TLG-S criteria are superior to both EORTC and PERCIST for predicting outcomes in patients with metastatic lung adenocarcinoma treated with erlotinib

Ho, Keang-Po; Fang, Yiqun; Chung, Hsiao Wen; Liu, Yuan Chang; Chang, Jeng-Shou; Hou, Ming; Yang, Cheng‐Ta; Cheng, Nai Ming; Su, Tzu Pei; Yen, Tzu Chen

doi:10.1007/s00259-016-3433-2

Cited by 25 publications

(23 citation statements)

References 41 publications

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“…We found a strong correlation between MLV and SUV mean (r = 0.90); this result is probably due to the few patients included in the study. Our result is consistent with observations in oncology, with some studies suggesting TLG as a better predictor of outcomes in patients with lung or cervical cancer [17, 25]. We found MLV independently associated with prognosis, like TLG, so the volume of the lung with an altered uptake may be more informative to assess prognosis than the mean SUV in this volume.…”

Section: Discussionsupporting

confidence: 92%

“…TLG could be better than SUV mean or SUV max as a prognostic marker because it accounts for intracellular glucose accumulation within the total volume of all regions of interest [16]. Recently, TLG was found to predict overall survival in patients with liver colorectal metastases and those with lung cancer treated with erlotinib [16, 17]. Recently, one study demonstrated the prognostic value of dual-time-point [ 18 F]FDG PET for IPF [18].…”

Section: Introductionmentioning

confidence: 99%

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[18F]FDG PET/CT predicts progression-free survival in patients with idiopathic pulmonary fibrosis

et al. 2017

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BackgroundIdiopathic pulmonary fibrosis (IPF) is a devastating disease characterized by an unpredictable course. Prognostic markers and disease activity markers are needed. The purpose of this single-center retrospective study was to evaluate the prognostic value of lung fluorodeoxyglucose ([18F]-FDG) uptake assessed by standardized uptake value (SUV), metabolic lung volume (MLV) and total lesion glycolysis (TLG) in patients with IPF.MethodsWe included 27 IPF patients (IPF group) and 15 patients with a gastrointestinal neuroendocrine tumor without thoracic involvement (control group). We quantified lung SUV mean and SUV max, MLV and TLG and assessed clinical data, high-resolution CT (HRCT) fibrosis and ground-glass score; lung function; gender, age, physiology (GAP) stage at inclusion and during follow-up; and survival.ResultsLung SUV mean and SUV max were higher in IPF patients than controls (p <0.00001). For patients with IPF, SUV mean, SUV max, MLV and TLG were correlated with severity of lung involvement as measured by a decline in forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO) and increased GAP score. In a univariate and in a multivariate Cox proportional-hazards model, risk of death was increased although not significantly with high SUV mean. On univariate analysis, risk of death was significantly associated with high TLG and MLV, which disappeared after adjustment functional variables or GAP index. Increased MLV and TLG were independent predictors of death or disease progression during the 12 months after PET scan completion (for every 100-point increase in TLG, hazard ratio [HR]: 1.11 (95% CI 1.06; 1.36), p = 0.003; for every 100-point increase in MLV, HR: 1.20 (1.04; 1.19), p = 0.002). On multivariable analysis including TLG or MLV with age, FVC, and DLCO or GAP index, TLG and MLV remained associated with progression-free survival (HR: 1.1 [1.03; 1.22], p = 0.01; and 1.13 [1.0; 1.2], p = 0.005).ConclusionFDG lung uptake may be a marker of IPF severity and predict progression-free survival for patients with IPF.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

[18F]FDG PET/CT predicts progression-free survival in patients with idiopathic pulmonary fibrosis

et al. 2017

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“…Using PERCIST criteria, patients are generally classified as complete metabolic responders (CMR; complete resolution of tumor (18F)FDG uptake), partial metabolic responders (PMR; reduction of a minimum of 30% in target lesion uptake), progressive metabolic disease (PMD; increase of a minimum of 30% in target lesion uptake or presentation of a new lesion), and stable metabolic disease (not CMR, PMR, or PMD) 6 7. Total lesion glycolysis using a systematic approach is a relatively new method measuring response by PET, and some studies have suggested that it may be superior to PERCIST and EORTC methods 29 31 32…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Early Response Assessment Using (18F)Fdg-Pet in Patients with Advanced Non-Small Cell Lung Cancer Treated with Tyrosine-Kinase Inhibitors

et al. 2017

Journal of Investigative Medicine

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The purpose of this meta-analysis was to determine the prognostic value of early response assessment using (18F)fluorodeoxyglucose (FDG)-positron emission thermography (PET) in patients with advanced non-small cell lung cancer (NSCLC) treated with tyrosine-kinase inhibitors (TKIs). MEDLINE, PubMed, Cochrane, EMBASE, and Google Scholar databases were searched until August 1, 2016 using the keywords non-small cell lung carcinoma, positron-emission tomography, fluorodeoxyglucose, prognosis, disease progression, survival, erlotinib, gefitinib, and afatinib. Inclusion criteria were studies of patients with stage III or IV NSCLC treated with a TKI and had response assessed by FDG-PET. Outcome measures were overall survival (OS) and progression-free survival (PFS). Of the 167 articles identified, 10 studies including 302 patients were included in the analysis. In 8 studies, patients were treated with erlotinib, and in 2 they were treated with gefitinib. The overall analysis revealed that early metabolic response was statistically associated with improved OS (HR=0.54; 95% CI 0.46 to 0.63; p<0.001), and with longer PFS (HR=0.23; 95% CI 0.17 to 0.33; p<0.001). Early response of patients with NSCLC treated with TKIs identified on FDG-PET is associated with improved OS and PFS.

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“…Several exploratory parameters mentioned in PERCIST look at both the SUL and the volume of the tumor, but these parameters require further validation. Total lesion glycolysis, the product of the mean SUL and the metabolic volume, showed predictive or prognostic values in cancers of the head and neck [10], lung [11], and uterus [12] to list just some, and in pancreas neuroendocrine tumors [13]. Simple product of volume and metabolic activity may not be the most accurate solution, and recently, a new metric was proposed that incorporates the commonly utilized metrics of SUV, metabolic tumor volume, and total lesion glycolysis into a single parameter [14].…”

Section: Performing Percistmentioning

confidence: 99%

PERCIST in Perspective

Wahl

2017

Nucl Med Mol Imaging

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Positron Emission tomography Response Criteria In Solid Tumors (PERCIST) version 1.0 was introduced in 2009 for objective assessment of tumor metabolic response using 18 F-FDG PET/CT. Practical PERCIST: A Simplified Guide to PET Response Criteria in Solid Tumors 1.0 was published in 2016 to review and clarify some of the issues with the PERCIST. In this article, we reflect on the benefits and challenges of implementing PERCIST, and speculate on topics that could be discussed in PERCIST 1.1 in the future.

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TLG-S criteria are superior to both EORTC and PERCIST for predicting outcomes in patients with metastatic lung adenocarcinoma treated with erlotinib

Cited by 25 publications

References 41 publications

[18F]FDG PET/CT predicts progression-free survival in patients with idiopathic pulmonary fibrosis

[18F]FDG PET/CT predicts progression-free survival in patients with idiopathic pulmonary fibrosis

Prognostic Value of Early Response Assessment Using (18F)Fdg-Pet in Patients with Advanced Non-Small Cell Lung Cancer Treated with Tyrosine-Kinase Inhibitors

PERCIST in Perspective

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