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Cegla P, Hofheinz F, Czepczyński R, Witkowska K, van den Hoff J, Trojanowski M, Bos-Liedke A, Cholewinski W. Value of [ 18F]FDG PET/CT parameters of the primary tumor in assessing overall survival in NSCLC patients with cN1-cN3 lymph nodes involvement. Rep Pract Oncol Radiother 2024; 29:97-102. [PMID: 39165594 PMCID: PMC11333082 DOI: 10.5603/rpor.99360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/23/2024] [Indexed: 08/22/2024] Open
Abstract
Background The aim of this retrospective study was to assess the value of 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT parameters in cN1-cN3 non-small cell lung cancer (NSCLC) patients. Materials and methods 59 consecutive patients (35 M, 24 F) with NSCLC who underwent pretreatment [18F]FDG PET/CT were enrolled to this study. Several primary tumor PET parameters, including the maximum and mean standardized uptake value (SUVmax and SUVmean), the metabolic active tumor volume (MTV) and the total lesion glycolysis (TLG = MTVxSUVmean), were extracted and analysed. Overall survival was defined as time from primary diagnosis to death or the last info. Results In the whole analysed group 44 patients underwent curative treatment, while 15, because of the severity of the disease, were classified for palliative treatment. Univariate Cox analysis of clinical and metric PET parameters revealed that MTV was a significant prognostic factor for OS (p = 0.024), while TLG and curative treatment showed a trend for significance (p < 0.1). In multivariate Cox regression (MTV and curative treatment) MTV remained a significant factor (p = 0.047). Conclusions Metabolic tumor volume of the primary tumor was the only independent prognostic factor for cN1-cN3 NSCLC patients.
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Affiliation(s)
- Paulina Cegla
- Department of Nuclear Medicine, Greater Poland Cancer Centre, Poznan, Poland
| | - Frank Hofheinz
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
| | - Rafał Czepczyński
- Department of Nuclear Medicine, Affidea, Poznan, Poland
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Jörg van den Hoff
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
| | - Maciej Trojanowski
- Greater Poland Cancer Registry, Greater Poland Cancer Centre, Poznan, Poland
| | | | - Witold Cholewinski
- Department of Nuclear Medicine, Greater Poland Cancer Centre, Poznan, Poland
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
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Grambozov B, Kalantari F, Beheshti M, Stana M, Karner J, Ruznic E, Zellinger B, Sedlmayer F, Rinnerthaler G, Zehentmayr F. Pretreatment 18-FDG-PET/CT parameters can serve as prognostic imaging biomarkers in recurrent NSCLC patients treated with reirradiation-chemoimmunotherapy. Radiother Oncol 2023; 185:109728. [PMID: 37301259 DOI: 10.1016/j.radonc.2023.109728] [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: 02/20/2023] [Revised: 05/02/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE Our study aimed to assess whether quantitative pretreatment 18F-FDG-PET/CT parameters could predict prognostic clinical outcome of recurrent NSCLC patients who may benefit from ablative reirradiation. MATERIALS AND METHODS Forty-eight patients with recurrent NSCLC of all UICC stages who underwent ablative thoracic reirradiation were analyzed. Twenty-nine (60%) patients received immunotherapy with or without chemotherapy in addition to reirradiation. Twelve patients (25%) received reirradiation only and seven (15%) received chemotherapy and reirradiation. Pretreatment 18-FDG-PET/CT was mandatory in initial diagnosis and recurrence, based on which volumetric and intensity quantitative parameters were measured before reirradiation and their impact on overall survival, progression-free survival, and locoregional control was assessed. RESULTS With a median follow-up time of 16.7 months, the median OS was 21.8 months (95%-CI: 16.2-27.3). On multivariate analysis, OS and PFS were significantly influenced by MTV (p < 0.001 for OS; p = 0.006 for PFS), TLG (p < 0.001 for OS; p = 0.001 for PFS) and SUL peak (p = 0.0024 for OS; p = 0.02 for PFS) of the tumor and MTV (p = 0.004 for OS; p < 0.001 for PFS) as well as TLG (p = 0.007 for OS; p = 0.015 for PFS) of the metastatic lymph nodes. SUL peak of the tumor (p = 0.05) and the MTV of the lymph nodes (p = 0.003) were only PET quantitative parameters that significantly impacted LRC. CONCLUSION Pretreatment tumor and metastastic lymph node MTV, TLG and tumor SUL peak significantly correlated with clinical outcome in recurrent NSCLC patients treated with reirradiation-chemoimmunotherapy.
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Affiliation(s)
- Brane Grambozov
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria.
| | - Forough Kalantari
- Department of Nuclear Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran; Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Markus Stana
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Josef Karner
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Elvis Ruznic
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Barbara Zellinger
- Institute of Pathology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Felix Sedlmayer
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria; radART - Institute for Research and Development on Advanced Radiation Technologies, Paracelsus Medical University, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Franz Zehentmayr
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria; radART - Institute for Research and Development on Advanced Radiation Technologies, Paracelsus Medical University, Salzburg, Austria
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Yoo J, Lee J, Cheon M, Kim H, Choi YS, Pyo H, Ahn MJ, Choi JY. Radiomics Analysis of 18F-FDG PET/CT for Prognosis Prediction in Patients with Stage III Non-Small Cell Lung Cancer Undergoing Neoadjuvant Chemoradiation Therapy Followed by Surgery. Cancers (Basel) 2023; 15:cancers15072012. [PMID: 37046673 PMCID: PMC10093358 DOI: 10.3390/cancers15072012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
We investigated the prognostic significance of radiomic features from 18F-FDG PET/CT to predict overall survival (OS) in patients with stage III NSCLC undergoing neoadjuvant chemoradiation therapy followed by surgery. We enrolled 300 patients with stage III NSCLC who underwent PET/CT at the initial work-up (PET1) and after neoadjuvant concurrent chemoradiotherapy (PET2). Radiomic primary tumor features were subjected to LASSO regression to select the most useful prognostic features of OS. The prognostic significance of the LASSO score and conventional PET parameters was assessed by Cox proportional hazards regression analysis. In conventional PET parameters, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of each PET1 and PET2 were significantly associated with OS. In addition, both the PET1-LASSO score and the PET2-LASSO score were significantly associated with OS. In multivariate Cox regression analysis, only the PET2-LASSO score was an independently significant factor for OS. The LASSO score showed better predictive performance for OS regarding the time-dependent receiver operating characteristic curve and decision curve analysis than conventional PET parameters. Radiomic features from PET/CT were an independent prognostic factor for the estimation of OS in stage III NSCLC. The newly developed LASSO score using radiomic features showed better prognostic results for individualized OS estimation than conventional PET parameters.
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Affiliation(s)
- Jang Yoo
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
| | - Jaeho Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Miju Cheon
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Correspondence: ; Tel.: +82-2-3410-2648; Fax: +82-2-3410-2639
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Radiomic and Volumetric Measurements as Clinical Trial Endpoints—A Comprehensive Review. Cancers (Basel) 2022; 14:cancers14205076. [PMID: 36291865 PMCID: PMC9599928 DOI: 10.3390/cancers14205076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary The extraction of quantitative data from standard-of-care imaging modalities offers opportunities to improve the relevance and salience of imaging biomarkers used in drug development. This review aims to identify the challenges and opportunities for discovering new imaging-based biomarkers based on radiomic and volumetric assessment in the single-site solid tumor sites: breast cancer, rectal cancer, lung cancer and glioblastoma. Developing approaches to harmonize three essential areas: segmentation, validation and data sharing may expedite regulatory approval and adoption of novel cancer imaging biomarkers. Abstract Clinical trials for oncology drug development have long relied on surrogate outcome biomarkers that assess changes in tumor burden to accelerate drug registration (i.e., Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) criteria). Drug-induced reduction in tumor size represents an imperfect surrogate marker for drug activity and yet a radiologically determined objective response rate is a widely used endpoint for Phase 2 trials. With the addition of therapies targeting complex biological systems such as immune system and DNA damage repair pathways, incorporation of integrative response and outcome biomarkers may add more predictive value. We performed a review of the relevant literature in four representative tumor types (breast cancer, rectal cancer, lung cancer and glioblastoma) to assess the preparedness of volumetric and radiomics metrics as clinical trial endpoints. We identified three key areas—segmentation, validation and data sharing strategies—where concerted efforts are required to enable progress of volumetric- and radiomics-based clinical trial endpoints for wider clinical implementation.
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Li TC, Zhao X, Liu YN, Wang GL, Liu KF, Zhao K. Prognostic value of node-to-primary tumor maximum standardized uptake value ratio in T1-4N1-3M0 non-small cell lung cancer patients treated with concurrent chemo-radiotherapy. Nucl Med Commun 2022; 43:901-907. [PMID: 35551163 PMCID: PMC9278701 DOI: 10.1097/mnm.0000000000001576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to identify whether NTR is the independent risk factor for progression-free survival (PFS) and overall survival (OS) in patients treated with concurrent chemo-radiotherapy (cCRT). METHODS We retrospectively studied 106 T1-4N1-3M0 non-small cell lung cancer patients treated with cCRT. The maximum standardized uptake value (SUVTumor) of the primary tumor and the metastatic lymph nodes (SUVLN) were measured. The prognostic significance of NTR for predicting PFS and OS was assessed. A multi-adjusted spline regression model was conducted to provide more precise estimates and examine the shape of the associations between NTR and the risk of progression. RESULTS From 2012 to 2017, 106 eligible patients were analyzed. The median follow-up time was 15.3 months (3.5-44.6 months). We determined the maximizing area under the time-dependent receiver operating characteristic curve was at an NTR of 0.73 for predicting PFS. The two-year PFS was significantly lower in the high-NTR group (35.7% vs. 55.4%, P = 0.02) and two-year OS (43.4% vs. 61.1%, P = 0.03 was also significantly worse. Multivariable analysis revealed that only NTR was an independent prognostic factor for PFS (hazard ratio [HR]: 10.04, P < 0.001) and OS (HR: 4.19, P = 0.03). The restricted cubic spline regression model showed that NTR had a non-linear relationship with log relative risk for progression. CONCLUSION NTR was an independent risk factor for predicting PFS and OS in T1-4N1-3M0 non-small cell lung cancer patients treated with cCRT.
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Affiliation(s)
- Tian-cheng Li
- Departments of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xin Zhao
- Departments of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yi-nuo Liu
- Departments of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guo-lin Wang
- Departments of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kai-feng Liu
- Departments of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kui Zhao
- Departments of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Predictive Value of 18F-FDG PET/CT Using Machine Learning for Pathological Response to Neoadjuvant Concurrent Chemoradiotherapy in Patients with Stage III Non-Small Cell Lung Cancer. Cancers (Basel) 2022; 14:cancers14081987. [PMID: 35454899 PMCID: PMC9031866 DOI: 10.3390/cancers14081987] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 12/20/2022] Open
Abstract
We investigated predictions from 18F-FDG PET/CT using machine learning (ML) to assess the neoadjuvant CCRT response of patients with stage III non-small cell lung cancer (NSCLC) and compared them with predictions from conventional PET parameters and from physicians. A retrospective study was conducted of 430 patients. They underwent 18F-FDG PET/CT before initial treatment and after neoadjuvant CCRT followed by curative surgery. We analyzed texture features from segmented tumors and reviewed the pathologic response. The ML model employed a random forest and was used to classify the binary outcome of the pathological complete response (pCR). The predictive accuracy of the ML model for the pCR was 93.4%. The accuracy of predicting pCR using the conventional PET parameters was up to 70.9%, and the accuracy of the physicians’ assessment was 80.5%. The accuracy of the prediction from the ML model was significantly higher than those derived from conventional PET parameters and provided by physicians (p < 0.05). The ML model is useful for predicting pCR after neoadjuvant CCRT, which showed a higher predictive accuracy than those achieved from conventional PET parameters and from physicians.
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Choi Y, Choi JY, Hong TH, Choi YL, Oh D, Woo SY, Shim YM, Zo JI, Kim HK, Lee KS. Trimodality therapy for locally advanced esophageal squamous cell carcinoma: the role of volume-based PET/CT in patient management and prognostication. Eur J Nucl Med Mol Imaging 2021; 49:751-762. [PMID: 34365522 DOI: 10.1007/s00259-021-05487-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 07/03/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the role of positron emission tomography/computed tomography (PET/CT) in predicting pathologic complete response (pCR) and identify relevant prognostic factors from clinico-imaging-pathologic features of locally advanced esophageal squamous cell carcinoma (eSCC) patients undergoing trimodality therapy. METHODS We evaluated 275 patients with eSCCs of T3-T4aN0M0 and T1-T4aN1-N3M0 who received trimodality therapy. We correlated volume-based PET/CT parameters before and after concurrent chemoradiation therapy with pCR after surgery, clinico-imaging-pathologic features, and patient survival. RESULTS pCR occurred in 75 (27.3%) of 275 patients, of whom 61 (80.9%) showed 5-year survival. Pre-total lesion glycolysis (pre-TLG, OR = 0.318, 95% CI 0.169 to 0.600), post-metabolic tumor volume (post-MTV, OR = 0.572, 95% CI 0.327 to 0.999), and % decrease of average standardized uptake value (% SUVavg decrease, OR = 2.976, 95% CI = 1.608 to 5.507) were significant predictors for pCR. Among them, best predictor for pCR was pre-TLG with best cutoff value of 205.67 and with AUC value of 0.591. Performance status (HR = 5.171, 95% CI 1.737 to 15.397), pathologic tumor size (HR = 1.645, 95% CI 1.351 to 2.002), pathologic N status (N1, HR = 1.572, 95% CI 1.010 to 2.446; N2, HR = 3.088, 95% CI 1.845 to 5.166), and post-metabolic tumor volume (HR = 1.506, 95% CI 1.033 to 2.195) were significant predictors of overall survival. CONCLUSION Pre-TLG, post-MTV, and % SUVavg decrease are predictive of pCR. Additionally, several clinico-imaging-pathologic factors are significant survival predictors in locally advanced eSCC patients undergoing trimodality therapy.
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Affiliation(s)
- Yeonu Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea
| | - Tae Hee Hong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea
| | - Yoon-La Choi
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Sook Young Woo
- Biostatistics Unit, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea. .,Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, 51353, Gyeongsangnam-Do, Korea.
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Monaco L, Gemelli M, Gotuzzo I, Bauckneht M, Crivellaro C, Genova C, Cortinovis D, Zullo L, Ammoni LC, Bernasconi DP, Rossi G, Morbelli S, Guerra L. Metabolic Parameters as Biomarkers of Response to Immunotherapy and Prognosis in Non-Small Cell Lung Cancer (NSCLC): A Real World Experience. Cancers (Basel) 2021; 13:cancers13071634. [PMID: 33915801 PMCID: PMC8037395 DOI: 10.3390/cancers13071634] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/22/2022] Open
Abstract
Immune-checkpoint inhibitors (ICIs) have been proven to have great efficacy in non-small cell lung cancer (NSCLC) as single agents or in combination therapy, being capable to induce deep and durable remission. However, severe adverse events may occur and about 40% of patients do not benefit from the treatment. Predictive factors of response to ICIs are needed in order to customize treatment. The aim of this study is to evaluate the correlation between quantitative positron emission tomography (PET) parameters defined before starting ICI therapy and responses to treatment and patient outcome. We retrospectively analyzed 92 NSCLC patients treated with nivolumab, pembrolizumab or atezolizumab. Basal PET/computed tomography (CT) scan parameters (whole-body metabolic tumor volume-wMTV, total lesion glycolysis-wTLG, higher standardized uptake volume maximum and mean-SUVmax and SUVmean) were calculated for each patient and correlated with outcomes. Patients who achieved disease control (complete response + partial response + stable disease) had significantly lower MTV median values than patients who had not (progressive disease) (77 vs. 160.2, p = 0.039). Furthermore, patients with MTV and TLG values lower than the median values had improved OS compared to patients with higher MTV and TLG (p = 0.03 and 0.05, respectively). No relation was found between the other parameters and outcome. In conclusion, baseline metabolic tumor burden, measured with MTV, might be an independent predictor of treatment response to ICI and a prognostic biomarker in NSCLC patients.
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Affiliation(s)
- Lavinia Monaco
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy; (L.M.); (L.G.)
| | - Maria Gemelli
- Medical Oncology, ASST Monza, San Gerardo Hospital, 20900 Monza, Italy; (M.G.); (D.C.)
| | - Irene Gotuzzo
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy; (L.M.); (L.G.)
- Correspondence:
| | - Matteo Bauckneht
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.B.); (S.M.)
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
| | - Cinzia Crivellaro
- Nuclear Medicine, ASST Monza San Gerardo Hospital, 20900 Monza, Italy;
| | - Carlo Genova
- UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
- Dipartimento di Medicina Interna e Specialità Mediche (DiMI), Facoltà di Medicina e Chirurgia, Università degli Studi di Genova, 16132 Genova, Italy
| | - Diego Cortinovis
- Medical Oncology, ASST Monza, San Gerardo Hospital, 20900 Monza, Italy; (M.G.); (D.C.)
| | - Lodovica Zullo
- UOC Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | | | - Davide Paolo Bernasconi
- Bicocca Biostatistics Bioinformatics and Bioimaging Center—B4, School of Medicine and Surgery, University Milano Bicocca, 20128 Milano, Italy;
| | - Giovanni Rossi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
- UO Oncologia Medica, Ospedale Padre Antero Micone, 16153 Genova, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.B.); (S.M.)
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
| | - Luca Guerra
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy; (L.M.); (L.G.)
- Nuclear Medicine, ASST Monza San Gerardo Hospital, 20900 Monza, Italy;
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Katsui K, Ogata T, Tada A, Watanabe K, Yoshio K, Kuroda M, Kiura K, Hiraki T, Toyooka S, Kanazawa S. A PET/CT volumetric parameter predicts prognosis of non-small cell lung cancer treated using preoperative chemoradiotherapy and surgery: A retrospective case series study. Mol Clin Oncol 2021; 14:73. [PMID: 33680461 PMCID: PMC7922798 DOI: 10.3892/mco.2021.2235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/17/2020] [Indexed: 12/25/2022] Open
Abstract
The purpose of the present study was to clarify whether positron emission tomography/computed tomography (PET/CT) volumetric parameters were prognostic predictors of non-small cell lung cancer (NSCLC) treatment in patients who had undergone preoperative concurrent chemoradiotherapy (CCRT) and surgery. In the present study, retrospectively surveyed the data of patients with NSCLC who underwent preoperative CCRT and surgery at Okayama University Hospital (Okayama, Japan) between April 2006 and March 2018. The maximum standardized uptake value (SUVmax) and volumetric parameters, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were calculated using PET/CT and the percentage decrease (Δ) in each parameter value post-CCRT. The SUVmax threshold for defining MTV was set at 2.5. Furthermore, the association between survival and PET parameter values was analyzed. A total of 52 patients were included in the present study. The median follow-up period was 50.65 months. In univariate analysis, ΔTLG was identified to be a significant predictor of progression-free survival (PFS; P=0.03). The 5-year PFS rates were 48.6 and 76.6% for patients with low ΔTLG and high ΔTLG, respectively. High ΔTLG was indicative of a higher overall survival rate (P=0.08). The present results suggest that ΔTLG calculated using PET/CT is a prognostic predictor of NSCLC treated using preoperative CCRT and surgery, and may help physicians determine treatment strategies.
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Affiliation(s)
- Kuniaki Katsui
- Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takeshi Ogata
- Department of Radiology, Iwakuni Clinical Center, Iwakuni, Yamaguchi 740-8510, Japan
| | - Akihiro Tada
- Department of Radiology, Okayama Diagnostic Imaging Center, Okayama 700-0913, Japan
| | - Kenta Watanabe
- Department of Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Kotaro Yoshio
- Department of Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Masahiro Kuroda
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama 700-8558, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Multiple Testing, Cut-Point Optimization, and Signs of Publication Bias in Prognostic FDG-PET Imaging Studies of Head and Neck and Lung Cancer: A Review and Meta-Analysis. Diagnostics (Basel) 2020; 10:diagnostics10121030. [PMID: 33271785 PMCID: PMC7761090 DOI: 10.3390/diagnostics10121030] [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: 10/19/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/23/2022] Open
Abstract
Positron emission tomography (PET) imaging with 2-deoxy-2-[18F]-fluorodeoxyglucose (FDG) was proposed as prognostic marker in radiotherapy. Various uptake metrics and cut points were used, potentially leading to inflated effect estimates. Here, we performed a meta-analysis and systematic review of the prognostic value of pretreatment FDG–PET in head and neck squamous cell carcinoma (HNSCC) and non-small cell lung cancer (NSCLC), with tests for publication bias. Hazard ratio (HR) for overall survival (OS), disease free survival (DFS), and local control was extracted or derived from the 57 studies included. Test for publication bias was performed, and the number of statistical tests and cut-point optimizations were registered. Eggers regression related to correlation of SUVmax with OS/DFS yielded p = 0.08/p = 0.02 for HNSCC and p < 0.001/p = 0.014 for NSCLC. No outcomes showed significant correlation with SUVmax, when adjusting for publication bias effect, whereas all four showed a correlation in the conventional meta-analysis. The number of statistical tests and cut points were high with no indication of improvement over time. Our analysis showed significant evidence of publication bias leading to inflated estimates of the prognostic value of SUVmax. We suggest that improved management of these complexities, including predefined statistical analysis plans, are critical for a reliable assessment of FDG–PET.
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Prognostic factors for overall survival of stage III non-small cell lung cancer patients on computed tomography: A systematic review and meta-analysis. Radiother Oncol 2020; 151:152-175. [PMID: 32710990 DOI: 10.1016/j.radonc.2020.07.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Prognosis prediction is central in treatment decision making and quality of life for non-small cell lung cancer (NSCLC) patients. However, conventional computed tomography (CT) related prognostic factors may not apply to the challenging stage III NSCLC group. The aim of this systematic review was therefore to identify and evaluate CT-related prognostic factors for overall survival (OS) of stage III NSCLC. METHODS The Medline, Embase, and Cochrane electronic databases were searched. After study selection, risk of bias was estimated for the included studies. Meta-analysis of univariate results was performed when sufficient data were available. RESULTS 1595 of the 11,996 retrieved records were selected for full text review, leading to inclusion of 65 studies that reported data of 144,513 stage III NSCLC patients andcompromising 26 unique CT-related prognostic factors. Relevance and validity varied substantially, few studies had low relevance and validity. Only four studies evaluated the added value of new prognostic factors compared with recognized clinical factors. Included studies suggested gross tumor volume (meta-analysis: HR = 1.22, 95%CI: 1.05-1.42), tumor diameter, nodal volume, and pleural effusion, are prognostic in patients treated with chemoradiation. Clinical T-stage and location (right/left) were likely not prognostic within stage III NSCLC. Inconclusive are several radiomic features, tumor volume, atelectasis, location (pulmonary lobes, central/peripheral), interstitial lung abnormalities, great vessel invasion, pit-fall sign, and cavitation. CONCLUSIONS Tumor-size and nodal size-related factors are prognostic for OS in stage III NSCLC. Future studies should carefully report study characteristics and contrast factors with guideline recognized factors to improve evidence evaluation and validation.
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Castello A, Rossi S, Lopci E. 18F-FDG PET/CT in Restaging and Evaluation of Response to Therapy in Lung Cancer: State of the Art. Curr Radiopharm 2019; 13:228-237. [PMID: 31886757 PMCID: PMC8493792 DOI: 10.2174/1874471013666191230144821] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 01/25/2019] [Accepted: 11/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Metabolic information provided by 18F-FDG PET/CT are useful for initial staging, therapy planning, response evaluation, and to a lesser extent for the follow-up of non-small cell lung cancer (NSCLC). To date, there are no established clinical guidelines in treatment response and early detection of recurrence. OBJECTIVE To provide an overview of 18F-FDG PET/CT in NSCLC and in particular, to discuss its utility in treatment response evaluation and restaging of lung cancer. METHODS A comprehensive search was used based on PubMed results. From all studies published in English those that explored the role of 18F-FDG PET/CT in the treatment response scenario were selected. RESULTS Several studies have demonstrated that modifications in metabolic activity, expressed by changes in SUV both in the primary tumor as well as in regional lymph nodes, are associated with tumor response and survival. Beside SUV, other metabolic parameters (i.e. MTV, TLG, and percentage changes) are emerging to be helpful for predicting clinical outcomes. CONCLUSION 18F-FDG parameters appear to be promising factors for evaluating treatment response and for detecting recurrences, although larger prospective trials are needed to confirm these evidences and to determine optimal cut-off values.
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Affiliation(s)
- Angelo Castello
- Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Sabrina Rossi
- Medical Oncology, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Egesta Lopci
- Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Italy
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Ganem J, Thureau S, Gouel P, Dubray B, Salaun M, Texte E, Vera P. Prognostic value of post-induction chemotherapy 18F-FDG PET-CT in stage II/III non-small cell lung cancer before (chemo-) radiation. PLoS One 2019; 14:e0222885. [PMID: 31603916 PMCID: PMC6788704 DOI: 10.1371/journal.pone.0222885] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The purpose of our present study was to assess the prognostic impact of FDG PET-CT after induction chemotherapy for patients with inoperable non-small-cell lung cancer (NSCLC). MATERIAL AND METHODS This retrospective study included 50 patients with inoperable stage II/III NSCLC from January 2012 to July 2015. They were treated for curative intent with induction chemotherapy, followed by concomitant chemoradiation therapy or sequential radiation therapy. FDG PET-CT scans were acquired at initial staging (PET1) and after the last cycle of induction therapy (PET2). Five parameters were evaluated on both scans: SUVmax, SUVpeak, SUVmean, TLG, MTV, and their respective deltas. The prognostic value of each parameter for overall survival (OS) and progression-free survival (PFS) was evaluated with Cox proportional-hazards regression models. RESULTS Median follow-up was 19 months. PET1 parameters, clinical and histopathological data were not predictive of the outcome. TLG2 and ΔTLG were prognostic factors for OS. TLG2 was the only prognostic factor for PFS. For OS, log-rank test showed that there was a better prognosis for patients with TLG2< 69g (HR = 7.1, 95%CI 2.8-18, p = 0.002) and for patients with ΔTLG< -81% after induction therapy (HR = 3.8, 95%CI 1.5-9.6, p = 0.02). After 2 years, the survival rate was 89% for the patients with low TLG2 vs 52% for the others. We also evaluated a composite parameter considering both MTV2 and ΔSUVmax. Patients with MTV2> 23cc and ΔSUVmax> -55% had significantly shorter OS than the other patients (HR = 5.7, 95%CI 2.1-15.4, p< 0.01). CONCLUSION Post-induction FDG PET might be an added value to assess the patients' prognosis in inoperable stage II/III NSCLC. TLG, ΔTLG as well as the association of MTV and ΔSUVmax seemed to be valuable parameters, more accurate than clinical, pathological or pretherapeutic imaging data.
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Affiliation(s)
- Julien Ganem
- Department of Nuclear Medicine, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France
- * E-mail:
| | - Sebastien Thureau
- Department of Nuclear Medicine, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France
- QuantIF-LITIS, EA 4108-FR, CNRS, University of Rouen, Rouen, France
| | - Pierrick Gouel
- Department of Nuclear Medicine, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France
- QuantIF-LITIS, EA 4108-FR, CNRS, University of Rouen, Rouen, France
| | - Bernard Dubray
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France
- QuantIF-LITIS, EA 4108-FR, CNRS, University of Rouen, Rouen, France
| | - Mathieu Salaun
- QuantIF-LITIS, EA 4108-FR, CNRS, University of Rouen, Rouen, France
- Department of Pneumology, Rouen University Hospital, Rouen, France
| | - Edgar Texte
- Department of Nuclear Medicine, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France
| | - Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France
- QuantIF-LITIS, EA 4108-FR, CNRS, University of Rouen, Rouen, France
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Xie HJ, Zhang X, Mo YX, Long H, Rong TH, Su XD. Tumor Volume Is Better Than Diameter for Predicting the Prognosis of Patients with Early-Stage Non-small Cell Lung Cancer. Ann Surg Oncol 2019; 26:2401-2408. [PMID: 31054041 DOI: 10.1245/s10434-019-07412-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study aimed to investigate whether tumor volume (TV) is better than diameter for predicting the prognosis of patients with early-stage non-small cell lung cancer (NSCLC) after complete resection. METHODS This study retrospectively reviewed the clinicopathologic characteristics of 274 patients with early-stage NSCLC who had received pretreatment computed tomography (CT) scans and complete resection. TV was semi-automatically measured from CT scans using an imaging software program. The optimal cutoff of TV was determined by X-tile software. Disease-free survival (DFS) and overall survival (OS) were assessed by the Kaplan-Meier method. The prognostic significance of TV and other variables was assessed by Cox proportional hazards regression analysis. RESULTS Using 3.046 cm3 and 8.078 cm3 as optimal cutoff values of TV, the patients were separated into three groups. A larger TV was significantly associated with poor DFS and OS in the multivariable analysis. Kaplan-Meier curves of DFS and OS showed significant differences on the basis of TV among patients with stage 1a disease, greatest tumor diameter (GTD) of 2 cm or smaller, and GTD of 2-3 cm, respectively. Using two TV cutoff points, three categories of TV were created. In 54 cases (19.7%), patients migrated from the GTD categories of 2 cm or smaller, 2-3 cm, and larger than 3 cm into the TV categories of 3.046 cm3 or smaller, 3.046-8.078 cm3, and larger than 8.078 cm3. CONCLUSION TV is an independent prognostic factor of DFS and OS for early-stage NSCLC. The findings show that TV is better than GTD for predicting the prognosis of patients with early-stage NSCLC.
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Affiliation(s)
- Hao-Jun Xie
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, China
| | - Xu Zhang
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, China
| | - Yun-Xian Mo
- State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Radiology, Sun Yat Sen University Cancer Center, Guangzhou, China
| | - Hao Long
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, China
| | - Tie-Hua Rong
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, China
| | - Xiao-Dong Su
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China. .,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. .,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, China.
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Pu Y, Zhang JX, Liu H, Appelbaum D, Meng J, Penney BC. Developing and validating a novel metabolic tumor volume risk stratification system for supplementing non-small cell lung cancer staging. Eur J Nucl Med Mol Imaging 2018; 45:2079-2092. [PMID: 29882161 DOI: 10.1007/s00259-018-4059-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/23/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE We hypothesized that whole-body metabolic tumor volume (MTVwb) could be used to supplement non-small cell lung cancer (NSCLC) staging due to its independent prognostic value. The goal of this study was to develop and validate a novel MTVwb risk stratification system to supplement NSCLC staging. METHODS We performed an IRB-approved retrospective review of 935 patients with NSCLC and FDG-avid tumor divided into modeling and validation cohorts based on the type of PET/CT scanner used for imaging. In addition, sensitivity analysis was conducted by dividing the patient population into two randomized cohorts. Cox regression and Kaplan-Meier survival analyses were performed to determine the prognostic value of the MTVwb risk stratification system. RESULTS The cut-off values (10.0, 53.4 and 155.0 mL) between the MTVwb quartiles of the modeling cohort were applied to both the modeling and validation cohorts to determine each patient's MTVwb risk stratum. The survival analyses showed that a lower MTVwb risk stratum was associated with better overall survival (all p < 0.01), independent of TNM stage together with other clinical prognostic factors, and the discriminatory power of the MTVwb risk stratification system, as measured by Gönen and Heller's concordance index, was not significantly different from that of TNM stage in both cohorts. Also, the prognostic value of the MTVwb risk stratum was robust in the two randomized cohorts. The discordance rate between the MTVwb risk stratum and TNM stage or substage was 45.1% in the modeling cohort and 50.3% in the validation cohort. CONCLUSION This study developed and validated a novel MTVwb risk stratification system, which has prognostic value independent of the TNM stage and other clinical prognostic factors in NSCLC, suggesting that it could be used for further NSCLC pretreatment assessment and for refining treatment decisions in individual patients.
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Affiliation(s)
- Yonglin Pu
- Department of Radiology, The University of Chicago, 5841 S. Maryland Ave., MC 2026, Chicago, IL, 60637, USA.
| | - James X Zhang
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Haiyan Liu
- Department of Nuclear Medicine, First Hospital and Molecular Imaging Precision Medical Collaborative Innovation Center, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Daniel Appelbaum
- Department of Radiology, The University of Chicago, 5841 S. Maryland Ave., MC 2026, Chicago, IL, 60637, USA
| | - Jianfeng Meng
- Department of Respiratory Medicine, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541002, Guangxi Zhuang Autonomous Region, China
| | - Bill C Penney
- Department of Radiology, The University of Chicago, 5841 S. Maryland Ave., MC 2026, Chicago, IL, 60637, USA
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16
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Cheng G, Huang H. Prognostic Value of 18F-Fluorodeoxyglucose PET/Computed Tomography in Non-Small-Cell Lung Cancer. PET Clin 2017; 13:59-72. [PMID: 29157386 DOI: 10.1016/j.cpet.2017.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related death with a poor prognosis. Numerous factors contribute to treatment outcome. 18F-fluorodeoxyglucose (FDG) uptake reflects tumor metabolic activity and is an important prognosticator in patients with NSCLC. Volume-based FDG-PET parameters reflect the metabolic status of a malignancy more accurately than maximum standardized uptake value and thus are better prognostic markers in lung cancer. FDG-avid tumor burden parameters may help clinicians to predict treatment outcomes before and during therapy so that treatment can be adjusted to achieve the best possible outcomes while avoiding side effects.
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Affiliation(s)
- Gang Cheng
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - He Huang
- Department of Nuclear Medicine, Luzhou People's Hospital, Luzhou, Sichuan Province, People's Republic of China
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17
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Im HJ, Bradshaw T, Solaiyappan M, Cho SY. Current Methods to Define Metabolic Tumor Volume in Positron Emission Tomography: Which One is Better? Nucl Med Mol Imaging 2017; 52:5-15. [PMID: 29391907 DOI: 10.1007/s13139-017-0493-6] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 08/17/2017] [Accepted: 08/28/2017] [Indexed: 12/22/2022] Open
Abstract
Numerous methods to segment tumors using 18F-fluorodeoxyglucose positron emission tomography (FDG PET) have been introduced. Metabolic tumor volume (MTV) refers to the metabolically active volume of the tumor segmented using FDG PET, and has been shown to be useful in predicting patient outcome and in assessing treatment response. Also, tumor segmentation using FDG PET has useful applications in radiotherapy treatment planning. Despite extensive research on MTV showing promising results, MTV is not used in standard clinical practice yet, mainly because there is no consensus on the optimal method to segment tumors in FDG PET images. In this review, we discuss currently available methods to measure MTV using FDG PET, and assess the advantages and disadvantages of the methods.
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Affiliation(s)
- Hyung-Jun Im
- 1Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA.,2Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Tyler Bradshaw
- 1Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Meiyappan Solaiyappan
- 3Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Steve Y Cho
- 1Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA.,3Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA.,4University of Wisconsin Carbone Cancer Center, Madison, WI USA
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18
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Finkle JH, Jo SY, Ferguson MK, Liu HY, Zhang C, Zhu X, Yuan C, Pu Y. Risk-stratifying capacity of PET/CT metabolic tumor volume in stage IIIA non-small cell lung cancer. Eur J Nucl Med Mol Imaging 2017; 44:1275-1284. [PMID: 28265739 PMCID: PMC6048959 DOI: 10.1007/s00259-017-3659-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/14/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Stage IIIA non-small cell lung cancer (NSCLC) is heterogeneous in tumor burden, and its treatment is variable. Whole-body metabolic tumor volume (MTVWB) has been shown to be an independent prognostic index for overall survival (OS). However, the potential of MTVWB to risk-stratify stage IIIA NSCLC has previously been unknown. If we can identify subgroups within the stage exhibiting significant OS differences using MTVWB, MTVWB may lead to adjustments in patients' risk profile evaluations and may, therefore, influence clinical decision making regarding treatment. We estimated the risk-stratifying capacity of MTVWB in stage IIIA by comparing OS of stratified stage IIIA with stage IIB and IIIB NSCLC. METHODS We performed a retrospective review of 330 patients with clinical stage IIB, IIIA, and IIIB NSCLC diagnosed between 2004 and 2014. The patients' clinical TNM stage, initial MTVWB, and long-term survival data were collected. Patients with TNM stage IIIA disease were stratified by MTVWB. The optimal MTVWB cutoff value for stage IIIA patients was calculated using sequential log-rank tests. Univariate and multivariate cox regression analyses and Kaplan-Meier OS analysis with log-rank tests were performed. RESULTS The optimal MTVWB cut-point was 29.2 mL for the risk-stratification of stage IIIA. We identified statistically significant differences in OS between stage IIB and IIIA patients (p < 0.01), between IIIA and IIIB patients (p < 0.01), and between the stage IIIA patients with low MTVWB (below 29.2 mL) and the stage IIIA patients with high MTVWB (above 29.2 mL) (p < 0.01). There was no OS difference between the low MTVWB stage IIIA and the cohort of stage IIB patients (p = 0.485), or between the high MTVWB stage IIIA patients and the cohort of stage IIIB patients (p = 0.459). Similar risk-stratification capacity of MTVWB was observed in a large range of cutoff values from 15 to 55 mL in stage IIIA patients. CONCLUSIONS Using MTVWB cutoff points ranging from 15 to 55 mL with an optimal value of 29.2 mL, stage IIIA NSCLC may be effectively stratified into subgroups with no significant survival difference from stages IIB or IIIB NSCLC. This may result in more accurate survival estimation and more appropriate risk adapted treatment selection in stage IIIA NSCLC.
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Affiliation(s)
- Joshua H Finkle
- Department of Radiology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA
| | - Stephanie Y Jo
- Department of Radiology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA
| | - Mark K Ferguson
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Hai-Yan Liu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chenpeng Zhang
- Department of Nuclear Medicine, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xuee Zhu
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Cindy Yuan
- Department of Radiology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA
| | - Yonglin Pu
- Department of Radiology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA.
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The role of 18F-fluorodeoxyglucose uptake of bone marrow on PET/CT in predicting clinical outcomes in non-small cell lung cancer patients treated with chemoradiotherapy. Eur Radiol 2016; 27:1912-1921. [PMID: 27590191 DOI: 10.1007/s00330-016-4568-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/17/2016] [Accepted: 08/18/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study aimed to assess the relationship between bone marrow (BM) FDG uptake on PET/CT and serum inflammatory markers and to evaluate the prognostic value of BM FDG uptake for predicting clinical outcomes in non-small cell lung cancer (NSCLC) patients. METHODS One hundred and six NSCLC patients who underwent FDG PET/CT for staging work-up and received chemoradiotherapy were enrolled. Mean BM FDG uptake (BM SUV) and BM-to-liver uptake ratio (BLR) were measured, along with volumetric parameters of PET/CT. The relationship of BM SUV and BLR with hematologic parameters and serum inflammatory markers was evaluated. Prognostic values of BM SUV and BLR for predicting progression-free survival (PFS) and overall survival (OS) were assessed. RESULTS BM SUV and BLR were significantly correlated with white blood cell count and C-reactive protein level. On univariate analysis, BLR was a significant prognostic factor for both PFS and OS. On multivariate analysis, TNM stage and BLR were independent prognostic factors for PFS, and only TNM stage was an independent prognostic factor for OS. CONCLUSIONS In NSCLC patients, FDG uptake of BM reflects the systemic inflammatory response and can be used as a biomarker to identify patients with poor prognosis. KEY POINTS • Bone marrow FDG uptake is correlated with serum inflammatory markers. • Bone marrow FDG uptake is an independent prognostic factor for progression-free survival. • Bone marrow FDG uptake can provide information on predicting lung cancer progression.
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Lee JW, Na JO, Kang DY, Lee SY, Lee SM. Prognostic Significance of FDG Uptake of Bone Marrow on PET/CT in Patients With Non-Small-Cell Lung Cancer After Curative Surgical Resection. Clin Lung Cancer 2016; 18:198-206. [PMID: 27495385 DOI: 10.1016/j.cllc.2016.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND This study evaluated the relationship between 18F-fluorodeoxyglucose (FDG) uptake in bone marrow (BM) on positron emission tomography (PET)/computed tomography (CT) imaging and serum inflammatory markers and assessed the prognostic value of FDG uptake of BM in patients with non-small-cell lung cancer (NSCLC) who underwent curative surgical resection. PATIENTS AND METHODS We retrospectively enrolled 110 NSCLC patients who underwent FDG PET/CT imaging and subsequent curative surgical resection. The maximum standardized uptake value of NSCLC (Tmax), mean FDG uptake of BM (BM SUV), and BM to liver uptake ratio (BLR) were measured. The relationships between BM SUV, BLR, and serum inflammatory markers were evaluated and the prognostic significance of PET/CT parameters for predicting recurrence-free survival (RFS) and overall survival (OS) were assessed. RESULTS BM SUV and BLR were significantly associated with serum C-reactive protein (CRP) level, white blood cell count, and the neutrophil to lymphocyte ratio (NLR). BLR was also significantly correlated with serum albumin and the platelet to lymphocyte ratio. In univariate analysis, tumor, node, metastases (TNM) stage, serum CRP level, NLR, Tmax, and BLR were significant prognostic factors for RFS and OS, whereas histopathology and tumor size were significant prognostic factors for RFS. In multivariate analysis, BLR, histopathology, TNM stage, and Tmax were independent prognostic factors for RFS and TNM stage and Tmax were independent prognostic factors for OS. CONCLUSION FDG uptake of BM on PET/CT imaging was correlated with serum inflammatory markers and was an independent predictor for RFS, along with FDG uptake of NSCLC.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University College of Medicine, International St Mary's Hospital, Incheon, Korea; Institute of Integrative Medicine, Catholic Kwandong University College of Medicine, International St Mary's Hospital, Incheon, Korea
| | - Ju Ock Na
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Du-Young Kang
- Department of Thoracic and Cardiovascular Surgery, Catholic Kwandong University College of Medicine, International St Mary's Hospital, Incheon, Korea
| | - Seock Yeol Lee
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
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Simone CB, Houshmand S, Kalbasi A, Salavati A, Alavi A. PET-Based Thoracic Radiation Oncology. PET Clin 2016; 11:319-32. [DOI: 10.1016/j.cpet.2016.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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22
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van Diessen JN, Chen C, van den Heuvel MM, Belderbos JS, Sonke JJ. Differential analysis of local and regional failure in locally advanced non-small cell lung cancer patients treated with concurrent chemoradiotherapy. Radiother Oncol 2016; 118:447-52. [DOI: 10.1016/j.radonc.2016.02.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 02/02/2016] [Accepted: 02/04/2016] [Indexed: 12/25/2022]
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