Value of FDG-PET in detecting residual or recurrent nonsmall cell lung cancer

Bury, Thierry; Corhay, Jean-Louis; Duysinx, Bernard; Daenen, Frédéric; Ghaye, Benoît; Barthélemy, Nicole; Rigo, Pierre; Bartsch, Pierre

doi:10.1183/09031936.99.14613769

Cited by 138 publications

(64 citation statements)

References 15 publications

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“…FDG-PET also offers improved sensitivity over CT imaging for differentiating new pulmonary nodules from scar tissue arising after surgical resection, radiation, and chemotherapy. For example, compared with CT, FDG-PET was 100% versus 71% sensitive and 92% versus 95% specific, respectively, in 126 NSCLC patients assessed before and after therapy (68). In a separate study of 63 NSCLC patients with suspected relapse, FDG-PET was 98% sensitive and had a negative predictive value of 93%; FDG-PET results stimulated a change in management of 40 (63%) patients (69).…”

Section: Fdg-pet Validated For Staging and Diagnosis: A Biomarker Of mentioning

confidence: 99%

Progress and Promise of FDG-PET Imaging for Cancer Patient Management and Oncologic Drug Development

Kelloff

Hoffman

Johnson

et al. 2005

Clinical Cancer Research

596

382

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2-[ 18 F]Fluoro-2-deoxyglucose positron emission tomography (FDG-PET) assesses a fundamentalpropertyof neoplasia, theWarburgeffect.This molecularimaging technique offers acomplementary approach to anatomic imaging that is more sensitive and specific in certain cancers. FDG-PET has been widely applied in oncology primarily as a staging and restaging tool that can guide patient care. However, because it accurately detects recurrent or residual disease, FDG-PETalso has significant potential for assessing therapy response. In this regard, it canimprove patient management by identifying responders early, before tumor size is reduced; nonresponders could discontinue futile therapy. Moreover, a reductioninthe FDG-PETsignal withindays or weeks of initiating therapy (e.g., in lymphoma, non^small cell lung, and esophageal cancer) significantly correlates with prolonged survival and other clinical end points now usedin drug approvals.These findings suggest that FDGPETcould facilitate drug development as an early surrogate of clinicalbenefit.This article reviews the scientificbasis ofFDG-PETandits development andapplicationasavaluableoncologyimagingtool. Its potential to facilitate drug development in seven oncologic settings (lung, lymphoma, breast, prostate, sarcoma, colorectal, and ovary) is addressed. Recommendations include initial validation against approved therapies, retrospective analyses to define the magnitude of change indicative of response, further prospective validation as a surrogate of clinical benefit, and application as a phase II/III trial end point to accelerate evaluation and approval of novel regimens and therapies. FDG-PET (2-[18 F]Fluoro-2-deoxyglucose positron emission tomography) is an accepted and widely used clinical imaging tool in oncology. U.S. Medicare reimbursement of FDG-PET recently expanded to encompass all cancer patients participating in certain prospective studies or registries in addition to more general coverage in 10 defined oncologic settings. Primarily covered are disease diagnosis, staging, and restaging, but FDG-PET is also approved for monitoring response to therapy in locally advanced and metastatic breast cancers when a change in therapy is anticipated. Clinical trials in breast cancer and other settings [e.g., non -small cell lung cancer (NSCLC) and esophageal cancer] have shown that FDG-PET imaging can provide an early indication of therapeutic response that is well correlated with clinical outcome. FDG-PET thus has the potential to improve patient management, particularly by signaling the need for early therapeutic changes in nonresponders, thereby obviating the side effects and costs of ineffective treatment. As an early surrogate for clinical benefit, the modality also has the potential to facilitate oncologic drug development by shortening phase II trials and detecting clinical benefit earlier in phase III investigations. Studies to further explore and validate these approaches are needed and can be conducted in parallel with those employing end points now use...

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Section: Fdg-pet Validated For Staging and Diagnosis: A Biomarker Of mentioning

confidence: 99%

Progress and Promise of FDG-PET Imaging for Cancer Patient Management and Oncologic Drug Development

Kelloff

Hoffman

Johnson

et al. 2005

Clinical Cancer Research

596

382

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“…PET is more accurate than conventional studies in detecting recurrent lung cancer and appears to be superior in distinguishing persistent or recurrent tumour from fibrotic scars [59,71]. However, false-positive studies do occur secondary to postirradiation inflammatory change and delaying the examination until 4 or 5 weeks postirradiation is recommended [72].…”

Section: Positron Emission Tomographymentioning

confidence: 99%

Diagnostic imaging of lung cancer

Hollings¹,

Shaw²

2002

Eur Respir J

120

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Carcinoma of the bronchus is the most common malignancy in the Western world. It is also the leading cause of cancer-related death accounting for 32% of all cancer deaths in males and 25% in females [1]. In the USA it causes more deaths than cancers of the colon, breast and prostate combined [2]. Disappointingly, in a recent UK survey of improvements in cancer survival [3], carcinoma of the bronchus showed the smallest percentage reduction in the number of deaths avoided between 1981-1990 (0.2%). This compares badly with breast (11% reduction) and melanoma (32%). The overall 5-yr survival for lung cancer diagnosed between 1986-1990 was only 5.3% (against 66% for breast and 76% for melanoma). It is on this background that the radiologist remains actively employed in the detection, diagnosis, staging and review of this common malignancy.

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“…In addition, conventional CT alone has been shown to be suboptimal in mediastinal restaging after treatment 8485 . 18 F-FDG PET has sensitivity of 93% to 100% and a specificity of 89% to 92% for detecting recurrent NSCLC 86–88. Patients with residual 18 F-FDG uptake after treatment have a poor prognosis when compared to those without residual 18 F-FDG uptake, taking into consideration the expected post-therapeutic inflammatory changes to avoid false-positive interpretation 84…”

Section: Methodsmentioning

confidence: 99%

¹⁸F-FDG PET/CT Imaging In Oncology

Almuhaideb

Παπαθανασίου

Bomanji

2011

Annals of Saudi Medicine

273

123

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Accurate diagnosis and staging are essential for the optimal management of cancer patients. Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose integrated with computed tomography (18F-FDG PET/CT) has emerged as a powerful imaging tool for the detection of various cancers. The combined acquisition of PET and CT has synergistic advantages over PET or CT alone and minimizes their individual limitations. It is a valuable tool for staging and restaging of some tumors and has an important role in the detection of recurrence in asymptomatic patients with rising tumor marker levels and patients with negative or equivocal findings on conventional imaging techniques. It also allows for monitoring response to therapy and permitting timely modification of therapeutic regimens. In about 27% of the patients, the course of managment is changed. This review provides guidance for oncologists/ radiotherapists and clinical and surgical specialists on the use of 18F-FDG PET/CT in oncology.

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Value of FDG-PET in detecting residual or recurrent nonsmall cell lung cancer

Cited by 138 publications

References 15 publications

Progress and Promise of FDG-PET Imaging for Cancer Patient Management and Oncologic Drug Development

Progress and Promise of FDG-PET Imaging for Cancer Patient Management and Oncologic Drug Development

Diagnostic imaging of lung cancer

¹⁸F-FDG PET/CT Imaging In Oncology

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Value of FDG-PET in detecting residual or recurrent nonsmall cell lung cancer

Cited by 138 publications

References 15 publications

Progress and Promise of FDG-PET Imaging for Cancer Patient Management and Oncologic Drug Development

Progress and Promise of FDG-PET Imaging for Cancer Patient Management and Oncologic Drug Development

Diagnostic imaging of lung cancer

18F-FDG PET/CT Imaging In Oncology

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¹⁸F-FDG PET/CT Imaging In Oncology