant associations between recurrence and low ΔSUVmax after surgical staging, and low SUVmax change after third cycle of chemotherapy. Multivariate analysis identified low ΔSUVmax after third cycle of chemotherapy as an independent risk factor for recurrence (P=.047, hazard ratio (HR) 16.375, 95% CI 1.041-257.536). Kaplan-Meier survival curves showed that PFS significantly differed in groups categorized based on ΔSUVmax after chemotherapy (P=.001, log-rank test). CONCLUSIONS 18F-FDG PET/CT allows for prediction of treatment response by the level of FDG uptake in terms of SUV at baseline and after chemotherapy. The metabolic response measured as ΔSUVmax after third cycle of chemotherapy appears to be promising predictor of recurrence in patients with advanced EOC.
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Affiliation(s)
- Tae Hun Kim
- Department of Obstetrics and Gynecology, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Junhwan Kim
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeon-Koo Kang
- Department of Nuclear Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Abstract
This article summarizes recent advances in PET/MR imaging in gynecologic cancers and the emerging clinical value of PET/MR imaging in the management of the 3 most common gynecologic malignancies: cervical, endometrial, and ovarian cancers. PET/MR imaging offers superior soft tissue contrast, improved assessment of primary tumor involvement because of high-resolution multiplanar reformats, and functional MR techniques such as diffusion-weighted MR imaging and dynamic contrast-enhanced MR imaging. This article discusses the challenges, future directions, and technical advances of PET/MR imaging, and the emerging new multimodality, multiparametric imaging techniques for integrating morphologic, functional, and molecular imaging data.
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13
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Khiewvan B, Torigian DA, Emamzadehfard S, Paydary K, Salavati A, Houshmand S, Werner TJ, Alavi A. An update on the role of PET/CT and PET/MRI in ovarian cancer. Eur J Nucl Med Mol Imaging 2017; 44:1079-1091. [PMID: 28180966 DOI: 10.1007/s00259-017-3638-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/24/2017] [Indexed: 01/22/2023]
Abstract
This review article summarizes the role of PET/CT and PET/MRI in ovarian cancer. With regard to the diagnosis of ovarian cancer, the presence of FDG uptake within the ovary of a postmenopausal woman raises the concern for ovarian cancer. Multiple studies show that FDG PET/CT can detect lymph node and distant metastasis in ovarian cancer with high accuracy and may, therefore, alter the management to obtain better clinical outcomes. Although PET/CT staging is superior for N and M staging of ovarian cancer, its role is limited for T staging. Additionally, FDG PET/CT is of great benefit in evaluating treatment response and has prognostic value in patients with ovarian cancer. FDG PET/CT also has value to detect recurrent disease, particularly in patients with elevated serum CA-125 levels and negative or inconclusive conventional imaging test results. PET/MRI may beneficial for tumor staging because MRI has higher soft tissue contrast and no ionizing radiation exposure compared to CT. Some non-FDG PET radiotracers such as 18F-fluorothymidine (FLT) or 11C-methionine (MET) have been studied in preclinical and clinical studies as well and may play a role in the evaluation of patients with ovarian cancer.
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Affiliation(s)
- Benjapa Khiewvan
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 10700
| | - Drew A Torigian
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Sahra Emamzadehfard
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Koosha Paydary
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Ali Salavati
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Sina Houshmand
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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14
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Valtorta S, Moro M, Prisinzano G, Bertolini G, Tortoreto M, Raccagni I, Pastorino U, Roz L, Sozzi G, Moresco RM. Metabolic Evaluation of Non-Small Cell Lung Cancer Patient-Derived Xenograft Models Using 18F-FDG PET: A Potential Tool for Early Therapy Response. J Nucl Med 2016; 58:42-47. [PMID: 27765858 DOI: 10.2967/jnumed.116.176404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/22/2016] [Indexed: 01/01/2023] Open
Abstract
Lung cancer heterogeneity makes response to therapy extremely hard to predict. Patient-derived xenografts (PDXs) are a reliable preclinical model that closely recapitulates the main characteristics of the parental tumors and may represent a useful asset for testing new therapies. Here, using PET imaging, we investigated whether lung cancer PDXs reproduce the metabolic characteristics of the corresponding parental tumors. METHODS We performed longitudinal 18F-FDG PET studies on 9 different PDX groups obtained by implanting primary-cancer fragments harvested from patients into mice. The SUVmax of each PDX was calculated and compared with the SUVmax of the corresponding parental tumor. RESULTS Tumor growth rate and uptake varied among the different PDXs and confirmed the preservation of individual characteristics. The intragroup reproducibility of PET measurements was good. Furthermore, PDXs from tumors with a higher metabolic rate displayed a rank order of uptake similar to that of the parental tumors. CONCLUSION PDXs reproduced the glucose metabolism of the parental tumors and therefore represent a promising preclinical model for the early assessment of therapy efficacy.
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Affiliation(s)
- Silvia Valtorta
- National Researches Council (CNR), Molecular Bioimaging and Physiology Institute (IBFM), Segrate, Italy.,Medicine and Surgery Department and Tecnomed Foundation, University of Milano-Bicocca, Monza, Italy
| | - Massimo Moro
- Tumor Genomics Unit, Experimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Prisinzano
- National Researches Council (CNR), Molecular Bioimaging and Physiology Institute (IBFM), Segrate, Italy.,Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Bertolini
- Tumor Genomics Unit, Experimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Tortoreto
- Molecular Pharmacology Unit, Experimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and
| | - Isabella Raccagni
- Medicine and Surgery Department and Tecnomed Foundation, University of Milano-Bicocca, Monza, Italy.,Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ugo Pastorino
- Thoracic Surgery Unit, Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Roz
- Tumor Genomics Unit, Experimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriella Sozzi
- Tumor Genomics Unit, Experimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosa Maria Moresco
- Medicine and Surgery Department and Tecnomed Foundation, University of Milano-Bicocca, Monza, Italy .,Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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15
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Abedi SM, Mardanshahi A, Shahhosseini R, Hosseinimehr SJ. Nuclear medicine for imaging of epithelial ovarian cancer. Future Oncol 2016; 12:1165-77. [PMID: 26984362 DOI: 10.2217/fon.16.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cancer is one of the leading causes of mortality worldwide. Usually, the diagnosis of cancer at an early stage is important to facilitate proper treatment and survival. Nuclear medicine has been successfully used in the diagnosis, staging, therapy and monitoring of cancers. Single-photon emission computed tomography and PET-based companion imaging agents are in development for use as a companion diagnostic tool for patients with ovarian cancer. The present review discusses the basic and clinical studies related to the use of radiopharmaceuticals in the diagnosis and management of ovarian cancer, focusing on their utility and comparing them with other imaging techniques such as computed tomography and MRI.
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Affiliation(s)
- Seyed Mohammad Abedi
- Department of Radiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Mardanshahi
- Department of Radiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roza Shahhosseini
- Department of Obstetrics & Gynecology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Seyed Jalal Hosseinimehr
- Department of Radiopharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.,Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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16
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Caobelli F, Alongi P, Evangelista L, Picchio M, Saladini G, Rensi M, Geatti O, Castello A, Laghai I, Popescu CE, Dolci C, Crivellaro C, Seghezzi S, Kirienko M, De Biasi V, Cocciolillo F, Quartuccio N. Predictive value of (18)F-FDG PET/CT in restaging patients affected by ovarian carcinoma: a multicentre study. Eur J Nucl Med Mol Imaging 2016; 43:404-13. [PMID: 26381775 DOI: 10.1007/s00259-015-3184-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 08/28/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Ovarian cancer is the eighth most common malignancy among women and has a high mortality rate. Prognostic factors able to drive an effective therapy are essential. (18)F-Fluoro-2-deoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) has been investigated in patients with epithelial ovarian cancer and showed promise in diagnosing, staging, detecting recurrent lesions and monitoring treatment response. Conversely, its prognostic role remains unclear. We aimed at assessing the prognostic value of (18)F-FDG PET/CT performed in the restaging process in a multicentre study. METHODS We evaluated 168 patients affected by ovarian carcinoma, who underwent a restaging (18)F-FDG PET/CT. The presence of local recurrences, lymph node involvement and distant metastasis was recorded as well as lesion dimensions, maximum and mean standardized uptake values (SUVmax and SUVmean, respectively). Progression-free survival (PFS) and overall survival (OS) at 3 and 4 years were computed by using Kaplan-Meier curves. Increased odds ratio was assessed using Cox regression analysis testing all lesion parameters measured by PET/CT. RESULTS PFS was significantly longer in patients with a negative than a positive restaging PET/CT study (3- and 4-year PFS 64 and 53% vs 23 and 12%, respectively; p < 0.001). Similarly, a negative study was associated with a significantly higher OS rate after 4 years of follow-up (67 vs 25% in negative and positive groups, respectively; p < 0.001). Lymph node or distant involvement were also independently associated with an increased risk of disease progression [hazard ratio (HR) 1.6 and 2.2, respectively; p = 0.003]. Moreover, PET/CT showed an incremental prognostic value compared to the International Federation of Gynecology and Obstetrics (FIGO) staging system. In the analysis of patient subsets, individuals with the same FIGO stage I-II but with negative PET had a significantly better 4-year OS than patients with low FIGO stage but positive PET. This implies that patients with the same FIGO stage can be further prognostically stratified using PET (p = 0.01). At receiver-operating characteristic (ROC) analysis, no thresholds for semiquantitative parameters were predictive of a worse outcome. CONCLUSION (18)F-FDG PET/CT has an important prognostic value in assessing the risk of disease progression and mortality rate. An efficacious therapy planning might therefore effectively rely on (18)F-FDG PET/CT findings. Semiquantitative data were not proven to be an effective tool to predict disease progression.
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Affiliation(s)
- Federico Caobelli
- Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hanover, Germany
| | - Pierpaolo Alongi
- Nuclear Medicine Unit, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.
- Nuclear Medicine Department, IRCSS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Laura Evangelista
- Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Maria Picchio
- Nuclear Medicine Department, IRCSS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giorgio Saladini
- Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Marco Rensi
- Nuclear Medicine Department, Hospital of Udine, Udine, Italy
| | - Onelio Geatti
- Nuclear Medicine Department, Hospital of Udine, Udine, Italy
| | - Angelo Castello
- Nuclear Medicine Department, University of Florence, Florence, Italy
| | - Iashar Laghai
- Nuclear Medicine Department, University of Florence, Florence, Italy
| | | | - Carlotta Dolci
- Nuclear Medicine Department; San Gerardo Hospital, Tecnomed Foundation, University of Milan-Bicocca, Milan, Italy
| | - Cinzia Crivellaro
- Nuclear Medicine Department; San Gerardo Hospital, Tecnomed Foundation, University of Milan-Bicocca, Milan, Italy
| | - Silvia Seghezzi
- Nuclear Medicine Department, Hospital of Treviglio, Treviglio, Bergamo, Italy
| | - Margarita Kirienko
- Nuclear Medicine Unit, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy
| | - Vincenzo De Biasi
- Nuclear Medicine Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Fabrizio Cocciolillo
- Nuclear Medicine Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Natale Quartuccio
- Nuclear Medicine Unit, Department of Biomedical Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy
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17
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Vallius T, Peter A, Auranen A, Carpén O, Kemppainen J, Matomäki J, Oksa S, Roering P, Seppänen M, Grénman S, Hynninen J. 18F-FDG-PET/CT can identify histopathological non-responders to platinum-based neoadjuvant chemotherapy in advanced epithelial ovarian cancer. Gynecol Oncol 2015; 140:29-35. [PMID: 26515076 DOI: 10.1016/j.ygyno.2015.10.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/22/2015] [Accepted: 10/24/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between the reduction of maximum standardized uptake values (SUVmax) in 18F-FDG-PET/CT to histopathological changes obtained with neoadjuvant chemotherapy (NACT) in advanced epithelial ovarian cancer (EOC). We wanted to evaluate whether 18F-FDG-PET/CT is useful for identifying patients who will not respond to NACT and would therefore benefit from second-line chemotherapy instead of interval debulking surgery (IDS). METHODS Twenty-six primarily inoperable EOC patients treated with NACT were enrolled in this study. 18F-FDG-PET/CT imaging was performed before diagnostic laparoscopy and after three to four NACT cycles. The relationship between the decrease in omental SUVmax from before to after NACT with omental histopathological response was examined in samples taken from the corresponding anatomical sites during IDS. Patients were divided into three groups according to chemotherapy-induced histopathological changes. Serum CA125 and HE4 halftimes during NACT as well as Ki-67 antigen expression in IDS samples were determined. RESULTS The median omental SUVmax change during NACT was -64% (range-16% to -84%), and it was associated with histopathological response (p=0.004, OR 0.9, CI 0.84-0.97). A SUVmax decrease of less than 57% identified histopathological non-responders. Progression-free survival (PFS) differed between the poor, moderate and good histopathological response groups (0.9 year vs. 1.2 years vs. 1.4 years, respectively, p=0.05). The SUVmax change was not associated with PFS. CONCLUSION 18F-FDG-PET/CT was able to identify patients who would not respond to NACT. To obtain a histopathological response in EOC, a substantial metabolic response in 18F-FDG-PET/CT is necessary.
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Affiliation(s)
- Tuulia Vallius
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Finland.
| | - Anniina Peter
- Department of Pathology, Turku University Hospital, University of Turku, Finland
| | - Annika Auranen
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Finland; Department of Obstetrics and Gynecology, Tampere University Hospital, Finland
| | - Olli Carpén
- Department of Pathology, Turku University Hospital, University of Turku, Finland; Auria biobank, Turku University Hospital, Finland
| | - Jukka Kemppainen
- Department of Clinical Physiology and Nuclear Medicine, Turku PET Centre, Turku University Hospital, University of Turku, Finland
| | - Jaakko Matomäki
- Department of Pediatrics, Turku University Hospital, University of Turku, Finland
| | - Sinikka Oksa
- Department of Obstetrics and Gynecology, Satakunta Central Hospital, Finland
| | - Pia Roering
- Department of Pathology, Turku University Hospital, University of Turku, Finland
| | - Marko Seppänen
- Department of Clinical Physiology and Nuclear Medicine, Turku PET Centre, Turku University Hospital, University of Turku, Finland
| | - Seija Grénman
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Finland
| | - Johanna Hynninen
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Finland
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Abstract
FDG-PET/CT has been evaluated in a variety of gynecologic malignancies in a variety of settings and is approved by the Centers for Medicare & Medicaid Services for the initial and subsequent treatment strategies of these malignancies. Cervical cancer is typically very FDG avid, and FDG-PET/CT appears to be most valuable for initial staging, radiation therapy planning, and detection of recurrent disease. For ovarian cancer, the most value of FDG-PET/CT appears to be for detecting recurrent disease in the setting of rising CA-125 level and negative or equivocal anatomical imaging studies. Initial studies evaluating response to therapy are promising and further work in this area is needed. FDG uptake in both nonmalignant and physiological processes in the pelvis can make interpretation of FDG-PET/CT in this region challenging and knowledge of these entities and patterns can avoid misinterpretation. Some of the most common findings relate to the cyclic changes that occur as part of the menstrual cycle in premenopausal women. Mucinous tumors and low-volume or peritoneal carcinomatosis are causes of false-negative results on FDG-PET/CT studies. As new tracers are developed, comparisons with patient outcomes and standards of care (eg, FDG-PET/CT) will be needed.
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Affiliation(s)
- Paul Grant
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Christopher Sakellis
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
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19
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Fludeoxyglucose F 18 PET-Computed Tomography: Management Changes Effecting Patient Outcomes in Gynecologic Malignancies. PET Clin 2015; 10:395-409. [PMID: 26099674 DOI: 10.1016/j.cpet.2015.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Outcome analysis in oncologic imaging is complex because of the multiple variables that can affect survival, including how early disease is diagnosed, the accuracy of staging at diagnosis, and where and how the patient is treated. Risk for tumor recurrence is estimated based on tumor histologic grade, stage at diagnosis, and other factors, including expressed molecular markers. This article reviews the data supporting the use of F 18 fluorodeoxyglucose PET-computed tomography in endometrial, ovarian, and cervical malignancies, with emphasis on the impact of imaging on treatment stratification and prognosis.
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20
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Musto A, Grassetto G, Marzola MC, Chondrogiannis S, Maffione AM, Rampin L, Fuster D, Giammarile F, Colletti PM, Rubello D. Role of 18F-FDG PET/CT in the carcinoma of the uterus: a review of literature. Yonsei Med J 2014; 55:1467-72. [PMID: 25323881 PMCID: PMC4205684 DOI: 10.3349/ymj.2014.55.6.1467] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In the present review we reported the value of 18F-fluorodeoxyglucose (FDG) PET/CT in face of uterine cancer, in terms of sensitivity, specificity and accuracy. Moreover, we made a comparison with the other imaging techniques currently used to evacuate these tumors including contrast-enhanced CT, contrast enhanced-MRI and transvaginal ultrasonography. FDG PET/CT has been reported to be of particular value in detecting occult metastatic lesions, in prediction of response to treatment and as a prognostic factor.
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Affiliation(s)
| | - Gaia Grassetto
- Nuclear Medicine Department, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | | | | | - Lucia Rampin
- Nuclear Medicine Department, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - David Fuster
- Nuclear Medicine Department, Hospital Clinic, Barcelona, Spain
| | | | - Patrick M Colletti
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Domenico Rubello
- Nuclear Medicine Department, Santa Maria della Misericordia Hospital, Rovigo, Italy.
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21
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Present and future role of FDG-PET/CT imaging in the management of gynecologic malignancies. Jpn J Radiol 2014; 32:313-23. [DOI: 10.1007/s11604-014-0317-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/02/2014] [Indexed: 01/03/2023]
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22
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Hebel CB, Behrendt FF, Heinzel A, Krohn T, Mottaghy FM, Bauerschlag DO, Verburg FA. Negative 18F-2-fluorodeoxyglucose PET/CT predicts good cancer specific survival in patients with a suspicion of recurrent ovarian cancer. Eur J Radiol 2014; 83:463-7. [DOI: 10.1016/j.ejrad.2013.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/06/2013] [Indexed: 11/30/2022]
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23
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Rockall A, Munari A, Avril N. New ways of assessing ovarian cancer response: metabolic imaging and beyond. Cancer Imaging 2012; 12:310-4. [PMID: 23022953 PMCID: PMC3460555 DOI: 10.1102/1470-7330.2012.9004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In patients with advanced ovarian cancer, it can be challenging to evaluate response to neoadjuvant chemotherapy on computed tomography (CT) due to disseminated small volume disease and serosal disease. In addition, measuring the change in size of tumour burden takes time in order to allow tumour shrinkage. Despite these challenges, serum CA-125 levels and CT are the standard tools for the assessment of treatment response in ovarian cancer. New functional imaging techniques may allow the identification of response earlier and with higher accuracy. In this review article, we describe the current literature on functional imaging techniques in ovarian cancer response assessment, focusing on fluorodeoxyglucose-positron emission tomography.
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Affiliation(s)
- Andrea Rockall
- Department of Diagnostic Imaging, St Bartholomew's Hospital, West Smithfield, London, UK.
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24
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Kumar Dhingra V, Kand P, Basu S. Impact of FDG-PET and -PET/CT imaging in the clinical decision-making of ovarian carcinoma: an evidence-based approach. ACTA ACUST UNITED AC 2012; 8:191-203. [PMID: 22375721 DOI: 10.2217/whe.11.91] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The most definitive role of fluorodeoxyglucose (FDG)-PET/computed tomography (CT) at present is surveillance and detecting recurrence in patients who have completed primary therapy but demonstrate a rising serum tumor marker (e.g., CA-125 levels). In this scenario, PET/CT demonstrates high sensitivity and accuracy in detecting lesions that are otherwise challenging, and appears superior (with less interobserver variability) compared with CT alone. Despite the fact that peritoneal deposits may be missed by PET/CT, the overall performance is better than CT alone. FDG-PET does not play a significant additional role in the primary diagnosis of ovarian cancers; however, the role of combined PET/CT modality has recently begun to be re-explored for initial disease staging, particularly because PET/CT can pick up small unsuspected lesions and thereby provide a better disease assessment of the whole body in a single examination. The baseline PET/CT also subserves an important role for future monitoring of therapy response. Therapy monitoring by PET could help to optimize neoadjuvant therapy protocols and to avoid ineffective therapy in nonresponders early in its course, although PET/CT has cost-effectiveness issues that need further evaluation. The prognostic value of FDG-PET/CT has been investigated in the following areas: in the preoperative setting to predict optimal cytoreduction; to assess the value of a positive FDG-PET following primary surgery; and when employed as a replacement for second-look laparotomy following completion of primary surgery and chemotherapy. The data, although promising, are still sparse in all the three domains for a definite recommendation.
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Affiliation(s)
- Vandana Kumar Dhingra
- Department of Nuclear Medicine, Cancer Research Institute, HIHT, Dehradun, Uttrakhand, India
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25
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26
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Dalla Palma M, Gregianin M, Fiduccia P, Evangelista L, Cervino AR, Saladini G, Borgato L, Nicoletto MO, Zagonel V. PET/CT imaging in gynecologic malignancies: a critical overview of its clinical impact and our retrospective single center analysis. Crit Rev Oncol Hematol 2012; 83:84-98. [PMID: 22245509 DOI: 10.1016/j.critrevonc.2011.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 07/22/2011] [Accepted: 10/04/2011] [Indexed: 12/01/2022] Open
Abstract
Gynecologic cancers represent a major global healthcare problem since they are associated with a significant mortality and morbidity. Over the last decade, considerable efforts have been spent in the development and optimization of novel diagnostic modalities to achieve an early diagnosis, aid in choosing appropriate treatment, improving long term surveillance, with the ultimate goal of increasing survival of gynecologic cancer patients. A growing body of evidence defines PET/CT as one of the most powerful tools for tumor, nodal and metastasis (TNM) cancer staging both in pre-treatment and in post treatment follow-up settings. At any phase of cancer evaluation, detection of metastasis represents one of the most critical impediments to the cure of tumor; traditional diagnostic imaging modalities, such as computed tomography (CT), are frequently found to inadequately stage the tumor, based on subsequent outcomes. As a consequence, patients may undergo pointless surgery for disease that could be treated with local medical therapies. In the setting of restaging, the ability to describe primary lesion, lymph nodes, possible metastases to peritoneum, bone, liver, lungs and brain renders PET/CT a potential alternative for a series of tests, including bone scanning, MRI or ultrasound, diagnostic CT, lymph node surgical sampling, that need to be used in combination in order to obtain a level of clinical confidence. In this review, we describe, the theoretical advantage and prognostic implications of PET/CT in the management of gynecologic cancer patients.
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27
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Chung HH, Kwon HW, Kang KW, Kim JW, Park NH, Song YS, Kang SB. Preoperative [F]FDG PET/CT predicts recurrence in patients with epithelial ovarian cancer. J Gynecol Oncol 2012; 23:28-34. [PMID: 22355464 PMCID: PMC3280063 DOI: 10.3802/jgo.2012.23.1.28] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/11/2011] [Accepted: 10/16/2011] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine whether [(18)F]FDG uptake on PET/CT imaging before surgical staging has prognostic significance in patients with epithelial ovarian cancer (EOC). METHODS Patients with EOC were imaged with integrated PET/CT before surgical staging. Hypermetabolic lesions were measured as the standardized uptake value (SUV) in primary and metastatic tumors. SUV distribution was divided into two regions at the level of umbilicus, and the impact of the ratio between above and below umbilicus (SUV(location) ratio) on progression-free survival (PFS) was examined using Cox proportional hazards regression. RESULTS Between January 2004 and December 2009, 55 patients with EOC underwent preoperative PET/CT. The median duration of PFS was 11 months (range, 3 to 43 months), and twenty (36.4%) patients experienced recurrence. In univariate analysis, high SUV(location) ratio (p=0.002; hazard ratio [HR], 1.974; 95% confidence interval [CI], 1.286 to 3.031) was significantly associated with recurrence. Malignant mixed mullerian tumor compared with endometrioid histology was also shown to have significance. In multivariate analysis, high SUV(location) ratio (p=0.005; HR, 2.418; 95% CI, 1.1315 to 4.447) and histology (serous, mucinous, and malignant mixed mullerian tumor compared with endometrioid type) were significantly associated with recurrence. Patients were categorized into two groups according to SUV(location) ratio (<0.3934 vs. ≥0.3934), and the Kaplan-Meier survival graph showed a significant difference in PFS between the groups (p=0.0021; HR, 9.47, log-rank test). CONCLUSION SUV distribution showed a significant association with recurrence in patients with EOC, and may be a useful predictor of recurrence.
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Affiliation(s)
- Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Woo Kwon
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Keon Wook Kang
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Noh-Hyun Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Major in Biomodulation, WCU and Department of Agricultural Biotechnology, Seoul National University, Seoul, Korea
| | - Soon-Beom Kang
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Relationship Among Glycolytic Phenotype, Grade, and Histological Subtype in Ovarian Carcinoma. Clin Nucl Med 2012; 37:49-53. [DOI: 10.1097/rlu.0b013e3182291e03] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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30
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Cottone L, Valtorta S, Capobianco A, Belloli S, Rovere-Querini P, Fazio F, Manfredi AA, Moresco RM. Evaluation of the Role of Tumor-Associated Macrophages in an Experimental Model of Peritoneal Carcinomatosis Using 18F-FDG PET. J Nucl Med 2011; 52:1770-7. [DOI: 10.2967/jnumed.111.089177] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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31
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Spectrum of fluorodeoxyglucose-positron emission tomography/computed tomography and magnetic resonance imaging findings of ovarian tumors. Jpn J Radiol 2011; 29:605-8. [DOI: 10.1007/s11604-011-0610-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 05/09/2011] [Indexed: 10/17/2022]
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32
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Head and neck cancer as a model for advances in imaging prognosis, early assessment, and posttherapy evaluation. Cancer J 2011; 17:159-65. [PMID: 21610469 DOI: 10.1097/ppo.0b013e31821e8a09] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Novel noninvasive functional imaging methods are necessary to predict therapeutic outcome and thereby improve the ability to properly select patients for treatment with both conventional and targeted therapies, to better evaluate therapeutic effectiveness during the early phases of treatment, and to enhance a priori risk assessment for treatment induced toxicity. Functional metabolic imaging typically involves pretreatment baseline magnetic resonance imaging (MRI) and/or positron emission tomographic (PET) scans and performance of subsequent scans during and/or after treatment. Imaging parameter changes are routinely attributed to the intervening therapy and clinical outcomes subsequently correlated with these changes. The physiologic parameter(s) that best correlate with clinical outcome and the relative utility of MRI versus PET are unknown, however. Furthermore, tumor vascular physiology and metabolic parameters are heterogeneous and dynamic processes. Large daily fluctuations often occur in the absence of treatment. The magnitude of this temporal variability is not established for MRI or for PET. Routine and meaningful clinical application of functional imaging requires understanding and quantification of the intrinsic variability of the underlying biologic processes and a demonstration that treatment-induced changes exceed intrinsic temporal variation.
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Fiaschetti V, Calabria F, Crusco S, Meschini A, Nucera F, Schillaci O, Simonetti G. MR-PET fusion imaging in evaluating adnexal lesions: a preliminary study. Radiol Med 2011; 116:1288-302. [PMID: 21892714 DOI: 10.1007/s11547-011-0720-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 12/28/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE The objective of this preliminary study was to examine the effects of combined magnetic resonance/positron emission tomography (MR-PET) evaluation in the morphofunctional characterisation of ovarian lesions. MATERIALS AND METHODS From June 2008 to September 2010, we evaluated 24 patients (mean age 44±10 years; range 24-74) with ovarian lesions incidentally detected on ultrasonography (US) and/or multislice computed tomography (CT). All patients underwent MR imaging of the pelvis and total-body CT-PET. PET and MR images were subsequently fused at postprocessing using specific anatomical criteria. Results were compared with the histological examination. RESULTS Of the 24 examined lesions, 19 were malignant and five were benign on histological examination. MR, CT-PET and MR-PET sensitivity was 84%, 74% and 94%, respectively and specificity 60%, 80% and 100%, respectively. Positive (PPV) and negative predictive (NPV) values were 93% and 44% for CT-PET, 89% and 50% for MR and 100% and 83% for MR-PET, respectively. CONCLUSIONS Pelvic MR-PET fusion imaging provides advantages in terms of sensitivity and especially specificity compared with MR imaging or CT-PET alone. The added value of this fusion imaging modality lies in combining the benefits of the morphological evaluation provided by MR imaging and the metabolic assessment provided by PET.
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Affiliation(s)
- V Fiaschetti
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Policlinico Universitario Tor Vergata, Viale Oxford 81, 00133, Roma, Italy
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Ovarian Cancer Management: The role of imaging and diagnostic challenges. Eur J Radiol 2011; 78:41-51. [DOI: 10.1016/j.ejrad.2010.11.039] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 05/05/2010] [Accepted: 11/30/2010] [Indexed: 11/18/2022]
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Kitajima K, Murakami K, Kaji Y, Sakamoto S, Sugimura K. Established, emerging and future applications of FDG-PET/CT in the uterine cancer. Clin Radiol 2011; 66:297-307. [PMID: 21356392 DOI: 10.1016/j.crad.2010.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 07/12/2010] [Accepted: 07/18/2010] [Indexed: 10/18/2022]
Abstract
Integrated positron emission tomography/computed tomography (PET/CT) with 2-[¹⁸F]fluoro-2-deoxy-D-glucose (FDG) is a useful technique to acquire both glucose metabolic and anatomic imaging data using a single device in a single diagnostic session and has opened a new field in clinical oncologic imaging. FDG-PET/CT has been used successfully for the staging, optimization of treatment, re-staging, therapy monitoring, and prognostic prediction of uterine cervical cancer and endometrial cancer as well as various malignant tumours. The present review discusses the current role of FDG-PET/CT in the management of uterine cancer, discussing its usefulness and limitations in the imaging of these patients.
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Affiliation(s)
- K Kitajima
- PET Diagnosis, Institute of Biomedical Research and Innovation, Kobe, Japan.
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Kitajima K, Murakami K, Sakamoto S, Kaji Y, Sugimura K. Present and future of FDG-PET/CT in ovarian cancer. Ann Nucl Med 2010; 25:155-64. [PMID: 21113691 DOI: 10.1007/s12149-010-0449-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022]
Abstract
Integrated FDG-PET/CT has been used successfully for the diagnosis, staging, restaging, therapy monitoring and prognostic prediction of ovarian cancer as well as various other malignant tumors. Compared with conventional PET/non-contrast CT images, combined PET/contrast-enhanced CT images with intravenous iodine contrast medium and sufficient radiation dose may contribute to a more accurate diagnosis with higher confidence. In the future, tracers other than FDG and integrated PET/MRI will be realized. We herein review the place and role of FDG-PET/CT in the management of ovarian cancer, discussing its usefulness and limitations in the imaging of these patients.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of PET Diagnosis, Institute of Biomedical Research and Innovation, 2-2 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
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Wahl RL, Javadi MS, Eslamy H, Shruti A, Bristow R. The Roles of Fluorodeoxyglucose-PET/Computed Tomography in Ovarian Cancer: Diagnosis, Assessing Response, and Detecting Recurrence. PET Clin 2010; 5:447-61. [PMID: 27157972 DOI: 10.1016/j.cpet.2010.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The potential roles of fluorodeoxyglucose positron emission tomography/computed tomography imaging in ovarian cancer include noninvasive characterization of an ovarian mass, staging, and treatment planning. This article assesses these roles for predicting and monitoring response to treatment, restaging, and early diagnosis of recurrence.
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Affiliation(s)
- Richard L Wahl
- Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Mehrbod Som Javadi
- Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hedieh Eslamy
- Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aditi Shruti
- Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Bristow
- Division of Gynecological Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Egawa-Takata T, Endo H, Fujita M, Ueda Y, Miyatake T, Okuyama H, Yoshino K, Kamiura S, Enomoto T, Kimura T, Inoue M. Early reduction of glucose uptake after cisplatin treatment is a marker of cisplatin sensitivity in ovarian cancer. Cancer Sci 2010; 101:2171-8. [PMID: 20678156 PMCID: PMC11158957 DOI: 10.1111/j.1349-7006.2010.01670.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Cisplatin is an effective chemotherapeutic agent for ovarian cancer, but the sensitivity of cancers differs in individual cases. Because cisplatin is reported to suppress glucose uptake, we investigated the correlation between glucose uptake and sensitivity to the drug. A fluorescent derivative of D-glucose, 2-NBDG (2-[N-(7-nitrobenz-2-oxa-1,3-diaxol-4-yl) amino]-2-deoxyglucose), was used to evaluate glucose uptake. Two ovarian cancer cell lines, SKOV-3 as a relatively resistant line and OVCAR-3 as a relatively sensitive line, were analyzed. Both cell lines had a decreased number of cells accompanied by cell death 24 h after cisplatin treatment, but not at 3 h. In contrast, glucose uptake was decreased 3 h after high-dose cisplatin treatment, which correlated with the sensitivity to the drug at 24 h. The protein levels of glucose transporter 1 (GLUT1) did not change with cisplatin treatment. In contrast, the membrane localization of GLUT1 disappeared after cisplatin treatment. Other cisplatin-resistant cell lines did not show an early decrease in glucose uptake after cisplatin treatment. The early decrease in glucose uptake and later cell death also correlated in cultured cancer cells from ovarian cancer patients. Thus, the decrease in glucose uptake at an early time point after high dose cisplatin treatment reflected cisplatin chemosensitivity in ovarian cancer cells. Measuring glucose uptake might be useful as a rapid evaluation of cisplatin chemosensitivity in ovarian cancer patients.
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Affiliation(s)
- Tomomi Egawa-Takata
- Department of Biochemistry, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, Japan
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Quarles van Ufford HME, van Tinteren H, Stroobants SG, Riphagen II, Hoekstra OS. Added value of baseline 18F-FDG uptake in serial 18F-FDG PET for evaluation of response of solid extracerebral tumors to systemic cytotoxic neoadjuvant treatment: a meta-analysis. J Nucl Med 2010; 51:1507-16. [PMID: 20847179 DOI: 10.2967/jnumed.110.075457] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
UNLABELLED The purpose of this study was to test the hypothesis that the level of baseline (18)F-FDG uptake in the primary tumor adds value to its relative change in (18)F-FDG uptake in serial PET scans in predicting the histopathologic response to systemic cytotoxic neoadjuvant treatment of patients with solid extracerebral tumors. METHODS We performed a literature search from January 1995 through November 2008 using PubMed and Embase. Two reviewers independently selected eligible studies for possible inclusion in the meta-analysis by reviewing titles and abstracts. Inclusion criteria were at least 10 patients, (18)F-FDG PET before and after therapy, (18)F-FDG PET performed with the intention of monitoring the response of solid extracerebral tumors in humans to cytotoxic neoadjuvant systemic therapy, attenuation-corrected (18)F-FDG PET studies, and studies presenting individual patient data (PET results and histopathologic reference test after treatment). Multilevel logistic regression was used to assess the effect of relative change of (18)F-FDG uptake ([baseline - end]/baseline) and baseline (18)F-FDG uptake value with type of tumor and type of treatment as level 1 covariates. RESULTS Nineteen studies (all observational; a total of 438 patients [median, 23 patients per study; range, 10-40]) were included, aiming at the accuracy of PET versus histopathology. To quantify PET, maximum standardized uptake value (SUV) was used in 6 studies, mean SUV in 7, SUV (subtype unclear) in 1, tumor-to-background ratio in 3, and dose uptake ratio in 1. The average overall histopathologic response rate was 0.47 (median, 0.50), ranging from 0.17 to 0.88. The relative change in (18)F-FDG uptake was the strongest indicator (P < 0.0001) for tumor response. Baseline (18)F-FDG was not significantly associated as a main factor; however, a significant interaction of baseline uptake and relative change after therapy was observed (P < 0.001). CONCLUSION Relative change in (18)F-FDG uptake was the strongest indicator for tumor response, but the level of baseline (18)F-FDG uptake in the primary tumor provided additional information about prediction of response to therapy. These data corroborate and extend the need for standardization, quality assurance, and control of PET studies quantifying (18)F-FDG in oncologic treatment monitoring.
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Haug AR, Auernhammer CJ, Wängler B, Schmidt GP, Uebleis C, Göke B, Cumming P, Bartenstein P, Tiling R, Hacker M. 68Ga-DOTATATE PET/CT for the early prediction of response to somatostatin receptor-mediated radionuclide therapy in patients with well-differentiated neuroendocrine tumors. J Nucl Med 2010; 51:1349-56. [PMID: 20720050 DOI: 10.2967/jnumed.110.075002] [Citation(s) in RCA: 161] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
UNLABELLED We aimed to evaluate (68)Ga-DOTATATE PET/CT for the early prediction of time to progression and clinical outcome after a first cycle of peptide receptor radionuclide treatment (PRRT) in a cohort of patients with well-differentiated neuroendocrine tumors. METHODS Thirty-three consecutive patients (22 men and 11 women; mean age +/- SD, 57.8 +/- 12.1 y) were investigated at baseline and again 3 mo after initiation of the first cycle of PRRT. (68)Ga-DOTATATE receptor expression was assessed using 2 measures of standardized uptake value (SUV): maximum SUV (SUV(max)) and tumor-to-spleen SUV ratio (SUV(T/S)). Percentage change in SUV scores after PRRT relative to baseline (DeltaSUV) was calculated. After completing 1-3 cycles of PRRT, patients entered the follow-up study, for estimation of time to progression. According to the Response Evaluation Criteria in Solid Tumors, progression was defined on the basis of contrast-enhanced CT. Clinical symptoms, as well as the tumor markers chromogranin A and neuron-specific enolase, were also recorded during regular follow-up visits. RESULTS The 23 of 31 patients with decreased SUV(T/S) after the first PRRT cycle had longer progression-free survival than did the 8 of 31 patients with stable or increased scores (median survival not reached vs. 6 mo, P = 0.002). For the 18 of 33 patients showing a reduction in SUV(max), there was no significant difference in progression-free survival (median survival not reached vs. 14 mo, P = 0.22). Multivariate regression analysis identified SUV(T/S) as the only independent predictor for tumor progression during follow-up. In the 17 of 33 patients with clinical symptoms before PRRT, DeltaSUV(T/S) correlated with clinical improvement (r = 0.52, P < 0.05), whereas DeltaSUV(max) did not (r = 0.42, P = 0.10). Changes in the tumor markers (chromogranin A and neuron-specific enolase) did not predict DeltaSUV scores, clinical improvement, or time to progression. CONCLUSION Decreased (68)Ga-DOTATATE uptake in tumors after the first cycle of PRRT predicted time to progression and correlated with an improvement in clinical symptoms among patients with well-differentiated neuroendocrine tumors; DeltaSUV(T/S) was superior to DeltaSUV(max) for prediction of outcome.
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Affiliation(s)
- Alexander R Haug
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich, Germany.
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Mirk P. Tumor regression model of cervical cancer--letter. Cancer Res 2010; 70:6104; author 6104. [PMID: 20610627 DOI: 10.1158/0008-5472.can-10-0948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kyriazi S, Kaye SB, deSouza NM. Imaging ovarian cancer and peritoneal metastases—current and emerging techniques. Nat Rev Clin Oncol 2010; 7:381-93. [DOI: 10.1038/nrclinonc.2010.47] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Present and future of PET and PET/CT in gynaecologic malignancies. Eur J Radiol 2010; 78:12-20. [PMID: 20116952 DOI: 10.1016/j.ejrad.2009.12.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 12/30/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To review the published data in literature on patients affected by gynaecological malignancies to establish the role of (18)F-FDG positron emission tomography (PET) and PET/CT in comparison to conventional imaging (CI). MATERIALS AND METHODS All papers specifically addressed to the role of (18)F-FDG PET and PET/CT in gynaecological malignancies published on PubMed/Medline, in abstracts from the principal international congresses, in the guidelines from national Societies that had appeared in literature until November 2009 were considered for the purpose of the present study. RESULTS AND CONCLUSIONS The use of (18)F-FDG PET, and even more of (18)F-FDG PET/CT, is increasing in the follow up of patients with gynaecologic malignancies and suspected recurrent disease: there is evidence in the literature that (18)F-FDG PET/CT has a higher sensitivity than CI in depicting occult metastatic spread. An interesting issue is represented by patients with ovarian cancer with an increase of the specific biomarker, CA-125, and negative/inconclusive findings at CI. The use of (18)F-FDG PET in differential diagnosis and staging is more controversial, but there is some evidence that a baseline PET examination performed before commencing therapy, for staging purpose, is also useful to evaluate the response to chemoradiation treatment. In several papers it has been suggested a relevant role of (18)F-FDG PET/CT in evaluating the entity of response to treatment and therefore to plan the subsequent therapeutic strategy.
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Herrmann K, Krause BJ, Bundschuh RA, Dechow T, Schwaiger M. Monitoring response to therapeutic interventions in patients with cancer. Semin Nucl Med 2009; 39:210-32. [PMID: 19341841 DOI: 10.1053/j.semnuclmed.2008.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Positron emission tomography (PET) and PET/computed tomography (CT) with the glucose analog (18)F-fluorodeoxyglucose (FDG) are increasingly used to assess response to therapy in patients, and there is converging evidence that changes in glucose utilization during therapy can be used to predict clinical outcome. Today, integrated PET/CT systems have mainly replaced stand-alone PET devices, providing the opportunity to integrate morphologic information and functional information. However, the use of PET/CT systems also gives rise to methodological challenges for the quantitative analysis of PET scans for treatment monitoring. Recently published single-center studies demonstrate that FDG-PET and FDG-PET/CT have been successfully used for monitoring of tumor response to cytotoxic therapy in a variety of tumor entities. The potential early identification of nonresponding tumors provides an opportunity to alter treatment regimens according to the individual chemosensitivity of the tumor tissue. In this article, we review the methodological background to monitoring of cancer treatment with PET/CT, the diagnostic and prognostic performance of PET/CT for predicting tumor response with the glucose analog FDG in various tumor entities, and the clinical potential of new imaging probes. In addition, the future direction of research and clinical applications is discussed.
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Affiliation(s)
- Ken Herrmann
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany.
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Schwarz JK, Grigsby PW, Dehdashti F, Delbeke D. The role of 18F-FDG PET in assessing therapy response in cancer of the cervix and ovaries. J Nucl Med 2009; 50 Suppl 1:64S-73S. [PMID: 19380409 DOI: 10.2967/jnumed.108.057257] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
For locally advanced cervical cancer, the current literature supports the use of (18)F-FDG PET for assessing treatment response 3 mo after the completion of concurrent chemoradiation. (18)F-FDG PET can provide reliable long-term prognostic information for these patients and, in the future, may be used to guide additional therapy. Investigational areas include the use of (18)F-FDG PET for monitoring response during radiotherapy and chemotherapy in the metastatic and neoadjuvant settings. For ovarian masses, the performance of (18)F-FDG PET in the detection of borderline tumors is limited, and the presence of physiologic (18)F-FDG uptake in normal ovaries of premenopausal women poses another limitation. Preliminary data suggest that the performance of (18)F-FDG PET and (18)F-FDG PET/CT is superior to that of CT alone in initial staging, but the sensitivity of both in the detection of carcinomatosis is limited. Preliminary data also suggest that (18)F-FDG PET may be promising for early prediction of response to chemotherapy and for prediction of response after the completion of chemotherapy. (18)F-FDG PET and (18)F-FDG PET/CT are most helpful in the evaluation of patients with suspected recurrent ovarian carcinoma, especially when CA-125 levels are rising and CT findings are normal or equivocal. PET and CT are complementary, and PET/CT should be used when available. Preliminary data suggest that the addition of (18)F-FDG PET/CT to the evaluation of these patients changes management in approximately a third and reduces overall treatment costs by accurately identifying patients who will or will not benefit from surgery.
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Affiliation(s)
- Julie K Schwarz
- Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri, USA
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Ben-Haim S, Ell P. 18F-FDG PET and PET/CT in the evaluation of cancer treatment response. J Nucl Med 2009; 50:88-99. [PMID: 19139187 DOI: 10.2967/jnumed.108.054205] [Citation(s) in RCA: 219] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Multimodality imaging, as represented by its greatest exponent, PET/CT, has a firm place in the evaluation of a patient presenting with cancer. With 18F-FDG, PET/CT is rapidly becoming the key investigative tool for the staging and assessment of cancer recurrence. In the last 5 y, PET/CT has also gained widespread acceptance as a key tool used to demonstrate early response to intervention and therapy. In this setting, a major clinical need is being addressed with 18F-FDG PET/CT, because of its inherent ability to demonstrate (before other markers of response) if disease modification has occurred. This review presents available evidence to this effect.
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Affiliation(s)
- Simona Ben-Haim
- Institute of Nuclear Medicine, University College London, and University College London Hospital, London, United Kingdom.
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Current World Literature. Curr Opin Obstet Gynecol 2009; 21:101-9. [DOI: 10.1097/gco.0b013e3283240745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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