Early Assessment of Metabolic Response by 18F-FDG PET During Concomitant Radiochemotherapy of Non–Small Cell Lung Carcinoma Is Associated With Survival

Yossi, Sena; Krhili, S.; Muratet, Jean-Pierre; Septans, Anne-Lise; Campion, Loı̈c; Denis, Fabrice

doi:10.1097/rlu.0000000000000615

Cited by 31 publications

(27 citation statements)

References 17 publications

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“…Several investigations are being conducted on the role of change in MTV and TLG as an early predictor of therapy response. [34][35][36][37] Thus, these metrics could provide useful measures of response in response-adaptive therapy regimens. However, for these metrics to be incorporated as a routine predictive biomarker, a PET segmentation methodology that yields precise values of these metrics is needed.…”

Section: Discussionmentioning

confidence: 99%

Practical no-gold-standard evaluation framework for quantitative imaging methods: application to lesion segmentation in positron emission tomography

et al. 2017

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Abstract. Recently, a class of no-gold-standard (NGS) techniques have been proposed to evaluate quantitative imaging methods using patient data. These techniques provide figures of merit (FoMs) quantifying the precision of the estimated quantitative value without requiring repeated measurements and without requiring a gold standard. However, applying these techniques to patient data presents several practical difficulties including assessing the underlying assumptions, accounting for patient-sampling-related uncertainty, and assessing the reliability of the estimated FoMs. To address these issues, we propose statistical tests that provide confidence in the underlying assumptions and in the reliability of the estimated FoMs. Furthermore, the NGS technique is integrated within a bootstrap-based methodology to account for patient-sampling-related uncertainty. The developed NGS framework was applied to evaluate four methods for segmenting lesions from F-Fluoro-2-deoxyglucose positron emission tomography images of patients with head-and-neck cancer on the task of precisely measuring the metabolic tumor volume. The NGS technique consistently predicted the same segmentation method as the most precise method. The proposed framework provided confidence in these results, even when gold-standard data were not available. The bootstrap-based methodology indicated improved performance of the NGS technique with larger numbers of patient studies, as was expected, and yielded consistent results as long as data from more than 80 lesions were available for the analysis.

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Section: Discussionmentioning

confidence: 99%

Practical no-gold-standard evaluation framework for quantitative imaging methods: application to lesion segmentation in positron emission tomography

et al. 2017

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“…That study also indicated the potential use of during‐RT 18 F‐FDG PET in early treatment response assessment by showing significant correlation of 18 F‐FDG reduction of the primary tumors and lymph nodes between during‐ and post‐RT 18 F‐FDG PET scans. Subsequent studies supported the application of during‐RT 18 F‐FDG PET in predicting treatment outcomes of NSCLC patients . But these studies were either retrospective in nature or lacked comparisons of serial 18 F‐FDG PET scans.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of volumetric metabolic parameter changes determined by during and after radiotherapy‐based ¹⁸F‐FDG PET/CT in stage III non‐small cell lung cancer

Chen

Guo

et al. 2019

The Kaohsiung J of Med Scie

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The aim of this prospective study was to evaluate the prognostic value of volumetric metabolic parameters assessed by during and after radiation‐based therapy 18F‐FDG PET/CT in patients with stage III non‐small cell lung cancer (NSCLC). We enrolled stage III NSCLC patients who had planned to receive definitive chemo‐radiation or radiotherapy (RT) and underwent 18F‐FDG PET/CT before treatment (PET1), during RT (at the fifth week, PET2) and after treatment (3 months later, PET3). By comparing with PET1, percentage changes of metabolic tumor volume (ΔMTV) and tumor total lesion glycolysis (ΔTLG) of PET2 and PET3 were calculated. We used medians of ΔTLG and ΔMTV as cut‐off values to stratify patients. Their prognostic values were evaluated by progression‐free survival (PFS) and overall survival (OS). Thirty patients were enrolled initially. Five were excluded due to multiple metastases or double cancer. The remaining 25 patients had PET2 at a median of 46 Gy. Data on PET3 were available in 19 patients. During‐RT ΔTLG (cut‐off: 65%) was a significant prognostic factor for PFS (P = 0.02) and OS (P < 0.01). During‐RT ΔMTV (cut‐off: 42%) had marginal significance for PFS (P = 0.07) and was significant for OS (P = 0.02). Of the PET3 parameters, neither ΔTLG nor ΔMTV was a significant prognostic factor for PFS and OS. We conclude that ΔTLG of during‐RT 18F‐FDG PET/CT may predict treatment response and thus provide opportunities to modify treatment for poor responders.

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“…Studies have also shown that preoperative staging PET/CT leads to change in the treatment planning and reduces the frequency of futile thoracotomies and the total number of thoracotomies (6,7). PET-based quantitative parameters have been proposed as reliable indicators of survival in patients with lung cancer in both pretreatment and posttreatment settings (8)(9)(10)(11)(12). In the posttherapy setting, several studies point to the usefulness of monitoring the treatment response based on decreased SUVs on serial 18 F-FDG PET imaging of the primary tumor (4,8).…”

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confidence: 99%

¹⁸F-FDG PET/CT: Therapy Response Assessment Interpretation (Hopkins Criteria) and Survival Outcomes in Lung Cancer Patients

Sheikhbahaei¹,

Mena²,

Marcus³

et al. 2016

J Nucl Med

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The purpose of this study was to evaluate the value of an 18 F-FDG PET/CT-based interpretation system (Hopkins criteria) to assess the therapy response and survival in lung cancer. Methods: This is an Institutional Review Board-approved, retrospective study. A total of 201 patients with biopsy-proven lung cancer, who underwent therapy assessment 18 F-FDG PET/CT within 6 mo (mean, 7.5 wk) of completion of treatment, were included. Patients were primarily treated with surgical resection, chemotherapy, radiation therapy, or a combination of these treatments. PET/CT studies were interpreted by 2 nuclear medicine physicians, and discrepancies were resolved by a third interpreter. The studies were scored using a qualitative 5-point scale for the primary tumor, mediastinum, distant metastatic site, if present, and overall assessment. Scores 1, 2, and 3 were considered negative and scores 4 and 5 were considered positive for residual disease. Patients were followed for a median of 12 mo (up to 128 mo). Kaplan-Meier plots with a Mantel-Cox log-rank test were performed considering death as the endpoint. Results: Overall, the PET/CT studies were positive in 144 (71.6%) and negative in 57 (28.4%) patients. There was substantial agreement between 2 interpreters (R1, R2), with a k of 0.78 (P , 0.001). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the Hopkins scoring system were 89%, 80%, 92.8%, 71.4%, and 86.7%, respectively. Overall, PET/CT resulted in starting a new treatment plan in 70.8% of patients with positive residual disease on therapy assessment PET/CT. There was a significant difference in overall survival (OS) between patients who were categorized as positive in comparison to those who were categorized as negative (hazard ratio [HR] 5 2.12; 95% confidence interval 5 1.44-3.12), which remained significant after adjustment for disease stage, prior clinical suspicion, and primary treatment. Subgroup analysis according to the tumor histology showed that positive Hopkins scoring could significantly predict the OS in both small cell lung cancer (HR 5 2.88; log-rank, P 5 0.02) and non-small cell lung cancer (HR 5 2.01; log-rank, P 5 0.001). Similarly, there was a significant difference in OS between patients with positive and negative Hopkins score both in those who had surgical resection as part of the primary treatment (HR 5 6.09; log-rank, P , 0.001) and in those who were treated with chemotherapy with or without radiation (HR 5 1.60; log-rank, P 5 0.02). Conclusion: The 5-point qualitative therapy response interpretation for lung cancer has substantial interinterpreter agreement and high accuracy and could significantly predict survival in lung cancer, irrespective of tumor histology and treatment modality.

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Early Assessment of Metabolic Response by 18F-FDG PET During Concomitant Radiochemotherapy of Non–Small Cell Lung Carcinoma Is Associated With Survival

Abstract: Early assessment of TLG response by 18F-FDG PET/CT during concomitant radiochemotherapy of non-small cell lung cancer might be associated with survival.

Cited by 31 publications

References 17 publications

Practical no-gold-standard evaluation framework for quantitative imaging methods: application to lesion segmentation in positron emission tomography

Practical no-gold-standard evaluation framework for quantitative imaging methods: application to lesion segmentation in positron emission tomography

Prognostic value of volumetric metabolic parameter changes determined by during and after radiotherapy‐based ¹⁸F‐FDG PET/CT in stage III non‐small cell lung cancer

¹⁸F-FDG PET/CT: Therapy Response Assessment Interpretation (Hopkins Criteria) and Survival Outcomes in Lung Cancer Patients

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Early Assessment of Metabolic Response by 18F-FDG PET During Concomitant Radiochemotherapy of Non–Small Cell Lung Carcinoma Is Associated With Survival

Abstract: Early assessment of TLG response by 18F-FDG PET/CT during concomitant radiochemotherapy of non-small cell lung cancer might be associated with survival.

Cited by 31 publications

References 17 publications

Practical no-gold-standard evaluation framework for quantitative imaging methods: application to lesion segmentation in positron emission tomography

Practical no-gold-standard evaluation framework for quantitative imaging methods: application to lesion segmentation in positron emission tomography

Prognostic value of volumetric metabolic parameter changes determined by during and after radiotherapy‐based 18F‐FDG PET/CT in stage III non‐small cell lung cancer

18F-FDG PET/CT: Therapy Response Assessment Interpretation (Hopkins Criteria) and Survival Outcomes in Lung Cancer Patients

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Prognostic value of volumetric metabolic parameter changes determined by during and after radiotherapy‐based ¹⁸F‐FDG PET/CT in stage III non‐small cell lung cancer

¹⁸F-FDG PET/CT: Therapy Response Assessment Interpretation (Hopkins Criteria) and Survival Outcomes in Lung Cancer Patients