The Role of 18F-FDG PET/CT as a Prognostic Factor in Patients with Synovial Sarcoma

Abstract

Purpose This research aims to investigate the potential of 18 Ffluorodeoxyglucose positron emission tomography/computed tomography (FDG PET) to predict pathologic response after neoadjuvant chemotherapy (NAC) and overall survival (OS) of patients with synovial sarcoma in Korea. Methods Twenty patients with synovial sarcoma from January 2001 to December 2011 were reviewed retrospectively. All patients underwent pre-treatment FDG PET and tumor removal. Patients were classified with the maximum SUV (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), age, sex, histologic subtype, tumor size, NAC, resection margin, and metastasis at diagnosis. Pathologic response was assessed using the French Federation of Cancer Centers system. Statistical analyses were analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards regression model, and Mann-Whitney test. Results Nine patients (45 %) showed pathologic response, and ten patients survived. Higher SUVmax, higher MTV, higher TLG, monophasic epithelial type, and metastasis at diagnosis were significantly related to poorer OS (p=0.047, 0.016, 0.016, 0.045, and 0.018, respectively). By multivariate analysis, metastasis at diagnosis was significantly related to poorer OS (p=0.012/HR=5.9, 95 % CI 1.47 to 24.1). The SUVmax, MTV, and TLG of the non-responder group were significantly higher than those of the responder group (p= 0.020, 0.020, and 0.020, respectively). There was no significant difference in size between the two groups (p=0.062). Conclusions A higher SUVmax on the pre-treatment scan, monophasic epithelial type, and metastasis at diagnosis were significantly associated with a poorer OS, and pathologic responders showed a higher SUVmax before NAC. The PET parameters can be used to predict OS and pathologic response in patients with synovial sarcomas before NAC.

Utility of Quantitative Parameters from Single-Photon Emission Computed Tomography/Computed Tomography in Patients with Destructive Thyroiditis

“…Thyroid volume was measured using the transaxial CTimages. The functional thyroid mass was then defined as the product of SUVmean and thyroid volume, which was conceptually the same as used for a metabolic tumor volume of F-18 fluorodeoxyglucose PET study ( 18 19 ).…”

Prognostic value of 18F-FDG PET-CT-based functional parameters in patients with soft tissue sarcoma

“…All 11 studies indicated high SUVmax, MTV, or/and TLG represented a worse prognosis than patients with low numerical value. In terms of association between PET parameters and OS and PFS, there are 7 studies [ 13 , 18 – 23 ] that only provided with prognostic information about SUVmax and 4 studies [ 11 , 12 , 24 , 25 ] analyzed prognostic value of MTV and TLG. The major characteristics of 11 publications are summarized in Table 1 .…”

“…However, there are several contradictions existing in included studies of this meta-analysis. There existed a study [ 11 ] which reported significant association between pretherapeutic higher SUVmax, higher MTV, higher TLG and poorer OS in patients with synovial sarcoma. However, in another study, [ 13 ] SUVmax was regarded as a significant independent prognostic marker for OS in STS while MTV and TLG failed to provide with significant prognostic information.…”

“…In particular, SUVmax is regarded as a limited parameter that can only represent the tumor activity and fail to signify the whole tumor volume. [ 11 , 12 ] However, there also existed studies which concluded that the volumetric parameter of PET-CT may not provide significant prognostic information. [ 13 ] Nevertheless, the overall analysis of the association between SUVmax, MTV, or TLG and prognosis in soft tissue sarcoma has not been systematically and scientifically assessed.…”

The Highest Metabolic Activity on FDG PET Is Associated With Overall Survival in Limited-Stage Small-Cell Lung Cancer

“…The clinical significance of volume-based PET parameters has been actively investigated in several kinds of malignancies including lung cancer. 29 – 33 The prognostic significance of volumetric PET parameters in SCLC has been also analyzed by several investigations. 20 , 21 , 24 In their subgroup analysis of LS-SCLC, Zhu et al 20 and Oh et al 21 demonstrated that patients with larger MTVs had significantly shorter median OS and PFS compared with those with smaller MTVs, as revealed by Kaplan–Meier survival curves.…”