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Kratochwil C, Flechsig P, Lindner T, Abderrahim L, Altmann A, Mier W, Adeberg S, Rathke H, Röhrich M, Winter H, Plinkert PK, Marme F, Lang M, Kauczor HU, Jäger D, Debus J, Haberkorn U, Giesel FL. 68Ga-FAPI PET/CT: Tracer Uptake in 28 Different Kinds of Cancer. J Nucl Med 2019; 60:801-805. [PMID: 30954939 DOI: 10.2967/jnumed.119.227967] [Citation(s) in RCA: 823] [Impact Index Per Article: 164.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/19/2019] [Indexed: 12/31/2022] Open
Abstract
The recent development of quinoline-based PET tracers that act as fibroblast-activation-protein inhibitors (FAPIs) demonstrated promising preclinical and clinical results. FAP is overexpressed by cancer-associated fibroblasts of several tumor entities. Here, we quantify the tumor uptake on 68Ga-FAPI PET/CT of various primary and metastatic tumors to identify the most promising indications for future application. Methods: 68Ga-FAPI PET/CT scans were requested by various referring physicians according to individual clinical indications that were considered insufficiently covered by 18F-FDG PET/CT or other imaging modalities. All PET/CT was performed 1 h after injection of 122-312 MBq of 68Ga-FAPI-04. We retrospectively identified 80 patients with histopathologically proven primary tumors or metastases or radiologically unequivocal metastatic lesions of histologically proven primary tumors. Tumor uptake was quantified by SUVmax and SUVmean (60% isocontour). Results: Eighty patients with 28 different tumor entities (54 primary tumors and 229 metastases) were evaluated. The highest average SUVmax (>12) was found in sarcoma, esophageal, breast, cholangiocarcinoma, and lung cancer. The lowest 68Ga-FAPI uptake (average SUVmax < 6) was observed in pheochromocytoma, renal cell, differentiated thyroid, adenoid cystic, and gastric cancer. The average SUVmax of hepatocellular, colorectal, head-neck, ovarian, pancreatic, and prostate cancer was intermediate (SUV 6-12). SUV varied across and within all tumor entities. Because of low background in muscle and blood pool (SUVmax < 2), the tumor-to-background contrast ratios were more than 3-fold in the intermediate and more than 6-fold in the high-intensity uptake group. Conclusion: Several highly prevalent cancers presented with remarkably high uptake and image contrast on 68Ga-FAPI PET/CT. The high and rather selective tumor uptake may open up new applications for noninvasive tumor characterization, staging examinations, or radioligand therapy.
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Affiliation(s)
- Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Flechsig
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Thomas Lindner
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Labidi Abderrahim
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Annette Altmann
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Walter Mier
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Hendrik Rathke
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Röhrich
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hauke Winter
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany.,Department of Surgery, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Frederik Marme
- Department Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany.,Department Obstetrics and Gynecology, University Hospital Mannheim, Mannheim, Germany
| | - Matthias Lang
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, University Hospital Heidelberg, Germany.,Clinical Cooperation Unit Applied Tumor Immunity, German Cancer Research Center, Heidelberg, Germany; and
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Huang SH, Xu W, Waldron J, Siu L, Shen X, Tong L, Ringash J, Bayley A, Kim J, Hope A, Cho J, Giuliani M, Hansen A, Irish J, Gilbert R, Gullane P, Perez-Ordonez B, Weinreb I, Liu FF, O'Sullivan B. Refining American Joint Committee on Cancer/Union for International Cancer Control TNM stage and prognostic groups for human papillomavirus-related oropharyngeal carcinomas. J Clin Oncol 2015; 33:836-45. [PMID: 25667292 DOI: 10.1200/jco.2014.58.6412] [Citation(s) in RCA: 306] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To refine stage and prognostic group for human papillomavirus (HPV) -related nonmetastatic (M0) oropharyngeal cancer (OPC). METHODS All patients with nonmetastatic (M0) p16-confirmed OPC treated with radiotherapy with or without chemotherapy from 2000 to 2010 were included. Overall survival (OS) was compared among TNM stages for patients with HPV-related and HPV-unrelated OPC separately. For HPV-related OPC, recursive partitioning analysis (RPA) derived new RPA stages objectively. Cox regression was used to calculate adjusted hazard ratios (AHRs) to derive AHR stages. The performance of survival prediction of RPA stage and AHR stage was assessed against the current seventh edition TNM stages. Prognostic groups were derived by RPA, combining RPA stage and nonanatomic factors. RESULTS The cohort comprised 573 patients with HPV-related OPC and 237 patients with HPV-unrelated OPC, with a median follow-up of 5.1 years. Lower 5-year OS with higher TNM stage was evident for patients with HPV-unrelated OPC (stage I, II, III, and IV 5-year OS: 70%, 58%, 50%, and 30%, respectively; P = .004) but not for patients with HPV-related OPC (stage I, II, III, and IV 5-year OS: 88%, 78%, 71%, and 74%, respectively; P = .56). RPA divided HPV-related OPC into RPA-I (T1-3N0-2b), RPA-II (T1-3N2c), and RPA-III (T4 or N3; 5-year OS: 82%, 76%, and 54%, respectively; P < .001). AHR also yielded a valid classification, but RPA stage demonstrated better survival prediction. A further RPA (including RPA stage, age, and smoking pack-years [PYs]) derived the following four valid prognostic groups for survival: group I (T1-3N0-N2c_≤ 20 PY), group II (T1-3N0-N2c_> 20 PY), group III (T4 or N3_age ≤ 70), and group IVA (T4 or N3_age > 70; 5-year OS: 89%, 64%, 57%, and 40%, respectively; P < .001). CONCLUSION An RPA-based TNM stage grouping (stage I/II/III: T1-3N0-N2b/T1-3N2c/T4 or N3, with M1 as stage IV) is proposed for HPV-related OPC as a result of significantly improved survival prediction compared with the seventh edition TNM, and prognostication is further improved by an RPA-based prognostic grouping within the American Joint Committee on Cancer/Union for International Cancer Control TNM framework for HPV-related OPC.
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Affiliation(s)
- Shao Hui Huang
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Wei Xu
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - John Waldron
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Lillian Siu
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Xiaowei Shen
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Li Tong
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Jolie Ringash
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew Bayley
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - John Kim
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew Hope
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - John Cho
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Aaron Hansen
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Jonathan Irish
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Patrick Gullane
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Bayardo Perez-Ordonez
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Ilan Weinreb
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Fei-Fei Liu
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada.
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