and 9 MRI Stadelhofen, Zurich, Switzerland (D)-18 F-fluoromethyltyrosine (D-18 F-FMT), or BAY 86-9596, is a novel 18 F-labeled tyrosine derivative rapidly transported by the L-amino acid transporter (LAT-1), with a faster blood pool clearance than the corresponding L-isomer. The aim of this study was to demonstrate the feasibility of tumor detection in patients with non-small cell lung cancer (NSCLC) or head and neck squamous cell cancer (HNSCC) compared with inflammatory and physiologic tissues in direct comparison to 18 F-FDG. Methods: 18 patients with biopsyproven NSCLC (n 5 10) or HNSCC (n 5 8) were included in this Institutional Review Board-approved, prospective multicenter study. All patients underwent 18 F-FDG PET/CT scans within 21 d before D-18 F-FMT PET/CT. For all patients, safety and outcome data were assessed. Results: No adverse reactions were observed related to D-18 F-FMT. Fifty-two lesions were 18 F-FDG-positive, and 42 of those were malignant (34 histologically proven and 8 with clinical reference). Thirty-two of the 42 malignant lesions were also D-18 F-FMT-positive, and 10 lesions had no tracer uptake above the level of the blood pool. Overall there were 34 true-positive, 8 true-negative, 10 false-negative, and only 2 false-positive lesions for D-18 F-FMT, whereas 18 F-FDG was true-positive in 42 lesions, with 10 false-positive and only 2 false-negative, resulting in a lesion-based detection rate for D-18 F-FMT and 18 F-FDG of 77% and 95%, respectively, with an accuracy of 78% for both tracers. A high D-18 F-FMT tumor-to-blood pool ratio had a negative correlation with overall survival (P 5 0.050), whereas the 18 F-FDG tumor-to-blood pool ratio did not correlate with overall survival. Conclusion: D-18 F-FMT imaging in patients with NSCLC and HNSCC is safe and feasible. The presented preliminary results suggest a lower sensitivity but higher specificity for D-18 F-FMT over 18 F-FDG, since there is no D-18 F-FMT uptake in inflammation. This increased specificity may be particularly beneficial in areas with endemic granulomatous disease and may improve clinical management. Further clinical investigations are needed to determine its clinical value and relevance for the prediction of survival prognosis.
Re-LVRS can be performed successfully in carefully selected patients as a palliative treatment. It may be performed as a bridge to transplantation or in patients with newly diagnosed intrapulmonary nodules or during elective cardiac surgery. Morbidity is acceptable and outcomes may be satisfactory with significantly improved lung function and reduced dyspnoea for at least 12 months postoperatively.
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