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Okada Y, Zama T, Itonaga T, Mikami R, Okubo M, Sugahara S, Nakai M, Abe K, Yoshimura M, Saito K. Association between PET-CT accumulation in the hypothalamic/pituitary regions and neuron-specific enolase/primary tumor in limited-stage small cell lung cancer: a case-controlled retrospective study. EJNMMI REPORTS 2024; 8:4. [PMID: 38748049 PMCID: PMC10962629 DOI: 10.1186/s41824-024-00190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/06/2023] [Indexed: 05/19/2024]
Abstract
BACKGROUND Research on the relationship between neuron-specific enolase (NSE) levels and normal organs, particularly the central nervous system, in small cell lung cancer is limited. Therefore, this study aimed to investigate the relationship between positron emission tomography-computed tomography (PET-CT) accumulation at hypothalamic/pituitary regions, tumor activity, and NSE level in limited-stage small cell lung cancer. We retrospectively analyzed patients who were diagnosed with limited-stage small cell lung cancer at Tokyo Medical University Hospital between July 1, 2019, and May 31, 2023, and were treated with chemoradiotherapy or radiotherapy. Leukocytes, erythrocytes, hemoglobin, platelets, total protein, albumin, NSE, and carcinoembryonic antigen were measured in blood samples obtained before treatment initiation. The maximum standardized uptake value (SUVmax), volume, and total lesion glycolysis (TLG) of each hypothalamic /pituitary region, primary tumor, and lymph node metastases were extracted from PET-CT images. The total tumor volume (primary tumor volume plus lymph node metastases volume) and total TLG (primary tumor TLG plus lymph node metastases TLG) were calculated. RESULTS This study included 19 patients (mean age, 70.1 ± 8.8 years; 13 men and 6 women); the pathology in all patients was small cell lung cancer. Patients were classified into two groups according to the NSE reference value (16.3 ng/mL): six patients having NSE level below the reference value and 13 having NSE level above the reference value. The SUVmax in the hypothalamic/pituitary region was 2.95 in the NSE < 16.3 ng/mL group and 4.10 in the NSE > 16.3 ng/mL group, with a statistically significant difference (p = 0.03). The total tumor volume was 17.8 mL in the NSE < 16.3 ng/mL group and 98.9 mL in the NSE > 16.3 ng/mL group, with a statistically significant difference (p < 0.01). A correlation coefficient of r = 0.458 (p = 0.0486) was observed between SUVmax in the hypothalamus/pituitary and NSE level. A correlation coefficient of r = 0.647 (p < 0.01) was also observed between total tumor volume and NSE level. Finally, a correlation coefficient of r = 0.53 (p = 0.01) was observed between hypothalamic/pituitary TLG and primary tumor TLG. CONCLUSIONS The findings demonstrated a correlation between hypothalamic/pituitary activity and tumor activity, suggesting the prognostic significance of NSE.
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Affiliation(s)
- Yukinori Okada
- Department of Radiology, Tokyo Medical University, Tokyo, Japan.
| | - Tatsuhiko Zama
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | | | - Ryuji Mikami
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Mitsuru Okubo
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Shinji Sugahara
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Motoki Nakai
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Koichiro Abe
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Mana Yoshimura
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
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Tas F, Ozturk A, Erturk K. Primary tumor SUV max and ratio of SUV max to primary tumor size on pretreatment 18F-FDG-PET/CT scan in small cell lung cancer : Which is superior for the prognosis? Wien Klin Wochenschr 2023; 135:478-487. [PMID: 36882606 DOI: 10.1007/s00508-023-02160-0] [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: 11/21/2022] [Accepted: 02/04/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND The prognostic impact of tumor SUVmax (t-SUVmax) in small cell lung cancer (SCLC) has been questioned with controversial results, and the significance of the ratio of tumor SUVmax to primary tumor size (SUVmax/t-size) in SCLC has yet to be clarified as well. In this study, a retrospective analysis was carried out to figure out the prognostic and predictive powers of pretreatment primary t‑SUVmax and t‑SUVmax/t-size ratio in patients with SCLC. METHODS A total of 349 SCLC patients who underwent pretreatment staging with PET/CT scan were enrolled in the study and analyzed retrospectively. RESULTS In limited disease SCLC (LD-SCLC), tumor size was significantly associated with both t‑SUVmax (p = 0.02) and t‑SUVmax/t-size (p = 0.0001). Furthermore, performance status, tumor size (p = 0.001), and liver metastasis were significantly associated with t‑SUVmax in extended disease SCLC (ED-SCLC). Moreover, tumor size (p = 0.0001), performance status, cigarette smoking history, and pulmonary/pleural metastasis were found to be correlated with t‑SUVmax/t-size. No associations were found between clinical stages and either t‑SUVmax or t‑SUVmax/t-size (p = 0.9 for both), and t‑SUVmax and t‑SUVmax/t-size values were found to have similar survival rates in both LD-SCLC and ED-SCLC patients. In univariate and multivariate analyses, both t‑SUVmax and t‑SUVmax/t-size were found not to be associated with overall survival (p > 0.05) CONCLUSION: This study does not advocate the use of either t‑SUVmax or t‑SUVmax/t-size on pretreatment 18F‑FDG-PET/CT scan as prognostic and predictive tools for both LD-SCLC and ED-SCLC patients. Likewise, we did not find that t‑SUVmax/t-size was superior to t‑SUVmax in that respect.
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Affiliation(s)
- Faruk Tas
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey.
- Institute of Oncology, Istanbul University, 34390, Istanbul, Capa, Turkey.
| | - Akın Ozturk
- Department of Medical Oncology outpatient clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kayhan Erturk
- Department of Medical Oncology, Koc University, Istanbul, Turkey
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Hicks RJ. The value of the Standardized Uptake Value (SUV) and Metabolic Tumor Volume (MTV) in lung cancer. Semin Nucl Med 2022; 52:734-744. [PMID: 35624032 DOI: 10.1053/j.semnuclmed.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 11/11/2022]
Abstract
The diagnosis, staging and therapeutic monitoring of lung cancer were amongst the first applications for which the utility of FDG PET was documented and FDG PET/CT is now a routine diagnostic tool for clinical decision-making. As well as having high sensitivity for detection of disease sites, which provides critical information about stage, the intensity of uptake provides deeper biological characterization, while the burden of disease also has potential clinical significance. These disease characteristics can easily be quantified on delayed whole-body imaging as the maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV), respectively. There have been significant efforts to harmonize the measurement of these features, particularly within the context of clinical trials. Nevertheless, however calculated, in general, a high SUVmax and large MTV have been shown to have an adverse prognostic significance. Nevertheless, the use of these parameters in the interpretation and reporting of clinical scans remains inconsistent and somewhat controversial. This review details the current status of semi-quantitative FDG PET/CT in the evaluation of lung cancer.
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Affiliation(s)
- Rodney J Hicks
- Department of Medicine, St Vincent's Medical School, University of Melbourne, Melbourne Academic Centre for Health, University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Central Clinical School, Alfred Hospital, Monash University, Melbourne VIC, Australia.
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Guo H, Xu K, Duan G, Wen L, He Y. Progress and future prospective of FDG-PET/CT imaging combined with optimized procedures in lung cancer: toward precision medicine. Ann Nucl Med 2022; 36:1-14. [PMID: 34727331 DOI: 10.1007/s12149-021-01683-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/30/2021] [Indexed: 12/19/2022]
Abstract
With a 5-year overall survival of approximately 20%, lung cancer has always been the number one cancer-specific killer all over the world. As a fusion of positron emission computed tomography (PET) and computed tomography (CT), PET/CT has revolutionized cancer imaging over the past 20 years. In this review, we focused on the optimization of the function of 18F-flurodeoxyglucose (FDG)-PET/CT in diagnosis, prognostic prediction and therapy management of lung cancers by computer programs. FDG-PET/CT has demonstrated a surprising role in development of therapeutic biomarkers, prediction of therapeutic responses and long-term survival, which could be conducive to solving existing dilemmas. Meanwhile, novel tracers and optimized procedures are also developed to control the quality and improve the effect of PET/CT. With the continuous development of some new imaging agents and their clinical applications, application value of PET/CT has broad prospects in this area.
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Affiliation(s)
- Haoyue Guo
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China
- School of Medicine, Tongji University, No. 1239 Siping Road, Shanghai, 200092, China
| | - Kandi Xu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China
- School of Medicine, Tongji University, No. 1239 Siping Road, Shanghai, 200092, China
| | - Guangxin Duan
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, 215123, China
| | - Ling Wen
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
| | - Yayi He
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China.
- School of Medicine, Tongji University, No. 1239 Siping Road, Shanghai, 200092, China.
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Prognostic Value of 18F-FDG-PET Parameters in Patients with Small Cell Lung Cancer: A Meta-Analysis and Review of Current Literature. Diagnostics (Basel) 2021; 11:diagnostics11020174. [PMID: 33530446 PMCID: PMC7912276 DOI: 10.3390/diagnostics11020174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 01/29/2023] Open
Abstract
Many studies have suggested a prognostic value of one or several positron emission tomography (PET) parameters in patients with small cell lung cancer (SCLC). However, studies are often small, and there is a considerable interstudy disagreement about which PET parameters have a prognostic value. The objective of this study was to perform a review and meta-analysis to identify the most promising PET parameter for prognostication. PubMed®, Cochrane, and Embase® were searched for papers addressing the prognostic value of any PET parameter at any treatment phase with any endpoint in patients with SCLC. Pooled hazard ratios (HRs) were calculated by a random effects model for the prognostic value of the baseline maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV). The qualitative analysis included 38 studies, of these, 19 studies were included in the meta-analyses. The pooled results showed that high baseline MTV was prognostic for overall survival (OS) (HR: 2.83 (95% confidence interval [CI]: 2.00–4.01) and progression-free survival (PFS) (HR: 3.11 (95% CI: 1.99–4.90)). The prognostic value of SUVmax was less pronounced (OS: HR: 1.50 (95% CI: 1.17–1.91); PFS: HR: 1.24 (95% CI: 0.94–1.63)). Baseline MTV is a strong prognosticator for OS and PFS in patients with SCLC. MTV has a prognostic value superior to those of other PET parameters, but whether MTV is superior to other prognosticators of tumor burden needs further investigation.
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Noronha V, Sekhar A, Patil VM, Menon N, Joshi A, Kapoor A, Prabhash K. Systemic therapy for limited stage small cell lung carcinoma. J Thorac Dis 2020; 12:6275-6290. [PMID: 33209466 PMCID: PMC7656383 DOI: 10.21037/jtd-2019-sclc-11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Systemic treatment in small cell lung carcinoma has been a challenge for oncologists for decades. The high propensity for recurrence is usually due to distant metastasis, which makes systemic treatment an essential component of treatment in small cell lung carcinoma. The regimen of cisplatin and etoposide (established in the mid-1980’s) concurrently with thoracic radiotherapy followed by prophylactic cranial irradiation (PCI) remains the standard of care in limited stage disease. Despite numerous trials, this regimen has not been improved upon. The standard combination regimen of cisplatin and etoposide has been compared to alternative platinum-containing regimens with drugs like epirubicin, irinotecan, paclitaxel, topotecan, pemetrexed, amrubicin and belotecan. Non-platinum containing regimens like ifosfamide and etoposide have also been tested. Attempts to intensify therapy have included the addition of a third drug like paclitaxel, ifosfamide, tirapazamine, tamoxifen, and thalidomide. Maintenance therapy following induction with chemotherapy, vandetanib and interferon-alpha have also been attempted. Molecularly directed targeted therapies and immunotherapeutic agents are areas of active research. In this review, we discuss the various systemic therapy options in limited stage small cell lung carcinoma, from the historical regimens to the modern-day therapy and promising areas of research. We also discuss the role of growth factors, the optimal number of chemotherapy cycles, the use of prognostic and predictive factors, the optimal timing of chemotherapy and the treatment of special populations of patients including older patients, and patients with comorbidities.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai; Homi Bhabha National Institute, Mumbai, India
| | - Anbarasan Sekhar
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai; Homi Bhabha National Institute, Mumbai, India
| | - Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai; Homi Bhabha National Institute, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai; Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai; Homi Bhabha National Institute, Mumbai, India
| | - Akhil Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai; Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai; Homi Bhabha National Institute, Mumbai, India
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Özdemir Ö, Batum Ö, Ermin S, Aksel N, Kömürcüoğlu B, Mertoğlu A, Deniz S, Balcı G, Koparal H, Özbilek E, Yılmaz U. Metabolic activity of primary tumour on PET/CT has a relationship with survival in stages I-III small-cell lung carcinoma. THE CLINICAL RESPIRATORY JOURNAL 2020; 14:695-702. [PMID: 32170990 DOI: 10.1111/crj.13186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/15/2020] [Accepted: 03/09/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION There is limited evidence about the prognostic value of FDG-PET/CT metrics in small cell lung cancer (SCLC) patients staged with TNM staging system. OBJECTIVES The aim of this study is to examine the prognostic value of pretreatment FDG-SUVmax in patients with SCLC staged with 8th TNM staging system. METHODS A total of 344 (292 male) SCLC patients with pretreatment FDG- PET/CT were included. One hundred fifty-three of cases were stages I-III, 191 were stage IV. SUVmax values were obtained for primary tumour, lymph nodes and metastases. Univariate and multivariate analysis were performed to determine the effect of pretreatment SUVmax, with cut-off value of median, on progression-free and overall survival (PFS and OS). RESULTS Median OS and PFS for patients with stages I-III were 16.50 and 11.00 months, respectively. Median OS and PFS for patients with stage IV were 10.00 and 7.00 months, respectively. SUVmax of the primary tumour (PT), lymph nodes or metastasis were not associated with OS and PFS on univariate analysis. On multivariate analysis, SUVmax -PT with cut-off value of 11.60 was found to be an independent prognostic factor for OS in patients with stages I-III (HR;1.88, 95% CI:1.15-3.08, P = .012). But the SUVmax -PT (HR; 1.60, 95% CI: 0.99-2.60; P = .057) for PFS was found to be a prognostic factor with marginal significance. SUVmax were not significantly associated with OS and PFS in patients with stage IV disease. CONCLUSION Pretreatment SUVmax -PT (median cut-off 11.6) may have a prognostic value of OS and PFS in patients with TNM staged I-III SCLC.
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Affiliation(s)
- Özer Özdemir
- Department of Pulmonology, Kemalpaşa State Hospital, İzmir, Turkey
| | - Özgür Batum
- Department of Pulmonology, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Sinem Ermin
- Department of Pulmonology, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Nimet Aksel
- Department of Pulmonology, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Berna Kömürcüoğlu
- Department of Pulmonology, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Aydan Mertoğlu
- Department of Pulmonology, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Sami Deniz
- Department of Pulmonology, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Günseli Balcı
- Department of Pulmonology, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Hakan Koparal
- Department of Nuclear Medicine, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Engin Özbilek
- Department of Nuclear Medicine, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Ufuk Yılmaz
- Department of Pulmonology, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
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Christensen TN, Langer SW, Villumsen KE, Johannesen HH, Löfgren J, Keller SH, Hansen AE, Kjaer A, Fischer BM. 18F-fluorothymidine (FLT)-PET and diffusion-weighted MRI for early response evaluation in patients with small cell lung cancer: a pilot study. Eur J Hybrid Imaging 2020; 4:2. [PMID: 34191195 PMCID: PMC8218141 DOI: 10.1186/s41824-019-0071-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/23/2019] [Indexed: 12/25/2022] Open
Abstract
Background Small cell lung cancer (SCLC) is an aggressive cancer often presenting in an advanced stage and prognosis is poor. Early response evaluation may have impact on the treatment strategy. Aim We evaluated 18F-fluorothymidine-(FLT)-PET/diffusion-weighted-(DW)-MRI early after treatment start to describe biological changes during therapy, the potential of early response evaluation, and the added value of FLT-PET/DW-MRI. Methods Patients with SCLC referred for standard chemotherapy were eligible. FLT-PET/DW-MRI of the chest and brain was acquired within 14 days after treatment start. FLT-PET/DW-MRI was compared with pretreatment FDG-PET/CT. Standardized uptake value (SUV), apparent diffusion coefficient (ADC), and functional tumor volumes were measured. FDG-SUVpeak, FLT-SUVpeak, and ADCmedian; spatial distribution of aggressive areas; and voxel-by-voxel analyses were evaluated to compare the biological information derived from the three functional imaging modalities. FDG-SUVpeak, FLT-SUVpeak, and ADCmedian were also analyzed for ability to predict final treatment response. Results Twelve patients with SCLC completed FLT-PET/MRI 1–9 days after treatment start. In nine patients, pretreatment FDG-PET/CT was available for comparison. A total of 16 T-sites and 12 N-sites were identified. No brain metastases were detected. FDG-SUVpeak was 2.0–22.7 in T-sites and 5.5–17.3 in N-sites. FLT-SUVpeak was 0.6–11.5 in T-sites and 1.2–2.4 in N-sites. ADCmedian was 0.76–1.74 × 10− 3 mm2/s in T-sites and 0.88–2.09 × 10−3 mm2/s in N-sites. FLT-SUVpeak correlated with FDG-SUVpeak, and voxel-by-voxel correlation was positive, though the hottest regions were dissimilarly distributed in FLT-PET compared to FDG-PET. FLT-SUVpeak was not correlated with ADCmedian, and voxel-by-voxel analyses and spatial distribution of aggressive areas varied with no systematic relation. LT-SUVpeak was significantly lower in responding lesions than non-responding lesions (mean FLT-SUVpeak in T-sites: 1.5 vs. 5.7; p = 0.007, mean FLT-SUVpeak in N-sites: 1.6 vs. 2.2; p = 0.013). Conclusions FLT-PET and DW-MRI performed early after treatment start may add biological information in patients with SCLC. Proliferation early after treatment start measured by FLT-PET is a promising predictor for final treatment response that warrants further investigation. Trial registration Clinicaltrials.gov, NCT02995902. Registered 11 December 2014 - Retrospectively registered.
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Affiliation(s)
- Tine Nøhr Christensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. .,Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark.
| | - Seppo W Langer
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Engholm Villumsen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Helle Hjorth Johannesen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Sune Høgild Keller
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Adam Espe Hansen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Malene Fischer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,PET Centre, School of Biomedical Engineering and Imaging Science, Kings College London, London, UK
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Quartuccio N, Evangelista L, Alongi P, Caobelli F, Altini C, Cistaro A, Lambertini A, Schiorlin I, Popescu CE, Linguanti F, Laudicella R, Scalorbi F, Di Pierro G, Asabella AN, Cuppari L, Margotti S, Lima GM, Scalisi S, Pacella S, Kokomani A, Ciaccio A, Sturiale L, Vento A, Cardile D, Baldari S, Panareo S, Fanti S, Rubini G, Schillaci O, Chiaravalloti A. Prognostic and diagnostic value of [18F]FDG-PET/CT in restaging patients with small cell lung carcinoma: an Italian multicenter study. Nucl Med Commun 2019; 40:808-814. [PMID: 31136534 DOI: 10.1097/mnm.0000000000001038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The presence of residual disease after initial treatment in small cell lung cancer (SCLC) influences prognosis and impacts patient management. To date, few data exist on the value of fluorine-18-fluorodeoxyglucose ([F]FDG)-PET/computed tomography (CT) in SCLC at restaging. Therefore, in restaging patients with SCLC, we aimed to (a) evaluate the prognostic value yielded by [F]FDG-PET/CT and (b) assess the diagnostic agreement between [F]FDG-PET/CT and contrast-enhanced computed tomography (ceCT). PATIENTS AND METHODS From a multicenter database, we evaluated 164 patients with SCLC who underwent [F]FDG-PET/CT for restaging purposes. PET scans were evaluated visually to identify the presence of recurrence. For each patient, the maximum and the mean standardized uptake value (SUVmax and SUVmean, respectively), metabolic tumor volume, and total lesion glycolysis were calculated, taking into account the lesion with the highest [F]FDG uptake (namely, the index lesion) in the local recurrences, lymph node involvement, and distant metastasis categories. Kaplan-Meier curves were computed to assess the effects of [F]FDG-PET/CT findings on overall survival (OS) and progression-free survival. Furthermore, the agreement between PET/CT and ceCT in detecting metastases was evaluated in 119 patients on a patient-based analysis (Cohen's κ; P < 0.05). RESULTS The presence of metastatic lesions at [F]FDG-PET/CT was associated with a significantly shorter OS (P = 0.039) and progression-free survival (P < 0.001). Higher SUVmax showed a trend toward a shorter OS (P = 0.065). The K-agreement between ceCT and PET/CT in recurrent SCLC was 0.37 (P < 0.001). PET/CT and ceCT showed the same number of lesions in 52 (43.7%) patients, whereas PET/CT detected additional lesions in 35 (29.4%) patients. CONCLUSION Detection of metastatic lesions at restaging by [F]FDG-PET/CT can predict a higher rate of progression and negatively influence OS in patients with SCLC. [F]FDG-PET/CT and ceCT seem to be complementary imaging modalities in patients with metastatic SCLC.
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Affiliation(s)
- Natale Quartuccio
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo
| | - Laura Evangelista
- Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Padua
| | - Pierpaolo Alongi
- Department of Radiological Sciences, Nuclear Medicine Unit, Fondazione Istituto G. Giglio, Cefalù
| | - Federico Caobelli
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Angelina Cistaro
- Positron Emission Tomography Centre, IRMET S.p.A., Affidea, Turin
| | - Alessandro Lambertini
- Nuclear Medicine Department, S.Orsola-Malpighi Hospital, University of Bologna, Bologna
| | | | | | - Flavia Linguanti
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio'
| | - Riccardo Laudicella
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina
| | - Federica Scalorbi
- Nuclear Medicine Department, IRCCS Istituto Nazionale dei Tumori, Milano
| | | | | | - Lea Cuppari
- Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Padua
| | - Simone Margotti
- Positron Emission Tomography Centre, IRMET S.p.A., Affidea, Turin
| | - Giacomo M Lima
- Nuclear Medicine Department, S.Orsola-Malpighi Hospital, University of Bologna, Bologna
| | - Salvatore Scalisi
- Department of Radiological Sciences, Nuclear Medicine Unit, Fondazione Istituto G. Giglio, Cefalù
| | - Sara Pacella
- Nuclear Medicine Department, Niguarda Ca' Granda Hospital
| | - Aurora Kokomani
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio'
| | - Alfonso Ciaccio
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio'
| | - Letterio Sturiale
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina
| | - Antonio Vento
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina
| | - Davide Cardile
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina
| | - Sergio Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina
| | - Stefano Panareo
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, S. Anna University Hospital, Ferrara
| | - Stefano Fanti
- Nuclear Medicine Department, S.Orsola-Malpighi Hospital, University of Bologna, Bologna
| | | | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Rome
- IRCCS Neuromed, Pozzilli (IS), Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, University Tor Vergata, Rome
- IRCCS Neuromed, Pozzilli (IS), Italy
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10
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Kobayashi M, Tanaka H, Tateishi U, Numao N, Yonese J, Ito M, Koga F, Fukushima H, Uehara S, Yoshida S, Yokoyama M, Ishioka J, Matsuoka Y, Saito K, Kihara K, Fujii Y. Impact of fluorodeoxyglucose uptake on positron emission tomography/computed tomography on chemosensitivity and survival in patients with metastatic urothelial carcinoma. Int J Urol 2019; 26:820-826. [PMID: 31140215 DOI: 10.1111/iju.14022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/19/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the impact of fluorodeoxyglucose uptake on positron emission tomography/computed tomography on chemosensitivity and survival in patients with metastatic urothelial carcinoma. METHODS The present study assessed 51 metastatic urothelial carcinoma patients undergoing fluorodeoxyglucose positron emission tomography/computed tomography before first-line systemic chemotherapy. Fluorodeoxyglucose uptake in metastases was evaluated using the maximum standardized uptake value, which was measured for all eligible lesions, and the highest value among the maximum standardized uptake value measurements in each case was defined as the highest maximum standardized uptake value. The associations between the highest maximum standardized uptake value and objective response rate to chemotherapy, progression-free survival or cancer-specific survival were analyzed. For cancer-specific survival, the C-index was compared between multivariate models that incorporated predictors in the Bajorin model including the Karnofsky performance status and the presence of visceral metastasis, and the Apolo model additionally including hemoglobin and albumin levels, with/without the highest maximum standardized uptake value. RESULTS The median age was 69 years. The Karnofsky performance status was ≥80% for all patients. Visceral metastasis was observed in 12 patients (24%). The objective response rate, median progression-free survival and median cancer-specific survival were 61%, 9 and 26 months in the entire cohort, respectively. The higher highest maximum standardized uptake value was significantly associated with a lower objective response rate, shorter progression-free survival and shorter cancer-specific survival (P = 0.01, <0.001 and 0.004, respectively). On multivariate analyses, the highest maximum standardized uptake value was an independent predictor for all end-points. In the multivariate models for cancer-specific survival, the C-index improved from 0.559 to 0.601 and from 0.604 to 0.652 by adding the highest maximum standardized uptake value to the parameter set of the Bajorin model and Apolo model, respectively. CONCLUSIONS Higher fluorodeoxyglucose uptake in metastases was significantly and independently associated with poor chemosensitivity and worse survival outcomes. Fluorodeoxyglucose positron emission tomography/computed tomography might aid in patient counseling and treatment decisions for metastatic urothelial carcinoma patients.
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Affiliation(s)
- Masaki Kobayashi
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noboru Numao
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Yonese
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masaya Ito
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiroshi Fukushima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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11
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Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, Elcim Y, Gundem E, Dirican B, Beyzadeoglu M. Utility of Molecular Imaging with 2-Deoxy-2-[Fluorine-18] Fluoro-DGlucose Positron Emission Tomography (18F-FDG PET) for Small Cell Lung Cancer (SCLC): A Radiation Oncology Perspective. Curr Radiopharm 2019; 12:4-10. [PMID: 30465520 DOI: 10.2174/1874471012666181120162434] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Although accounting for a relatively small proportion of all lung cancers, small cell lung cancer (SCLC) remains to be a global health concern with grim prognosis. Radiotherapy (RT) plays a central role in SCLC management either as a curative or palliative therapeutic strategy. There has been considerable progress in RT of SCLC, thanks to improved imaging techniques leading to accurate target localization for precise delivery of RT. Positron emission tomography (PET) is increasingly used in oncology practice as a non-invasive molecular imaging modality. METHODS Herein, we review the utility of molecular imaging with 2-deoxy-2-[fluorine-18] fluoro-Dglucose PET (18F-FDG PET) for SCLC from a radiation oncology perspective. RESULTS There has been extensive research on the utility of PET for SCLC in terms of improved staging, restaging, treatment designation, patient selection for curative/palliative intent, target localization, response assessment, detection of residual/recurrent disease, and prediction of treatment outcomes. CONCLUSION PET provides useful functional information as a non-invasive molecular imaging modality and may be exploited to improve the management of patients with SCLC. Incorporation of PET/CT in staging of patients with SCLC may aid in optimal treatment allocation for an improved therapeutic ratio. From a radiation oncology perspective, combination of functional and anatomical data provided by integrated PET/CT improves discrimination between atelectasis and tumor, and assists in the designation of RT portals with its high accuracy to detect intrathoracic tumor and nodal disease. Utility of molecular imaging for SCLC should be further investigated in prospective randomized trials to acquire a higher level of evidence for future potential applications of PET.
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Affiliation(s)
- Omer Sager
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Ferrat Dincoglan
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Selcuk Demiral
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Bora Uysal
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Hakan Gamsiz
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Yelda Elcim
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Esin Gundem
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Bahar Dirican
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
| | - Murat Beyzadeoglu
- Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey
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12
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Salem A, Mistry H, Hatton M, Locke I, Monnet I, Blackhall F, Faivre-Finn C. Association of Chemoradiotherapy With Outcomes Among Patients With Stage I to II vs Stage III Small Cell Lung Cancer: Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol 2019; 5:e185335. [PMID: 30520977 PMCID: PMC6439849 DOI: 10.1001/jamaoncol.2018.5335] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/07/2018] [Indexed: 01/30/2023]
Abstract
Importance There is limited evidence to guide stage I to II small cell lung cancer (SCLC) treatment. Objective To examine the characteristics and outcomes among patients with stage I to II SCLC treated with modern chemoradiotherapy. Design, Setting, and Participants In this post hoc secondary analysis of the Concurrent Once-Daily vs Twice-Daily Radiotherapy Trial (CONVERT), a multicenter phase 3 trial conducted in patients with limited-stage SCLC from April 7, 2008, to November 29, 2013, patients with TNM stage I to II SCLC were compared with those with stage III disease. Data analysis was performed from November 1, 2017, to February 28, 2018. Interventions In CONVERT, patients were randomized to receive twice-daily (45 Gy in 30 fractions) or once-daily (66 Gy in 33 fractions) chemoradiotherapy. Prophylactic cranial irradiation (PCI) was offered, if indicated. Main Outcomes and Measures The primary trial end point was overall survival (OS). TNM staging information was collected prospectively; this was an unplanned analysis because stratification was not performed according to TNM stage. Results A total of 509 (277 [54.4%] men; mean [SD] age, 61.5 [8.3] years) of 543 patients (93.7%) with TNM staging information were eligible for this subgroup analysis, and 86 of the 509 (16.9%) had TNM stage I to II disease. The median gross tumor volume was smaller in patients with stage I to II disease (38.4 cm3; range, 2.2-593.0 cm3) compared with patients with stage III disease (93 cm3; range, 0.5-513.4 cm3) (P < .001). No other significant differences were found in baseline and treatment characteristics and chemoradiotherapy adherence between the 2 groups or the number of patients with stage I to II disease (78 [90.7%]) and stage III disease (346 [81.8%]) who received PCI (P = .10). Patients with stage I to II disease achieved longer OS (median, 50 months [95% CI, 38 to not reached months] vs 25 months [95% CI, 21-29 months]; hazard ratio, 0.60 [95% CI, 0.44-0.83]; P = .001) compared with patients with stage III disease. In patients with stage I to II disease, no significant survival difference was found between the trial arms (median, 39 months in the once-daily arm vs 72 months in the twice-daily arm; P = .38). Apart from lower incidence of acute esophagitis in patients with stage I to II disease compared with patients with stage III disease (grade ≥3, 9 [11.3%] vs 82 [21.1%]; P < .001), the incidences of acute and late toxic effects were not significantly different. Conclusions and Relevance Patients with stage I to II SCLC in CONVERT achieved long-term survival with acceptable toxic effects after chemoradiotherapy and PCI. This study suggests that patients with stage I to II small cell lung cancer treated with modern chemoradiotherapy have better outcomes compared with patients with stage III disease, providing information that practitioners can potentially give their patients to aid clinical decisions. Trial Registration ClinicalTrials.gov identifier: NCT00433563.
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Affiliation(s)
- Ahmed Salem
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Hitesh Mistry
- Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | | | | | - Isabelle Monnet
- Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Fiona Blackhall
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
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13
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Zhu D, Wang Y, Wang L, Chen J, Byanju S, Zhang H, Liao M. Prognostic value of the maximum standardized uptake value of pre-treatment primary lesions in small-cell lung cancer on 18F-FDG PET/CT: a meta-analysis. Acta Radiol 2018; 59:1082-1090. [PMID: 29256260 DOI: 10.1177/0284185117745907] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) has been widely used in clinical practice. However, the prognostic value of the pre-treatment standardized uptake value (SUV) for patients with small-cell lung cancer (SCLC) remains controversial. Purpose To investigate the prognostic role of pre-treatment 18F-FDG PET on SCLC patients by meta-analysis. Material and Methods Extensive literature searches of the PubMed, EMBASE, Web of Science, and Cochrane Library databases were conducted to identify literature published until 5 May 2017. Comparative analyses of the pooled hazard ratios (HRs) for event-free survival (EFS) and overall survival (OS) were performed to assess their correlations with the pre-treatment maximum SUV (SUVmax). Either the fixed- or the random-effects model was adopted, depending on the heterogeneity observed across the studies. Subgroup analyses were performed to assess the robustness of the results. Results Twelve studies with 1062 patients were included. The pooled HR for OS of 11 studies was 1.13 (95% confidence interval [CI] = 1.05-1.22; P = 0.001; I2 = 0%) and the pooled HR for EFS of nine studies was 1.09 (95% CI = 1.02-1.17; P = 0.014; I2 = 0%), indicating that patients with high SUVs may have poorer prognoses. Begg's test detected no significant publication bias. The prognostic role of the SUVmax remained similar in the subgroup analyses. Conclusion Our meta-analysis indicated that the pre-treatment SUVmax of primary lesions can be an important prognostic factor for OS and EFS in patients with SCLC. A high SUVmax may indicate poorer prognosis.
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Affiliation(s)
- Dongyong Zhu
- Department of Radiology, ZhongNan Hospital of WuHan University, Wuhan City, PR China
| | - Yanfang Wang
- Department of Radiology, ZhongNan Hospital of WuHan University, Wuhan City, PR China
| | - Lisha Wang
- Department of Neurology, ZhongNan Hospital of WuHan University, Wuhan City, PR China
| | - Jie Chen
- Department of Radiology, ZhongNan Hospital of WuHan University, Wuhan City, PR China
| | - Sama Byanju
- Department of Radiology, ZhongNan Hospital of WuHan University, Wuhan City, PR China
| | - Hanfei Zhang
- Department of Radiology, ZhongNan Hospital of WuHan University, Wuhan City, PR China
| | - Meiyan Liao
- Department of Radiology, ZhongNan Hospital of WuHan University, Wuhan City, PR China
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14
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Aktan M, Kanyilmaz G, Yavuz BB, Koc M, Eryılmaz MA, Adli M. Prognostic value of pre-treatment 18F-FDG PET uptake for nasopharyngeal carcinoma. LA RADIOLOGIA MEDICA 2017:10.1007/s11547-017-0837-4. [PMID: 29177728 DOI: 10.1007/s11547-017-0837-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/14/2017] [Indexed: 02/01/2023]
Abstract
PURPOSE To evaluate the prognostic value of maximal standardized uptake values (SUVmax) from serial fluor-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS Fifty-two patients with NPC who underwent 18F-FDG PET/CT scan before radiotherapy with/without chemotherapy were reviewed retrospectively. Twenty-seven patients (52%) were applied 3-D conformal radiotherapy and 25 patients (48%) applied intensity-modulated radiotherapy (IMRT). Fourteen (27%) patients were given neoadjuvant chemotherapy and forty-four (84.6%) patients were given concomitant and adjuvant chemotherapy. RESULTS Median follow-up time was 34 months (range 5.6-66.4 months). Forty-four (84.6%) patients were alive at last follow-up and eight (15.4%) had died. The best cut-off value of the SUVmax for the primary tumor site (SUVmax-PT) was 13 and 9 for the lymph nodes (SUVmax-LN). Patients with SUVmax-PT ≥ 13.0 and SUVmax-LN ≥ 9 had a significantly higher risk for the development of the distant metastases (p = 0.044 and p = 0.038). DFS was affected in patients with SUVmax-PT ≥ 13 (log rank χ 2 = 2.54, p = 0.017) and was significantly lower in patients with SUVmax-LN ≥ 9 for the lymph nodes (log rank χ 2 = 5.81, p = 0.013). OS was not affected by SUV levels. A multivariate Cox proportional hazard model of DFS included age (≥ 40), SUVmax-LN (< 9), T stage (T1-2) and neoadjuvant chemotherapy are significantly better prognosis for the DFS. CONCLUSION 18F-FDG PET/CT uptake before treatment, as determined by SUVmax, may be a valuable tool to evaluate prognosis in NPC patients.
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Affiliation(s)
- Meryem Aktan
- Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, 42090, Konya, Turkey.
| | - Gul Kanyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, 42090, Konya, Turkey
| | - Berrin Benli Yavuz
- Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, 42090, Konya, Turkey
| | - Mehmet Koc
- Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, 42090, Konya, Turkey
| | - Mehmet Akif Eryılmaz
- Department of Otorhinolaryngology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mustafa Adli
- Department of Radiation Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
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