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Zirakchian Zadeh M. PET/CT in assessment of colorectal liver metastases: a comprehensive review with emphasis on 18F-FDG. Clin Exp Metastasis 2023; 40:465-491. [PMID: 37682423 DOI: 10.1007/s10585-023-10231-9] [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] [Received: 06/14/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
Approximately 25% of those who are diagnosed with colorectal cancer will develop colorectal liver metastases (CRLM) as their illness advances. Despite major improvements in both diagnostic and treatment methods, the prognosis for patients with CRLM is still poor, with low survival rates. Accurate employment of imaging methods is critical in identifying the most effective treatment approach for CRLM. Different imaging modalities are used to evaluate CRLM, including positron emission tomography (PET)/computed tomography (CT). Among the PET radiotracers, fluoro-18-deoxyglucose (18F-FDG), a glucose analog, is commonly used as the primary radiotracer in assessment of CRLM. As the importance of 18F-FDG-PET/CT continues to grow in assessment of CRLM, developing a comprehensive understanding of this subject becomes imperative for healthcare professionals from diverse disciplines. The primary aim of this article is to offer a simplified and comprehensive explanation of PET/CT in the evaluation of CRLM, with a deliberate effort to minimize the use of technical nuclear medicine terminology. This approach intends to provide various healthcare professionals and researchers with a thorough understanding of the subject matter.
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Affiliation(s)
- Mahdi Zirakchian Zadeh
- Molecular Imaging and Therapy and Interventional Radiology Services, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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The Value of 18F-FDG-PET-CT Imaging in Treatment Evaluation of Colorectal Liver Metastases: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12030715. [PMID: 35328267 PMCID: PMC8947194 DOI: 10.3390/diagnostics12030715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Up to 50% of patients with colorectal cancer either have synchronous colorectal liver metastases (CRLM) or develop CRLM over the course of their disease. Surgery and thermal ablation are the most common local treatment options of choice. Despite development and improvement in local treatment options, (local) recurrence remains a significant clinical problem. Many different imaging modalities can be used in the follow-up after treatment of CRLM, lacking evidence-based international consensus on the modality of choice. In this systematic review, we evaluated 18F-FDG-PET-CT performance after surgical resection, thermal ablation, radioembolization, and neoadjuvant and palliative chemotherapy based on current published literature. (2) Methods: A systematic literature search was performed on the PubMed database. (3) Results: A total of 31 original articles were included in the analysis. Only one suitable study was found describing the role of 18F-FDG-PET-CT after surgery, which makes it hard to draw a firm conclusion. 18F-FDG-PET-CT showed to be of additional value in the follow-up after thermal ablation, palliative chemotherapy, and radioembolization. 18F-FDG-PET-CT was found to be a poor to moderate predictor of pathologic response after neoadjuvant chemotherapy. (4) Conclusions: 18F-FDG-PET-CT is superior to conventional morphological imaging modalities in the early detection of residual disease after thermal ablation and in the treatment evaluation and prediction of prognosis during palliative chemotherapy and after radioembolization, and 18F-FDG-PET-CT could be considered in selected cases after neoadjuvant chemotherapy and surgical resection.
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3
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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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Rodríguez-Fraile M, Cózar-Santiago M, Sabaté-Llobera A, Caresia-Aróztegui A, Delgado-Bolton R, Orcajo-Rincon J, de Arcocha-Torres M, García-Velloso M, García-Talavera P. FDG PET/CT in colorectal cancer. Rev Esp Med Nucl Imagen Mol 2020. [DOI: 10.1016/j.remnie.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rodríguez-Fraile M, Cózar-Santiago MP, Sabaté-Llobera A, Caresia-Aróztegui AP, Delgado Bolton RC, Orcajo-Rincon J, de Arcocha-Torres M, García-Velloso MJ, García-Talavera P. FDG PET/CT in colorectal cancer. Rev Esp Med Nucl Imagen Mol 2019; 39:57-66. [PMID: 31776063 DOI: 10.1016/j.remn.2019.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 12/24/2022]
Abstract
Colorectal cancer is the third most frequent cancer worldwide. Although its incidence is increasing, mainly in those aged under50, mortality has decreased by 50% in the more developed countries, principally due to the adoption of new practices in prevention, diagnosis and treatment. In particular, the various diagnostic imaging modalities allow improved therapeutic decision-making, evaluation of the response and early detection of recurrence. The aim of this paper is to review the available scientific evidence on the value of positron emission tomography with 18F-FDG (18F-FDG PET/CT) in the colorectal cancer, with special emphasis on the indications of the guidelines and recommendations of the main international scientific associations regarding this imaging technique.
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Affiliation(s)
- M Rodríguez-Fraile
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular.
| | - M P Cózar-Santiago
- Servicio de Medicina Nuclear, ERESA-Hospital General Universitario de Valencia, Valencia, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - A Sabaté-Llobera
- Servicio de Medicina Nuclear-IDI, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - A P Caresia-Aróztegui
- Servicio de Medicina Nuclear, Parc Taulí Hospital Universitari, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - R C Delgado Bolton
- Departamento de Diagnóstico por la Imagen y Medicina Nuclear, Hospital San Pedro-Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - J Orcajo-Rincon
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - M de Arcocha-Torres
- Unidad de Radiofarmacia, Hospital Universitario Marqués de Valdecilla, Santander, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - M J García-Velloso
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - P García-Talavera
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
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Advanced imaging to predict response to chemotherapy in colorectal liver metastases - a systematic review. HPB (Oxford) 2018; 20:120-127. [PMID: 29196021 DOI: 10.1016/j.hpb.2017.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The assessment of colorectal liver metastases (CRLM) after treatment with chemotherapy is challenging due to morphological and/or functional change without changes in size. The aim of this review was to assess the value of FDG-PET, FDG-PET-CT, CT and MRI in predicting response to chemotherapy in CRLM. METHODS A systematic review was undertaken based on PRISMA statement. PubMed and Embase were searched up to October 2016 for studies on the accuracy of PET, PET-CT, CT and MRI in predicting RECIST or metabolic response to chemotherapy and/or survival in patients with CRLM. Articles evaluating the assessment of response after chemotherapy were excluded. RESULTS Sixteen studies met the inclusion criteria and were included for further analysis. Study results were available for 6 studies for FDG-PET(-CT), 6 studies for CT and 9 studies for MRI. Generally, features predicting RECIST or metabolic response often predicted shorter survival. The ADC (apparent diffusion coefficient, on MRI) seems to be the most promising predictor of response and survival. In CT-related studies, few attenuation-related parameters and texture features show promising results. In FDG-PET(-CT), findings were ambiguous. CONCLUSION Radiological data on the prediction of response to chemotherapy for CRLM is relatively sparse and heterogeneous. Despite that, a promising parameter might be ADC. Second, there seems to be a seemingly counterintuitive correlation between parameters that predict a good response and also predict poor survival.
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Detection and Viability of Colorectal Liver Metastases After Neoadjuvant Chemotherapy: A Multiparametric PET/CT-MRI Study. Clin Nucl Med 2017; 42:258-263. [PMID: 28166142 DOI: 10.1097/rlu.0000000000001538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to compare combined gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA)-enhanced and diffusion-weighted (DW) MRI with IV contrast-enhanced F-FDG PET/CT to detect and assess the viability of colorectal liver metastases (CLMs) after neoadjuvant chemotherapy (NAC). PATIENTS AND METHODS After NAC, 45 patients with CLMs were prospectively enrolled and underwent combined Gd-EOB-DTPA-enhanced and DW-MRI and contrast-enhanced F-FDG PET/CT. Forty patients subsequently underwent surgery based on intraoperative ultrasound, which served as the reference standard for the presence of CLMs. The number of metastases detected by each technique was then compared. In 69 resected metastases, the SUVmean and SUVmax, mean and maximum target-to-background ratio (TBR), total lesion glycolysis, metabolic tumor volume, and mean and minimum apparent diffusion coefficient (ADC) were examined to identify correlations with the corresponding tumor viability (TV) determined from histological specimens. RESULTS Intraoperative ultrasound revealed 153 CLMs, 122 of which were resected. The detection rate of MRI and contrast-enhanced F-FDG PET/CT were similar (P = 0.61). The SUVmax and minimum ADC were negatively correlated (r = -0.34, P = 0.005) on preoperative imaging after NAC. However, TV was significantly correlated with the maximum TBR (r = 0.33, P = 0.006) and mean TBR (r = 0.37, P = 0.002), but not with the minimum ADC (r = -0.02, P = 0.9) or mean ADC (r = 0.01, P = 0.9). CONCLUSIONS Combined Gd-EOB-DTPA-enhanced and DW-MRI and contrast-enhanced F-FDG PET/CT allow confident detection of CLMs, but only F-FDG PET metrics are associated with TV after NAC.
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Lau LF, Murone C, Williams DS, Standish R, Lee ST, Christophi C, Scott AM, Muralidharan V. Metabolic response evaluation for colorectal liver metastases and correlation to pathologic response and tumour markers. ANZ J Surg 2016; 88:E108-E113. [PMID: 27452367 DOI: 10.1111/ans.13680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tumour metabolic response to chemotherapy is increasingly recognized as a prognostic indicator for colorectal cancer liver metastases (CRCLM). However, its clinical role and the underlying biological mechanism of its prognostic ability are unclear. This study compares metabolic to pathologic response for CRCLM, and correlates metabolic response to tumour expression of six key biomarkers. METHODS Thirty-seven patients who had positron emission tomography imaging before and after pre-operative chemotherapy prior to liver resection for CRCLM were included. Metabolic response was assessed according to the positron emission tomography response criteria in solid tumours (PERCIST) and correlated to recurrence-free and overall survival. PERCIST was compared to tumour regression grading, computed tomography (CT) response, tumour necrosis and mucin and immunohistochemical expression of Ki-67, hypoxia inducible factor 1α, vascular endothelial growth factor, p53, p16 and vimentin. Area under the receiver operating characteristic curve (AUC), Kaplan-Meier survival, Spearman's correlation (rs ) and multivariate Cox regression analyses were used. RESULTS PERCIST correlated significantly to 2-year mortality (AUC = 0.162, P < 0.01) and 2-year recurrence (AUC = 0.284, P = 0.03). Metabolically responsive tumours conferred a better overall survival (P = 0.01) and recurrence-free survival (P = 0.03). Tumour regression grading did not stratify for outcome. Metabolic response was significantly correlated to Ki-67 and p16 expression (rs = 0.559 and rs = -0.549, respectively). Multivariate analysis revealed only PERCIST to be correlated to death and recurrence. CONCLUSION Pre-operative PERCIST assessment of CRCLM was more prognostic than pathologic and CT response assessment. Metabolic non-response correlated with tumour proliferation and loss of tumour suppression.
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Affiliation(s)
- Lawrence F Lau
- Department of Surgery, Austin Hospital, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Carmel Murone
- Department of Pathology, Austin Hospital, The University of Melbourne, Heidelberg, Victoria, Australia.,Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - David S Williams
- Department of Pathology, Austin Hospital, The University of Melbourne, Heidelberg, Victoria, Australia.,Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Richard Standish
- Department of Pathology, Austin Hospital, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Sze Ting Lee
- Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia.,Department of Molecular Imaging and Therapy, Austin Hospital, Heidelberg, Victoria, Australia
| | - Christopher Christophi
- Department of Surgery, Austin Hospital, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Andrew M Scott
- Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia.,Department of Molecular Imaging and Therapy, Austin Hospital, Heidelberg, Victoria, Australia
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Burger IA, Casanova R, Steiger S, Husmann L, Stolzmann P, Huellner MW, Curioni A, Hillinger S, Schmidtlein CR, Soltermann A. 18F-FDG PET/CT of Non-Small Cell Lung Carcinoma Under Neoadjuvant Chemotherapy: Background-Based Adaptive-Volume Metrics Outperform TLG and MTV in Predicting Histopathologic Response. J Nucl Med 2016; 57:849-54. [PMID: 26823566 DOI: 10.2967/jnumed.115.167684] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/22/2015] [Indexed: 01/08/2023] Open
Abstract
UNLABELLED Assessment of tumor response after chemotherapy using (18)F-FDG PET metrics is gaining acceptance. Several studies have suggested that the parameters metabolically active tumor volume (MTV) and total lesion glycolysis (TLG) are superior to SUVmax for measuring tumor burden. However, the measurement of MTV and TLG is still controversial; the most common method uses an absolute threshold of 42% of SUVmax Recently, we implemented a background-adaptive method to determine the background-subtracted lesion activity (BSL) and the background-subtracted volume (BSV). In this study, we investigated the correlation between such PET metrics and histopathologic response in non-small cell lung carcinoma (NSCLC). METHODS Forty-four NSCLC patients were retrospectively identified. Their PET/CT data on both types of scan before and after neoadjuvant chemotherapy were analyzed regarding SUVmax, MTV, TLG, BSL, and BSV, as well as the relative changes in these parameters. The tumor regression score as an indicator of histopathologic response was scored on hematoxylin- and eosin-stained sections of the surgical specimens using a 4-tiered scale (scores 1-4). The correlation between score and the absolute and relative PET metrics after chemotherapy was analyzed using Spearman rank correlation tests. RESULTS Tumors that demonstrated a good response after neoadjuvant chemotherapy had significantly lower (18)F-FDG activity than nonresponding tumors (scores 3 and 4: SUVmax, 4.2 [range, 1.8-7.9] vs. scores 1 and 2: SUVmax, 8.1 [range, 1.4-40.4]; P = 0.001). The same was found for change in SUVmax and score (P = 0.001). PET volume metrics based on a 42% fixed threshold for SUVmax did not correlate with score (TLG, P = 0.505; MTV, P = 0.386). However, both of the background activity-based PET volume metrics-BSL and BSV-significantly correlated with score (P < 0.001 each). CONCLUSION PET volume metrics based on background-adaptive methods correlate better with histopathologic tumor regression score in NSCLC patients under neoadjuvant chemotherapy than algorithms and methods using a fixed threshold (42% SUVmax).
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Affiliation(s)
- Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Ruben Casanova
- Department of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Seraina Steiger
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Lars Husmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Paul Stolzmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Alessandra Curioni
- Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland; and
| | - C Ross Schmidtlein
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alex Soltermann
- Department of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
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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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Decreased ERCC1 Expression After Platinum-Based Neoadjuvant Chemotherapy in non-Small Cell Lung Cancer. Pathol Oncol Res 2014; 21:423-31. [PMID: 25194563 DOI: 10.1007/s12253-014-9839-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 08/29/2014] [Indexed: 10/24/2022]
Abstract
We have already demonstrated in a small cohort of 17 non-small cell lung cancer patients that ERCC1 (excision repair cross-complementation group 1) protein expression decreased after platinum-based treatment, however, certain clinicopathological parameters, such as histologic subtypes, ERCC1 expression scores, chemotherapeutic combinations, response rate, gender and smoking history were not analyzed. The aim of our present study was to extend the studied cohort and analyze those parameters. ERCC1 protein expression was examined in 46 patients treated with neoadjuvant chemotherapy. 46 bronchoscopic biopsy samples (27 squamous cell carcinomas /SCC/ and 19 adenocarcinomas /ADC/) together with their corresponding surgical biopsies were studied. ERCC1 immunohistochemistry was performed on formalin-fixed, paraffin-embedded tissues. Staining scores were calculated by multiplying the percentage of positive tumor cells (0-100) by the staining intensity (0-3). 24/27 bronchoscopic SCC tissues expressed ERCC1. Thirteen of these cases became negative after neoadjuvant therapy and the expression differences between pre- and postchemotherapy samples were highly significant (p < 0.001). 11/19 bronchoscopic ADC tissues expressed ERCC1. Six of these cases became negative after neoadjuvant therapy and the expression differences were significant (p < 0.010). There was no newly expressed ERCC1 postoperatively. Comparison of staining score changes revealed more pronounced decrease in SCC (p = 0.032). We observed no correlation between initial ERCC1 level or ERCC1 decrease and overall survival, but we demonstrated correlations between decrease in ERCC1 expression and histologic subtypes of tumors and gender. We could confirm our previous data in a larger cohort that platinum-based chemotherapy affects the ERCC1 expression probably referring to an induction of tumor cell selection.
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She WH, Chan ACY, Poon RTP, Cheung TT, Chok KSH, Chan SC, Lo CM. Defining an optimal surgical strategy for synchronous colorectal liver metastases: staged versus simultaneous resection? ANZ J Surg 2014; 85:829-33. [PMID: 24981795 DOI: 10.1111/ans.12739] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Wong Hoi She
- Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation; Department of Surgery; The University of Hong Kong; Hong Kong
| | - Albert Chi Yan Chan
- Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation; Department of Surgery; The University of Hong Kong; Hong Kong
| | - Ronnie Tung Ping Poon
- Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation; Department of Surgery; The University of Hong Kong; Hong Kong
- State Key Laboratory for Liver Research; The University of Hong Kong; Hong Kong
| | - Tan To Cheung
- Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation; Department of Surgery; The University of Hong Kong; Hong Kong
| | - Kenneth Siu Ho Chok
- Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation; Department of Surgery; The University of Hong Kong; Hong Kong
| | - See Ching Chan
- Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation; Department of Surgery; The University of Hong Kong; Hong Kong
- State Key Laboratory for Liver Research; The University of Hong Kong; Hong Kong
| | - Chung Mau Lo
- Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation; Department of Surgery; The University of Hong Kong; Hong Kong
- State Key Laboratory for Liver Research; The University of Hong Kong; Hong Kong
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