Spatial Heterogeneity in Sarcoma <sup>18</sup>F-FDG Uptake as a Predictor of Patient Outcome

Eary, Janet F.; O’Sullivan, Finbarr; O’Sullivan, Janet; Conrad, Ernest U.

doi:10.2967/jnumed.108.053397

Cited by 200 publications

(164 citation statements)

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“…Still, recent studies have shown promising results for tumor heterogeneity measurements with PET, providing important information on prognosis or therapy effects in oncologic patients. Eary et al have shown that heterogeneity analysis on pretherapeutic PET is a strong predictor of patient outcome in sarcoma (11). In that study with 238 patients with soft-tissue and bone sarcoma, an increase of 6.5% in heterogeneity assessed by a new heterogeneity parameter corresponded to a 65% increased risk of death.…”

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Textural Parameters of Tumor Heterogeneity in ¹⁸F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer

et al. 2014

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18 F-FDG PET/CT is effective in the assessment of therapy response. Changes in glucose uptake or tumor size are used as a measure. Tumor heterogeneity was found to be a promising predictive and prognostic factor. We investigated textural parameters for their predictive and prognostic capability in patients with rectal cancer using histopathology as the gold standard. In addition, a comparison to clinical outcome was performed. Methods: Twenty-seven patients with rectal cancer underwent 18 F-FDG PET/CT before, 2 wk after the start, and 4 wk after the completion of neoadjuvant chemoradiotherapy. In all PET/CT scans, conventional parameters (tumor volume, diameter, maximum and mean standardized uptake values, and total lesion glycolysis [TLG]) and textural parameters (coefficient of variation [COV], skewness, and kurtosis) were determined to assess tumor heterogeneity. Values on pretherapeutic PET/CT as well as changes early in the course of therapy and after therapy were compared with histopathologic response. In addition, the prognostic value was assessed by correlation with time to progression and survival time. Results: The COV showed a statistically significant capability to assess histopathologic response early in therapy (sensitivity, 68%; specificity, 88%) and after therapy (79% and 88%, respectively). Thereby, the COV had a higher area under the curve in receiver-operating-characteristic analysis than did any analyzed conventional parameter for early and late response assessment. The COV showed a statistically significant capability to evaluate disease progression and to predict survival, although the latter was not statistically significant. Conclusion: Tumor heterogeneity assessed by the COV, being superior to the investigated conventional parameters, is an important predictive factor in patients with rectal cancer. Furthermore, it can provide prognostic information. Therefore, its application is an important step for personalized treatment of rectal cancer.

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Textural Parameters of Tumor Heterogeneity in ¹⁸F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer

et al. 2014

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“…Beyond the relatively simple measurements of the level of tumor uptake or size, there is increasing recognition that measurement of the spatial heterogeneity of 18 F-FDG PET image characteristics can give predictive information on baseline, pretherapy, imaging in several solid tumors including sarcoma (15), head and neck and cervix tumors (16)(17)(18), and esophageal carcinoma (19). In NSCLC, a potential heterogeneity parameter using SUV volume histograms has been described but not clinically tested (20).…”

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Are Pretreatment ¹⁸F-FDG PET Tumor Textural Features in Non–Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?

et al. 2012

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There is evidence in some solid tumors that textural features of tumoral uptake in 18 F-FDG PET images are associated with response to chemoradiotherapy and survival. We have investigated whether a similar relationship exists in non-small cell lung cancer (NSCLC). Methods: Fifty-three patients (mean age, 65.8 y; 31 men, 22 women) with NSCLC treated with chemoradiotherapy underwent pretreatment 18 F-FDG PET/CT scans. Response was assessed by CT Response Evaluation Criteria in Solid Tumors (RECIST) at 12 wk. Overall survival (OS), progression-free survival (PFS), and local PFS (LPFS) were recorded. Primary tumor texture was measured by the parameters coarseness, contrast, busyness, and complexity. The following parameters were also derived from the PET data: primary tumor standardized uptake values (SUVs) (mean SUV, maximum SUV, and peak SUV), metabolic tumor volume, and total lesion glycolysis. Results: Compared with nonresponders, RECIST responders showed lower coarseness (mean, 0.012 vs. 0.027; P 5 0.004) and higher contrast (mean, 0.11 vs. 0.044; P 5 0.002) and busyness (mean, 0.76 vs. 0.37; P 5 0.027). Neither complexity nor any of the SUV parameters predicted RECIST response. By Kaplan-Meier analysis, OS, PFS, and LPFS were lower in patients with high primary tumor coarseness (median, 21.1 mo vs. not reached, P 5 0.003; 12.6 vs. 25.8 mo, P 5 0.002; and 12.9 vs. 20.5 mo, P 5 0.016, respectively). Tumor coarseness was an independent predictor of OS on multivariable analysis. Contrast and busyness did not show significant associations with OS (P 5 0.075 and 0.059, respectively), but PFS and LPFS were longer in patients with high levels of each (for contrast: median of 20.5 vs. 12.6 mo, P 5 0.015, and median not reached vs. 24 mo, P 5 0.02; and for busyness: median of 20.5 vs. 12.6 mo, P 5 0.01, and median not reached vs. 24 mo, P 5 0.006). Neither complexity nor any of the SUV parameters showed significant associations with the survival parameters. Conclusion: In NSCLC, baseline 18 F-FDG PET scan uptake showing abnormal texture as measured by coarseness, contrast, and busyness is associated with nonresponse to chemoradiotherapy by RECIST and with poorer prognosis. Measurement of tumor metabolic heterogeneity with these parameters may provide indices that can be used to stratify patients in clinical trials for lung cancer chemoradiotherapy.

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“…Spatial heterogeneity in sarcoma uptake has been shown to be independently predictive of patient outcome. Eary et al found that baseline 18 F-FDG in diagnostic scans and tumor grade was somewhat weaker in outcome prediction, suggesting that new methods for incorporating 18 F-FDG tumor uptake distribution and for incorporating standardized uptake value into diagnostic methods for sarcomas can provide significant tumor diagnostic information (26). Figure 3 shows tumors with high levels of 18 F-FDG uptake heterogeneity.…”

Section: F-fdg and Sarcoma Diagnosismentioning

confidence: 99%

Imaging in Sarcoma

Eary

Conrad

2011

J Nucl Med

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Spatial Heterogeneity in Sarcoma ¹⁸F-FDG Uptake as a Predictor of Patient Outcome

Cited by 200 publications

References 16 publications

Textural Parameters of Tumor Heterogeneity in ¹⁸F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer

Textural Parameters of Tumor Heterogeneity in ¹⁸F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer

Are Pretreatment ¹⁸F-FDG PET Tumor Textural Features in Non–Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?

Imaging in Sarcoma

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Spatial Heterogeneity in Sarcoma 18F-FDG Uptake as a Predictor of Patient Outcome

Cited by 200 publications

References 16 publications

Textural Parameters of Tumor Heterogeneity in 18F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer

Textural Parameters of Tumor Heterogeneity in 18F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer

Are Pretreatment 18F-FDG PET Tumor Textural Features in Non–Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?

Imaging in Sarcoma

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Spatial Heterogeneity in Sarcoma ¹⁸F-FDG Uptake as a Predictor of Patient Outcome

Textural Parameters of Tumor Heterogeneity in ¹⁸F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer

Textural Parameters of Tumor Heterogeneity in ¹⁸F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer

Are Pretreatment ¹⁸F-FDG PET Tumor Textural Features in Non–Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?