Evaluation of Response to Neoadjuvant Therapy by Quantitative 2-Deoxy-2-[F]Fluoro-D-Glucose with Positron Emission Tomography in Patients with Esophageal Cancer

Arslan, Nuri; Miller, Tom R.; Dehdashti, Farrokh; Battafarano, Richard J.; Siegel, Barry A.

doi:10.1016/s1536-1632(02)00011-2

Cited by 79 publications

(43 citation statements)

References 27 publications

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“…When using metabolic parameters of FDG PET, OTR may be assessed 4 weeks from the start of CRT (after 40 Gy irradiation), as in the present study. However, it must be accounted for that FDG PET may have difficulty in differentiating between complete responses and residual disease or post-treatment inflammation (28), as glucose accumulates in tumor and inflammatory cells, and inflammatory cells are common in irradiated esophageal tissue. Therefore, uptake on an 18 F-FDG PET scan may represent either residual tumor or esophagitis.…”

Section: Discussionmentioning

confidence: 99%

18F-fluorodeoxyglucose positron emission computed tomography for monitoring tumor response in esophageal carcinoma treated with concurrent chemoradiotherapy

Zhang¹,

Wang

et al. 2017

Oncol Lett

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Abstract. The aim of the present study was to explore the value of 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) in monitoring the early tumor response of esophageal squamous cell carcinoma (ESCC) treated with concurrent chemoradiotherapy (CRT). A total of 48 patients with pathologically proven ESCC were retrospectively analyzed. All patients underwent two serial 18 F-FDG PET scans at baseline (pre-CRT) and 40 Gy/4 weeks of starting radiation therapy (inter-CRT). All patients received intensity-modulated radiotherapy (with a total radiation dose of 59.6 Gy) concurrently with cisplatin-based chemotherapy. The maximum standardized uptake value (SUV max ) and metabolic tumor volume (MTV) were measured using 18 F-FDG PET. The percentage changes (Δ) in SUV max and MTV between two serial scans were calculated and were revealed to be associated with the objective tumor response (oTR), according to the Response Evaluation Criteria in Solid Tumors 1.1. Among the 48 patients, 20.8% achieved a complete response, 68.8% exhibited a partial response and the oTR rate was 89.6%. On the pre-CRT PET scans, the mean SUV max and MTV were 14.1±5.8 and 58.2±25.4 cm . Univariate analysis revealed that ΔSUV max and ΔMTV were significantly associated with oTR (P= 0.010 and P= 0.001, respectively). ΔMTV was used as a predictor and a cut-off value of 54% discriminated responders from non-responders with a sensitivity of 69.8% and a specificity of 100% (P=0.001). The area under the receiver operating characteristic curve was 0.837 (95% confidence interval, 0.702-0.928). The results of the present study indicated that interim 18 F-FDG PET scans may provide early prognostic value for determining oTR in patients with ESCC undergoing treatment with CRT.

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Section: Discussionmentioning

confidence: 99%

18F-fluorodeoxyglucose positron emission computed tomography for monitoring tumor response in esophageal carcinoma treated with concurrent chemoradiotherapy

Zhang¹,

Wang

et al. 2017

Oncol Lett

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“…PET has been shown useful for reevaluation of patients following neoadjuvant treatment protocols [6, 7, 10, 11, 17,23,24,25,26]. The interpretation of postinduction SUV, however, remains difficult and is confounded by different factors especially after neoadjuvant protocols including radiotherapy [5, 8, 26].…”

Section: Discussionmentioning

confidence: 99%

Correlation of PET/CT Findings and Histopathology after Neoadjuvant Therapy in Non-Small Cell Lung Cancer

Poettgen¹,

Theegarten

Eberhardt³

et al. 2007

Oncology

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Objectives: Prediction of histopathological response with PET/CT scans after neoadjuvant chemoradiotherapy is limited by confounding factors which have been evaluated in this analysis. Methods:¹⁸F-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT findings [standard uptake value (SUV), residual tumor volume] were correlated with histopathological parameters of the resection specimens (tumor cell density, necrosis, scar, macrophage infiltration) in patients with locally advanced non-small cell lung cancer (stage IIIA/IIIB) after neoadjuvant induction chemotherapy (platinum-based doublet) and concurrent chemoradiotherapy (cisplatin/vinorelbine/45 Gy). Results: Sixty patients [40 male/20 female, median age 56 years (34–78)] completed induction therapy, 46 patients (stage IIIA/IIIB: 16/30; squamous cell carcinoma 41%, adenocarcinoma 48%, large cell carcinoma 11%) were resected. Pathologic complete response of the primary tumor was observed in 19 patients (41%) with a broad range of SUV_mean (0.4–9.8, mean 3.0) after neoadjuvant therapy. A high rate of histopathological complete remissions (44%) was observed in tumors with a postinduction SUV >2.5 and volumes larger than the median (7.9 cm³) before resection. SUV_mean was positively correlated with the macrophage score (r = 0.39, p = 0.007) and tumor cell density (r = 0.32, p = 0.03). Conclusions: These observations suggest that postinduction FDG uptake should be interpreted with caution in larger residual tumor volumes, since high SUV levels may be due to macrophage infiltration and not viable tumor tissue.

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“…MTV and mean SUV can be measured by contouring margins defined by thresholds. Then, TLG can be calculated by multiplying MTV by mean SUV, which weights the volumetric burden and metabolic activity of tumors (3)(4)(5). Commercially available tools for tumor analysis enable rapid and easier measurement of MTV or TLG (3).…”

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confidence: 99%

Prognostic Value of Metabolic Tumor Volume and Total Lesion Glycolysis in Head and Neck Cancer: A Systematic Review and Meta-Analysis

et al. 2014

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We conducted a comprehensive systematic review of the literature on volumetric parameters and a meta-analysis of the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with head and neck cancer (HNC). Methods: A systematic search of MEDLINE and EMBASE was performed using the key words PET, head and neck, and volume. Inclusion criteria were 18 F-FDG PET used as an initial imaging tool; studies limited to HNC; patients who had not undergone surgery, chemotherapy, or radiotherapy before PET scans; and studies reporting survival data. Event-free survival and overall survival were considered markers of outcome. The impact of MTV or TLG on survival was measured by the effect size hazard ratio (HR). Data from each study were analyzed using Review Manager. Results: Thirteen studies comprising 1,180 patients were included in this study. The combined HR for adverse events was 3.06 (2.33-4.01, P , 0.00001) with MTV and 3.10 (2.27-4.24, P , 0.00001) with TLG, meaning that tumors with high volumetric parameters were associated with progression or recurrence. Regarding overall survival, the pooled HR was 3.51 (2.62-4.72, P , 0.00001) with MTV and 3.14 (2.24-4.40, P , 0.00001) with TLG. There was no evidence of significant statistical heterogeneity at an I 2 of 0%. Conclusion: MTV and TLG are prognostic predictors of outcome in patients with HNC. Despite clinically heterogeneous HNC and the various methods adopted between studies, we can confirm that patients with a high MTV or TLG have a higher risk of adverse events or death.

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Evaluation of Response to Neoadjuvant Therapy by Quantitative 2-Deoxy-2-[F]Fluoro-D-Glucose with Positron Emission Tomography in Patients with Esophageal Cancer

Cited by 79 publications

References 27 publications

18F-fluorodeoxyglucose positron emission computed tomography for monitoring tumor response in esophageal carcinoma treated with concurrent chemoradiotherapy

18F-fluorodeoxyglucose positron emission computed tomography for monitoring tumor response in esophageal carcinoma treated with concurrent chemoradiotherapy

Correlation of PET/CT Findings and Histopathology after Neoadjuvant Therapy in Non-Small Cell Lung Cancer

Prognostic Value of Metabolic Tumor Volume and Total Lesion Glycolysis in Head and Neck Cancer: A Systematic Review and Meta-Analysis

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