Prognostic significance of total lesion glycolysis in patients with advanced non-small cell lung cancer receiving chemotherapy

Zaizen, Yoshiaki; Azuma, Koichi; Kurata, Seiji; Sadashima, Eiji; Hattori, Satoshi; Sasada, Tetsuro; Imamura, Yohei; Kaida, Hayato; Kawahara, Akihiko; Kinoshita, Takashi; Ishibashi, Masatoshi; Hoshino, Tomoaki

doi:10.1016/j.ejrad.2012.07.009

Cited by 50 publications

(32 citation statements)

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“…Third, SUV measures a single highly metabolic focus that may not accurately reflect the metabolic activity of the whole tumor. To overcome these limitations of SUV, MTV and TLG have been studied as prognostic factors for NSCLC (7,8,10,14,15 (10). Other studies have confirmed that TLG and MTV are better indices of patient survival than SUV max or mean SUV (7,8,10,14,15).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Total Lesion Glycolysis by ¹⁸F-FDG PET/CT in Surgically Resected Stage IA Non–Small Cell Lung Cancer

Park

Cho

et al. 2014

J Nucl Med

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Despite the favorable prognosis of stage IA non-small cell lung cancer (NSCLC), the disease recurs after complete surgical resection in 20%-30% of patients. This study determined the prognostic value of various metabolic parameters of 18 F-FDG PET/CT in surgically resected stage IA NSCLC. Methods: We retrospectively reviewed 248 patients with stage IA NSCLC who underwent lobectomy and complete lymph node dissection after PET/CT. A region of interest was drawn on the primary lesion, and metabolic indices such as metabolic tumor volume, maximum standardized uptake value (SUV max ), and total lesion glycolysis (TLG) were measured using an SUV cutoff of 2.5. Results: The patients included 134 men and 114 women, and the mean age was 63.03 ± 10.01 y; 129 were stage T1a (#2 cm) and 119 were T1b (.2 cm). The median follow-up period was 36.6 mo. Recurrence took place in 15 patients. The mean (±SD) SUV max , metabolic tumor volume, and TLG were 4.55 ± 3.75, 5.92 ± 5.57, and 14.42 ± 17.35, respectively. The cutoffs of SUV max and TLG were 3.7 and 13.76, respectively. The 5-y overall survival (OS) was 95.1% in low-SUV max patients and 82.2% in high-SUV max patients (P 5 0.02). The 5-y OS was 93.7% in low-TLG patients and 78.3% in high-TLG patients (P 5 0.01). On multivariate analysis, TLG was a risk factor for OS (hazard ratio, 3.159; P 5 0.040), but SUV max showed marginal significance (P 5 0.064). The concordance index of the TLG model was 0.676 (95% CI, 0.541-0.812). Conclusion: TLG was a significant prognostic factor for OS in patients with stage IA NSCLC. Lungcanceri s the second most common cancer in both men and women and the most common cause of cancer death in the world (1). Non-small cell lung cancer (NSCLC) accounts for 80%-85% of all lung cancer cases. Oncologic treatment options for NSCLC typically include surgery, radiation, and chemotherapy, either alone or in combination. TNM stage has been considered the primary prognostic factor in NSCLC. However, tumor-and patientspecific factors vary even within the same disease stage, creating a heterogeneous population of patients, each with an individual prognosis that requires consideration of patient-and tumor-specific factors for best estimation (2,3). Recently, the incidence of earlystage NSCLC has increased as a result of the use of low-dose CT for screening. However, despite having early-stage disease, up to 20%-30% of patients with stage IA NSCLC relapse after surgical treatment. Therefore, other prognostic factors besides TNM stages are needed to identify patients at high risk for recurrence, predict prognosis, and recommend individualized adjuvant therapy (4).18 F-FDG PET relies on the fact that most neoplasms are highly metabolically active and therefore can be detected on a background of relatively less active normal tissues. When performed in addition to qualitative evaluation by visual inspection, 18 F-FDG PET can provide several semiquantitative measurements of radioactivity concentration in each tissue compartment, such as standardized uptake value (SUV...

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Total Lesion Glycolysis by ¹⁸F-FDG PET/CT in Surgically Resected Stage IA Non–Small Cell Lung Cancer

Park

Cho

et al. 2014

J Nucl Med

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“…It is possible that once a lung tumour shows metastatic spread, the anatomic extent of the tumour is more important in predicting prognosis than the metabolic activity of the primary tumour only. Although this supposition should be confirmed with a larger number of patients with stage IV disease, this might be the reason why the introduction of other measures of metabolic activity such as tumour glycolysis and metabolic volume as well as heterogeneity and texture analysis are very promising as prognostic factors [44][45][46][47][48][49]. However, these "new" derived metabolic parameters seem to be more interesting in large tumours, due to the inability of PET to characterise tracer distribution within small tumours because of its limited spatial resolution.…”

Section: Discussionmentioning

confidence: 99%

Primary tumour standardised uptake value is prognostic in nonsmall cell lung cancer: a multivariate pooled analysis of individual data

et al. 2015

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18 F-fluoro-2-deoxy-D-glucose positron emission tomography (PET) complements conventional imaging for diagnosing and staging lung cancer. Two literature-based meta-analyses suggest that maximum standardised uptake value (SUVmax) on PET has univariate prognostic value in nonsmall cell lung cancer (NSCLC). We analysed individual data pooled from 12 studies to assess the independent prognostic value of binary SUVmax for overall survival.After searching the published literature and identifying unpublished data, study coordinators were contacted and requested to provide data on individual patients. Cox regression models stratified for study were used. Data were collected for 1526 patients (median age 64 years, 60% male, 34% squamous cell carcinoma, 47% adenocarcinoma, 58% stage I-II). The combined univariate hazard ratio for SUVmax was 1.43 (95% CI 1.22-1.66) and nearly identical if the SUV threshold was calculated stratifying for histology. Multivariate analysis of patients with stage I-III disease identified age, stage, tumour size and receipt of surgery as independent prognostic factors; adding SUV (HR 1.58, 95% CI 1.27-1.96) improved the model significantly. The only detected interaction was between SUV and stage IV disease.SUV seems to have independent prognostic value in stage I-III NSCLC, for squamous cell carcinoma and for adenocarcinoma. @ERSpublications SUV has independent prognostic value in stage I-III NSCLC, both for squamous cell carcinoma and for adenocarcinoma

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“…Furthermore, the CT scan can be used for PET attenuation correction. Quantitative indices in PET, such as the standardized uptake value (SUV) (3), metabolic volume, and total lesion glycolysis (4,5), can be used to diagnose the disease, to provide prognostic and predictive information, and to optimize radiotherapy planning. Furthermore, it has been established that molecular imaging with PET is valuable in the early assessment of therapy response of several tumor types (6)(7)(8)(9).…”

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confidence: 99%

Comparison of a Free-Breathing CT and an Expiratory Breath-Hold CT with Regard to Spatial Alignment of Amplitude-Based Respiratory-Gated PET and CT Images

Vos

Grootjans

Meeuwis

et al. 2014

Journal of Nuclear Medicine Technology

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Respiratory motion during PET has a significant effect on the quantification of radiotracer uptake in PET images. Even when respiratory motion is considered using PET gating techniques, inaccuracies in standardized uptake values can be caused by inappropriate attenuation correction due to a spatial mismatch between PET and CT. In this study, the effect of breath-hold CT imaging on the spatial match between CT and amplitude-based respiratory-gated PET images is investigated. Methods: Wholebody 18 F-FDG PET/CT imaging was performed in 52 patients with 125 lung lesions. 18 F-FDG PET was performed using optimized, amplitude-based respiratory gating. For CT, 36 patients were randomly assigned to the free-breathing (FB) group and 16 to the restexpiratory breath-hold (BH) group. Spatial mismatch between the PET and CT images was quantified by measuring the distance between the centroids of PET and CT lesions and calculating the Jaccard similarity coefficient (JSC). Results: In the upper lobes, the average distance between the centroids of the PET and CT lesions was 4.7 ± 3.1 and 6.0 ± 3.0 mm for the FB and BH groups, respectively (P 5 0.11). For the middle and lower lobes, the distances were 5.8 ± 4.3 and 5.1 ± 2.9 mm (P 5 0.70), respectively, and for the central region 4.8 ± 4.6 and 5.6 ± 2.0 mm (P 5 0.24), respectively. The JSC for the upper lobes was 0.28 ± 0.17 and 0.28 ± 0.19, for the FB and the BH group, respectively (P 5 0.83). For the middle and lower lobes, the JSC was 0.22 ± 0.16 and 0.28 ± 0.18 (P 5 0.20), respectively, and for the central region 0.39 ± 0.17 and 0.13 ± 0.04 (P 5 0.04), respectively. Conclusion: Providing breathing instructions to the patients during the CT acquisition did not improve the spatial alignment between the respiratory-gated PET images and the CT images. The difficulty experienced in using this clinical protocol, such as patient compliance and operator dependence, emphasizes the need for other strategies.Key Words: amplitude-based optimal respiratory gating; lung tumors; standardized uptake value; breath hold CT; spatial alignment PET combined with CT is an essential multimodality molecular imaging method for accurate staging and diagnosis of a variety of diseases, particularly in oncology (1,2). The advantage of combined PET/CT imaging is that it provides both anatomic and molecular information on the patient, improving detection, localization, and characterization of disease (2). Furthermore, the CT scan can be used for PET attenuation correction. Quantitative indices in PET, such as the standardized uptake value (SUV) (3), metabolic volume, and total lesion glycolysis (4,5), can be used to diagnose the disease, to provide prognostic and predictive information, and to optimize radiotherapy planning. Furthermore, it has been established that molecular imaging with PET is valuable in the early assessment of therapy response of several tumor types (6-9).During PET acquisition, patients are instructed to breathe freely because of the relatively long image acquisition times. As a cons...

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Prognostic significance of total lesion glycolysis in patients with advanced non-small cell lung cancer receiving chemotherapy

Cited by 50 publications

References 20 publications

Prognostic Value of Total Lesion Glycolysis by ¹⁸F-FDG PET/CT in Surgically Resected Stage IA Non–Small Cell Lung Cancer

Prognostic Value of Total Lesion Glycolysis by ¹⁸F-FDG PET/CT in Surgically Resected Stage IA Non–Small Cell Lung Cancer

Primary tumour standardised uptake value is prognostic in nonsmall cell lung cancer: a multivariate pooled analysis of individual data

Comparison of a Free-Breathing CT and an Expiratory Breath-Hold CT with Regard to Spatial Alignment of Amplitude-Based Respiratory-Gated PET and CT Images

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Prognostic significance of total lesion glycolysis in patients with advanced non-small cell lung cancer receiving chemotherapy

Cited by 50 publications

References 20 publications

Prognostic Value of Total Lesion Glycolysis by 18F-FDG PET/CT in Surgically Resected Stage IA Non–Small Cell Lung Cancer

Prognostic Value of Total Lesion Glycolysis by 18F-FDG PET/CT in Surgically Resected Stage IA Non–Small Cell Lung Cancer

Primary tumour standardised uptake value is prognostic in nonsmall cell lung cancer: a multivariate pooled analysis of individual data

Comparison of a Free-Breathing CT and an Expiratory Breath-Hold CT with Regard to Spatial Alignment of Amplitude-Based Respiratory-Gated PET and CT Images

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Prognostic Value of Total Lesion Glycolysis by ¹⁸F-FDG PET/CT in Surgically Resected Stage IA Non–Small Cell Lung Cancer

Prognostic Value of Total Lesion Glycolysis by ¹⁸F-FDG PET/CT in Surgically Resected Stage IA Non–Small Cell Lung Cancer