Prognostic models integrating quantitative parameters from baseline and interim positron emission computed tomography in patients with diffuse large B-cell lymphoma: post-hoc analysis from the SAKK38/07 clinical trial

Positron emission computed tomography (PET/CT) in patients with diffuse large B-cell lymphoma (DLBCL) enrolled in a prospective clinical trial were reviewed to test the impact of quantitative parameters from interim PET/CT scans on overall (OS) and progression-free (PFS) survival. We centrally reviewed baseline and interim PET/CT scans of 138 patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone given every 14 days (R-CHOP14) in the SAKK38/07 trial ( ClinicalTrial.gov identifier: NCT00544219). Cutoff values for maximum standardized uptake value (SUV_max), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and metabolic heterogeneity (MH) were defined by receiver operating characteristic analysis. Responses were scored using the Deauville scale (DS). Patients with DS 5 at interim PET/CT (defined by uptake >2 times higher than in normal liver) had worse PFS (P = 0.014) and OS (P < 0.0001). A SUV_max reduction (Δ) greater than 66% was associated with longer PFS (P = 0.0027) and OS (P < 0.0001). Elevated SUV_max, MTV, TLG, and MH at interim PET/CT also identified patients with poorer outcome. At multivariable analysis, ΔSUV_max and baseline MTV appeared independent outcome predictors. A prognostic model integrating ΔSUV_max and baseline MTV discriminated three risk groups with significantly (log-rank test for trend, P < 0.0001) different PFS and OS. Moreover, the integration of MH and clinical prognostic indices could further refine the prediction of OS. PET metrics-derived prognostic models perform better than the international indices alone. Integration of baseline and interim PET metrics identified poor-risk DLBCL patients who might benefit from alternative treatments.     

Early assessment with 18F-fluorodeoxyglucose positron emission tomography/computed tomography can help predict the outcome of neoadjuvant chemotherapy in triple negative breast cancer

BackgroundIn patients with triple-negative breast cancer (TNBC), pathology complete response (pCR) to neoadjuvant chemotherapy (NAC) is associated with improved prognosis. This prospective study was designed and powered to investigate the ability of interim ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸FDG-PET/CT) to predict pathology outcomes to NAC early during treatment.Patients and methodsConsecutive TNBC women underwent ¹⁸FDG-PET/CT at baseline and after two courses of NAC. Maximum standardised uptake value (SUV_max) in the primary tumour and lymph nodes at each examination and the evolution (ΔSUV_max) between the two scans were measured. NAC was continued irrespective of PET results. Correlations between PET parameters and pathology response, and between PET parameters and event-free survival (EFS), were examined.ResultsFifty patients without distant metastases were enroled. At completion of NAC, surgery showed pCR in 19 patients, while 31 had residual tumour. Mean follow-up was 30.3 months. Thirteen patients, all with residual tumour, experienced relapse. Of all assessed clinical, biological and PET parameters, ΔSUV_max in the primary tumour was the most predictive of pathology results (p < 0.0001; Mann–Whitney-U test) and EFS (p = 0.02; log rank test). A threshold of 42% decrease in SUV was identified because it offered the best accuracy in predicting EFS. There were 32 metabolic responders (⩾42% decrease in SUV_max) and 18 non-responders. Within responders, the pCR rate was 59% and the 3-year EFS 77.5%. In non-responders, the pCR rate was 0% and the 3-year EFS 47.1%.ConclusionInterim ¹⁸FDG can early predict the inefficacy of NAC in TNBC patients. It shows promise as a potential contributory biomarker in these patients.     

Prognostic value of maximum standardized uptake value measured by pretreatment 18F-FDG PET/CT in locally advanced head and neck squamous cell carcinoma

Purpose/objectives

To evaluate the prognostic impact of maximum standardized uptake value (SUV_max) in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) undergoing pretreatment [F-18] fluoro-d-glucose-positron emission tomography/computed tomography (FDG PET/CT) imaging.

Materials/methods

Fifty-eight patients undergoing FDG PET/CT before radical treatment with definitive radiotherapy (±concomitant chemotherapy) or surgery + postoperative (chemo)radiation were analyzed. The effects of clinicopathological factors (age, gender, tumor location, stage, Karnofsky Performance Status (KPS), and treatment strategy) including primary tumor SUV_max and nodal SUV_max on overall survival (OS), disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) were evaluated. Kaplan–Meier survival curves were generated and compared with the log-rank test.

Results

Median follow-up for the whole population was 31 months (range 2.3–53.5). Two-year OS, LRC, DFS and DMFS, for the entire cohort were 62.1, 78.3, 55.2 and 67.2%, respectively. Median pretreatment SUV_max for the primary tumor and lymph nodes was 11.85 and 5.4, respectively. According to univariate analysis, patients with KPS < 80% (p < 0.001), AJCC stage IVa or IVb vs III (p = 0.037) and patients undergoing radiotherapy vs surgery (p = 0.042) were significantly associated with worse OS. Patients with KPS < 80% (p = 0.003) or age ≥65 years (p = 0.007) had worse LRC. The KPS < 80% was the only factor associated with decreased DFS (p = 0.001). SUV_max of the primary tumor or the lymph nodes were not associated with OS, DFS or LRC. The KPS < 80% (p = 0.002), tumor location (p = 0.047) and AJCC stage (p = 0.025) were associated with worse cancer-specific survival (CSS). According to Cox regression analysis, on multivariate analysis KPS < 80% was the only independent parameter determining worse OS, DFS, CSS. Regarding LRC only patients with IK < 80% (p = 0.01) and ≥65 years (p = 0.01) remained statistically significant. Nodal SUV_max was the only factor associated with decreased DMFS. Patients with a nodal SUV_max > 5.4 presented an increased risk for distant metastases (HR, 3.3; 95% CI 1.17–9.25; p = 0.023).

Conclusions

The pretreatment nodal SUV_max in patients with locally advanced HNSCC is prognostic for DMFS. However, according to our results primary tumor SUV_max and nodal SUV_max were not significantly related to OS, DFS or LRC. Patients presenting KPS < 80% had worse OS, DFS, CSS and LRC.

     

Total lesion glycolysis in oral squamous cell carcinoma as a biomarker derived from pre-operative FDG PET/CT outperforms established prognostic factors in a newly developed multivariate prediction model

Purpose: Retrospective study to investigate the impact of image derived biomarkers from [¹⁸F]FDG PET/CT prior to surgical resection in patients with initial diagnosis of oral squamous cell carcinoma (OSCC), namely SUV_max, SUV_mean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary tumor to predict overall survival (OS).Materials and Methods: 127 subsequent patients with biopsy-proven OSCC were included who underwent [¹⁸F]FDG PET/CT before surgery. SUV_max, SUV_mean, MTV and TLG of the primary tumor were measured. OS was estimated according to Kaplan-Meier and compared between median-splitted groups by the log-rank test. Prognostic parameters were analyzed by uni-/multivariate Cox-regression.Results: During follow-up 52 (41%) of the patients died. Median OS was longer for patients with lower MTV or lower TLG. SUV_max and SUV_mean failed to be significant predictors for OS. Univariate Cox-regression identified MTV, TLG, lymph node status and UICC stage as prognostic factors. By multivariate Cox-regression MTV and TLG turned out to be independent prognostic factors for OS.Conclusions: The pre-therapeutic [¹⁸F]FDG PET/CT parameters MTV and TLG in the primary tumor are prognostic for OS of patients with an initial diagnosis of OSCC. TLG is the strongest independent prognostic factor for OS and outperforms established prognostic parameters in OSCC.     

Prognostic value of 18FDG PET/CT volumetric parameters in the survival prediction of patients with pancreatic cancer

PurposeTo investigate the value of ¹⁸ FDG PET/CT volumetric parameters in the prediction of overall survival (OS) in patients with pancreatic cancer and also, assess their independence relative to well-established clinico-pathological variables.MethodsWe conducted a retrospective analysis of patients with a confirmed diagnosis of pancreatic cancer who underwent ¹⁸ FDG PET/CT. The tumour maximum standardised uptake value (SUV_max) in addition to SUV_mean, metabolic tumour volume (MTV) and total lesion glycolysis (TLG) were calculated. The prognostic value of ¹⁸ FDG PET/CT and clinico-pathological parameters for OS were assessed using univariate and multivariable analyses.ResultsA sum of 89 patients were analysed in this study. Median survival for patients categorised as having high TLG (≥55) and low TLG (<55) was 18 vs 5 months (p < 0.001). Similarly, the respective high vs low SUV_mean, MTV and SUVmax were 18 vs 6 months (p = 0.001), 16 vs 6 months (p = 0.002) and 18 vs 6 months (p = 0.001). Univariate analysis showed SUV_max, SUV_mean, MTV, TLG, tumour size, tumour differentiation and presence of distant metastasis as prognostic factors for OS. On multivariable analysis, TLG (HR 2.0, 95% CI 1.26–3.18, p = 0.004) and the presence of distant metastasis (HR 3.37, 95% CI 1.97–5.77, p < 0.001) emerged as independent prognostic factors. Subgroup analysis identified TLG as the only significant PET metric after adjusting for the presence of distant metastasis.Conclusions¹⁸ FDG PET/CT is a useful tool in the preoperative evaluation of patients with pancreatic cancer. Tumour TLG offer an independent prognostic value in both potentially operable and metastatic disease settings.     

Anal cancer maximum F-18 fluorodeoxyglucose uptake on positron emission tomography is correlated with prognosis

Purpose

To evaluate anal cancer uptake of F-18 fluorodeoxyglucose (FDG) measured as the maximum standardized uptake value (SUV_max) by positron emission tomography (PET) and its correlation with prognostic factors.

Patients and methods

The study population consisted of 77 patients with stages 0-IIIB anal cancer who underwent pre-treatment FDG-PET. Tumor histology included 65 squamous cell, 11 basaloid, and 1 small cell cancers. SUV_max and sites of lymph node metastasis were recorded. We analyzed the association between SUV_max and prognostic factors.

Results

The mean SUV_max was 10.0 (range 1.0-43.1). The stage distribution included: 2 stage 0, 7 stage I, 49 stage II, 10 stage IIIA, 9 stage IIIB. SUV_max and clinical tumor size were not associated (R² = 0.338). Histology did not significantly influence SUV_max (mean SUV_max 10.0 for squamous versus 9.90 for basaloid). Higher SUV_max was associated with an increased risk of nodal metastasis at diagnosis (p < 0.0001). Higher SUV_max was associated with worse disease-free survival (p = 0.05). Patients with high anal tumor SUV_max at diagnosis were at an increased risk of persistent or recurrent disease on post-therapy FDG-PET performed less than 4 months after completing therapy (p = 0.0402).

Conclusions

SUV_max is a valuable biomarker of anal cancer prognosis, predicting increased risk of lymph node metastasis and worse disease-free survival.     

Metabolic Characteristics of Advanced Biliary Tract Cancer Using 18F‐Fluorodeoxyglucose Positron Emission Tomography and Their Clinical Implications

Background.

In advanced biliary tract cancer (BTC), the metabolic landscape has not been evaluated by ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) yet. Furthermore, reports of the clinical implications of these metabolic features are limited. We aimed to evaluate the metabolic features and their clinical relevance in advanced BTC using ¹⁸F-FDG PET.

Patients and Methods.

We consecutively enrolled patients with advanced BTC who underwent ¹⁸F-FDG PET prior to palliative chemotherapy between 2003 and 2013. We evaluated the findings of PET, such as SUV_max, the number of lesions and organs with FDG uptake, pathologic findings, and clinical outcomes.

Results.

A total of 106 patients were enrolled: (53 intrahepatic cholangiocarcinoma [ICC], 7 extrahepatic BTC, 30 gallbladder cancer [GB Ca], and 16 ampulla of Vater cancer [AoV Ca]). The median SUV_max differed according to the primary origin (ICC, 9.10; extrahepatic BTC, 5.90; GB Ca, 9.10; and AoV Ca, 6.37; p = .008) and histologic differentiation (well differentiated, 4.95; moderately differentiated, 6.60; poorly differentiated, 14.50; p = .004). Patients in the high metabolic group (SUV_max of ≥7.5) had more poorly differentiated histology and more organs and lesions with FDG uptake than did those in the low metabolic group (SUV_max of <7.5). The low metabolic group had a significantly longer OS (11.4 vs. 7.4 months, p = .007) and PFS (6.6 vs. 4.3 months, p = .024) than high metabolic group. In multivariate analysis, SUV_max was a significant prognostic factor for overall survival (OS; p = .047) and progression-free survival (PFS; p = .039).

Conclusion.

Metabolic characteristics of advanced BTC differ according to primary origin and histology. These metabolic features could be prognostic factors for OS and PFS in advanced BTC.

Implications for Practice:

The metabolic landscape of advanced biliary tract cancer and its clinical meanings have not yet been comprehensively studied. This study shows that metabolic characteristics of advanced biliary tract cancer differ significantly according to primary origin and histology. Moreover, this metabolic activity is associated with patients’ outcomes, including overall survival and progression-free survival. This study supports tumor heterogeneity in terms of cancer metabolism in biliary tract cancer.     

应用根治性IMRT结合降低预防照射区剂量治疗Ⅲ期SCLC研究

目的 分析应用根治性IMRT结合降低预防照射区剂量治疗Ⅲ期SCLC的疗效和不良反应。方法 回顾分析2010—2012年间收治的40例Ⅲ期SCLC患者资料。PGTV总剂量60 Gy分30次,PTV总剂量54 Gy分30次。全部接受了铂类联合依托泊苷或替尼泊苷方案的诱导化疗,31例辅助化疗,22例同期放化疗。17例患者接受了脑预防照射(25 Gy分10次)。采用RECIST 1.0和CTCAE 4.0 标准分别评价近期疗效和不良反应。采用Kaplan-Meier法计算生存率。结果 近期有效率98%。随访率100%,随访时间满2年者22例。1、2年OS分别为84%、48%,LRFS分别为89%、85%,PFS分别为61%、41%。治疗相关性肺炎发生率0~1级65%、2级 25%、3级5%、5级5%,治疗相关性食管炎发生率0~1级53%、2级43%、3级5%。结论 初步结果显示根治性IMRT结合降低预防照射区剂量治疗Ⅲ期SCLC是安全有效的,值得进一步大样本前瞻性随机分组研究。     

Independent prognostic value of pre-treatment 18-FDG-PET in high-grade gliomas

The prognostic value of PET with (18F)-fluoro-2-deoxy-d-glucose (FDG) has been shown in high-grade gliomas (HGG), but not compared with consensual prognostic factors. We sought to evaluate the independent predictive value of pre-treatment FDG-PET on overall (OS) and event-free survival (EFS). We retrospectively analyzed 41 patients with histologically-confirmed HGG (31 glioblastomas and 10 anaplastic gliomas). The pre-treatment uptake of FDG was assessed qualitatively by five-step visual metabolic grading, and quantitatively by the ratio between the tumor and contralateral maximal standardized uptake value (T/CL). EFS and OS following PET were compared with FDG uptake by univariate analysis, and by two multivariate analyses: one including main consensual prognostic factors (age, KPS, extent of surgery and histological grade), and the other including the classification system of the Radiation Therapy Oncology Group (Recursive Partitioning Analysis, RPA). Median OS and EFS were 13.8 and 7.4 months, respectively, for glioblastomas, and over 25.8 and 12 months, respectively, for anaplastic gliomas (P = 0.040 and P = 0.027). The T/CL ratio predicted OS in the entire group [P = 0.003; Hazard Ratio (HR) = 2.3] and in the glioblastoma subgroup (P = 0.018; HR = 2), independently of age, Karnofsky performance status, histological grade, and surgery, and independently of RPA classification. T/CL ratio tended to predict EFS in the whole group (P = 0.052). The prognostic value of visual metabolic grade on OS was less significant than T/CL ratio, both in the entire group and in the glioblastoma subgroup (P = 0.077 and P = 0.059). Quantitative evaluation of the ratio between the maximal tumor and contralateral uptake in pre-treatment FDG-PET provides significant additional prognostic information in newly-diagnosed HGG, independently of consensual prognostic factors.     

[18F]‐Fluorodeoxyglucose Positron Emission Tomography Standardized Uptake Value as a Predictor of Adjuvant Chemotherapy Benefits in Patients With Nasopharyngeal Carcinoma

Background.

The role of adjuvant chemotherapy for the treatment of nasopharyngeal carcinoma (NPC) is controversial, and the identification of adequate predictive factors is warranted. Therefore, we aimed to investigate whether the mean standardized uptake value (SUV) measured on [¹⁸F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) could predict the survival benefits for NPC patients that receive adjuvant chemotherapy.

Materials and Methods.

The data for 174 NPC patients who underwent PET/computed tomography before chemoradiation between January 2004 and January 2012 were reviewed. The SUV_75% was recorded for primary tumors. All patients received intensity-modulated radiotherapy and cisplatin-based chemotherapy. Adjuvant chemotherapy consisted of 3 cycles of 75 mg/m² cisplatin and 1,000 mg/m² fluorouracil for 4 days.

Results.

The optimal cutoff value was 8.35 for SUV_75%, with 112 (64.4%) patients having lower SUV_75% and 62 (35.6%) having higher SUV_75%. Patients with lower SUV_75% had significantly better 5-year overall survival (OS) and distant metastasis-free survival. Multivariate analysis revealed that tumor stage, SUV_75%, and adjuvant chemotherapy were significant prognostic factors for OS. Patients with higher SUV_75% had significantly higher 5-year OS rates with adjuvant chemotherapy than without adjuvant chemotherapy (84.3% vs. 32.4%, respectively; p < .001). However, in the lower SUV_75% group, no differences in 5-year OS were observed between patients who received and those who did not receive adjuvant chemotherapy (92.4% vs. 93.3%, respectively; p = .682).

Conclusion.

The SUV_75% on FDG PET for primary tumors could successfully identify NPC patients who may benefit from adjuvant chemotherapy.     

Utility of 18F-FDG PET for Predicting Histopathologic Response in Esophageal Carcinoma following Chemoradiation

IntroductionFor patients with esophageal cancer undergoing neoadjuvant chemoradiation (CRT) followed by surgical resection, complete histopathologic response (pCR) is associated with favorable overall survival (OS). The aim of this study was to evaluate the correlation between ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG PET) response to neoadjuvant CRT and pCR.MethodsMaximum standardized uptake values and standardized uptake ratios (SURs) were measured before and after CRT. SUR was normalized to liver uptake and mediastinal blood pool uptake. FDG PET complete response was defined as metabolic activity normalization to hepatic and blood pool activity. The correlation between FDG PET parameters and pCR was examined through logistic regression analyses.ResultsIn total, 193 patients were monitored for a median of 3.6 years after initiation of CRT. Most tumors were adenocarcinoma (85%) and stage T3 (75%). Complete FDG PET response and pCR occurred in 27% and 34% of patients, respectively. Histologic findings, chemotherapy type, tumor stage, and radiation dose were not significantly associated with complete radiographic response. The rates of pCR in patients with and without radiographic complete response were 42% and 31% (p = 0.17), respectively. No predictive correlation was found between pCR and change in maximum standardized uptake value (p = 0.25), in SUR normalized to blood pool uptake (p = 0.20), or in SUR normalized to liver uptake (p = 0.15). The 5-year OS rate was 46% for patients with a complete FDG PET response versus 44% without a complete response (p = 0.78). The 5-year OS rate of patients who achieved pCR was 49% versus 43% for patients with residual tumor (p = 0.04).ConclusionFor patients with esophageal cancer who received neoadjuvant chemoradiation, pretreatment and posttreatment FDG PET parameters did not correlate with pCR or OS.     

Multi-institutional analysis of cervical esophageal carcinoma patients treated with definitive chemoradiotherapy: TROD 01-005 study

The aim of this study was to examine the prognostic factors and treatment outcomes of cervical esophageal carcinoma (CEC) patients who underwent definitive chemoradiotherapy (CRT). The clinical data of 175 biopsy-confirmed CEC patients treated with definitive CRT between April 2005 and September 2021 were retrospectively analyzed. The prognostic factors predicting overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS) were assessed in uni- and multivariable analyses. The median age of the entire cohort was 56 years (range: 26–87 years). All patients received definitive radiotherapy with a median total dose of 60 Gy, and 52% of the patients received cisplatin-based concurrent chemotherapy. The 2-year OS, PFS, and LRFS rates were 58.8%, 46.9%, and 52.4%, respectively, with a median follow-up duration of 41.6 months. Patients’ performance status, clinical nodal stage, tumor size, and treatment response were significant prognostic factors for OS, PFS, and LRFS in univariate analysis. Non-complete treatment response was an independent predictor for poor OS (HR = 4.41, 95% CI, 2.78–7.00, p < 0.001) and PFS (HR = 4.28, 95% CI, 2.79–6.58, p < 0.001), whereas poor performance score was a predictor for worse LRFS (HR = 1.83, 95% CI, 1.12–2.98, p = 0.02) in multivariable analysis. Fifty-two patients (29.7%) experienced grade II or higher toxicity. In this multicenter study, we demonstrated that definitive CRT is a safe and effective treatment for patients with CEC. Higher radiation doses were found to have no effect on treatment outcomes, but a better response to treatment and a better patient performance status did.     

疗前FDG标准摄取值预测局部晚期鼻咽癌调强放疗疗效探讨

目的 评价疗前PE-CT FDG最大标准摄取值(SUV_max)预测局部晚期鼻咽癌调强放疗(IMRT)预后的价值。方法 140例疗前行全身或头颈部FDG PET-CT并接受根治性IMRT的Ⅲ~Ⅳ_b期(UICC/AJCC-6^th分期)鼻咽癌病例被纳入研究。分别分析鼻咽原发灶 SUV_max（SUV_max-P)、颈部转移淋巴结 SUV_max(SUV_max-N)与临床各因素和临床疗效的关系。结果 全组 SUV_max-P中位数为10.4,SUV_max-N为6.2。SUV_max-P与T分期(R=0.279,P=0.001)、SUV_max-N与N分期(R=0.334,P=0.000)均相关。局部复发与无复发患者 SUV_max-P中位数为9.2与10.4(U=560.50,P=0.805),SUV_max-N中位数为4.0与5.0(U=576.00,P=0.908)。远处转移与无转移患者 SUV_max-P中位数为11.9与9.8(U=987.50,P=0.014),SUV_max-N中位数为5.0与5.0(U=1266.00,P=0.348)。与 5年无远处转移生存(DMFS)和 5年总生存(OS)相关最佳截断点 SUV_max-P均为10.2。SUV_max-P≤10.2与>10.2患者 5年DMFS和OS分别为95.5%与69.1%(χ²=15.88,P=0.000)和94.0%与68.4%(χ²=15.56,P=0.000)。多因素分析显示 SUV_max-P是 5年DMFS及OS的预后因素(HR=7.87,P=0.001及 HR=5.14,P=0.003)。结论 疗前原发灶FDG SUV_max可能是预测局部晚期鼻咽癌IMRT后远处转移和生存的有效生物学指标。     

Prognostic value of interim 18F-FDG PET/CT in diffuse large B-cell lymphoma

Objective: Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease. The prognostic factor currently used is not accurate enough to predict the outcomes of patients with DLBCL. The prognostic significance of interim PET/CT in DLBCL remains controversial. The aim of this study is to determine the predictive value of interim 18F-FDG PET/CT after first-line treatment in patients with DLBCL. Methods: Thirty-two patients with DLBCL underwent baseline, interim and post-treatment 18F-FDG PET/CT scans. Imaging results were analyzed for the survival of patients via software SPSS 13.0, retrospectively. Results: Thirty-one of the 32 patients were treated with R-CHOP regimen, and interim 18F-FDG PET/CT of 24 patients was performed after 2 cycles of treatment. After a median follow-up period of 16.7 months, the 2-year progression-free survival (PFS) rates were significantly different between the groups above and below SUV max cut-off value of 2.5 (P=0.039). No significant differences were found in the 2-year PFS rates if SUV max cut-off values were set as 2.0 and 3.0, respectively (P=0.360; P=0.113). Conclusions: Interim PET/CT could predict the prognosis of DLBCL patients with the SUV max cut-off value of 2.5, but more clinical data should be concluded to confirm this conclusion.     

Pelvic lymph node F‐18 fluorodeoxyglucose uptake as a prognostic biomarker in newly diagnosed patients with locally advanced cervical cancer

BACKGROUND:

The objective of the current study was to evaluate the prognostic significance of the maximum standardized uptake value (SUV_max) of F‐18 fluorodeoxyglucose (FDG) as measured by positron emission tomography (PET) in pelvic lymph nodes in patients with cervical cancer.

METHODS:

The authors studied cervical cancer patients with pelvic lymph node metastasis, as evidenced on FDG‐PET, who were treated between November 2003 and October 2008. The maximum dimension and SUV_max for the most FDG‐avid pelvic lymph node (SUV_PLN) and the SUV_max of the primary cervical tumor (SUV_cervix) were recorded from the FDG‐PET/computed tomography (CT) scan. The SUV_PLN was analyzed for its association with treatment response, pelvic disease recurrence, disease‐specific survival, and overall survival.

RESULTS:

The population was comprised of 83 women with International Federation of Gynecology and Obstetrics (FIGO) stages IB1 to IIIB cervical cancer. The average SUV_PLN was 6.9 (range, 2.1‐33.0), whereas the average SUV_cervix was 14.0 (range, 3.2‐38.4). The SUV_cervix and SUV_PLN were found to be weakly correlated (correlation coefficient [R²] = 0.301). The average size of the pelvic lymph nodes was 2.1 cm (range, 0.6‐7.9 cm), and was also found to be only weakly associated with the SUV_PLN (R² = 0.225). The SUV_PLN was found to be correlated with an increased risk of persistent disease after treatment (P = .0025), specifically within the pelvic lymph node region (P = .0003). The SUV_PLN was found to be predictive of an increased risk of ever developing pelvic disease recurrence (P = .0035). Patients with a higher SUV_PLN were found to have significantly worse disease‐specific (P = .0230) and overall survival (P = .0378) using Kaplan?Meier evaluation. A Cox proportional hazards model for the risk of pelvic disease recurrence was performed including SUV_PLN, patient age, and tumor stage, and found only an increased SUV_PLN to be an independent predictor.

CONCLUSIONS:

SUV_PLN is a prognostic biomarker, predicting treatment response, pelvic recurrence risk, and disease‐specific survival in patients with cervical cancer. Cancer 2010. © 2010 American Cancer Society.     

The metabolic response using F-fluorodeoxyglucose-positron emission tomography/computed tomography and the change in the carcinoembryonic antigen level for predicting response to pre-operative chemoradiotherapy in patients with rectal cancer

Background and purpose

To predict tumor regression in pre-operative chemoradiotherapy (CRT) using ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) and serum carcinoembryonic antigen (CEA) in patients with rectal cancer.

Materials and methods

The metabolic response of the tumor was assessed by determining the maximal standardized uptake value (SUV_max), absolute difference (ΔSUV_max), and SUV reduction ratio (SRR) on pre- and post-CRT PET/CT scans. The serum CEA, absolute difference (ΔCEA), and the CEA reduction ratio (CRR) were also determined. A receiver-operating characteristic (ROC) curve was generated.

Results

Of all seventy two patients, mean pre- and post-CRT SUV_max was 14.9 and 5.8, respectively. The mean pre- and post-CRT CEA level was 15.5 ng/ml and 5.4 ng/ml, respectively. Forty-three patients (59.8%) were classified as responders (Dworak’s tumor regression grade 3-4) and 36 patients (50%) achieved tumor down-staging. ROC analysis showed that both post-CRT SUV_max and SRR were predictive factors for responders (p = 0.03 and p = 0.02, respectively). A threshold of post-CRT SUV_max was 5.4 and that of SRR was 53.1%. Pre-CRT SUV_max, ΔSUV_max, and all parameters in regard to CEA were not significant in ROC analysis.

Conclusions

The post-CRT SUV_max and SRR are potential factors for predicting tumor response in pre-operative CRT. The patients with lower post-CRT SUV_max and higher SRR could be expected to achieve maximum tumor regression after pre-operative CRT in this study.     

Prognostic significance of 18F-FDG PET/CT in patients with colorectal cancer liver metastases after hepatectomy

Introduction

Colorectal cancer liver metastasis (CRLM) can be cured with surgery. To improve survival, optimal selection of CRLM patients should be done cautiously, which may be facilitated by preoperative [F-18] fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT).

The Prognostic Significance of Maximum Standardized Uptake Value of Primary Tumor in Surgically Treated Non–Small-Cell Lung Cancer Patients: Analysis of 413 Cases

BackgroundIntegrated PET/CT is widely used in the preoperative staging and prognostic assessment of non–small-cell lung cancer (NSCLC) patients. The aims of this study were to evaluate the prognostic significance of SUV_max of primary tumor in patients undergoing surgical treatment and, in order to minimize technical interferences, to verify whether SUV_max standardized by SUV_max liver or SUV_max blood pool provided additional prognostic information.Patients and MethodsA retrospective study of 413 consecutive NSCLC patients undergoing potentially curative surgical resection after PET/CT obtained in the same PET center over a 6-year period. The SUV_max was calculated drawing region of interest around the primitive tumor, the liver, and the aortic arch in PET images. The same procedure was performed for 2 adjacent planes and the average of these measures was considered.ResultsNine patients were considered 30-day postoperative deaths and were excluded from the analysis. At the end of the study, 312 (77.2%) of the 404 patients were alive (median follow-up, 26 months) and 92 had died (median survival, 17 months). At multivariate analysis tumor-node-metastasis stage, primary tumor grading and primary tumor SUV_max (T-SUV_max) were found to be independent prognostic factors, while T-SUV_max/SUV_max blood pool ratio, and T-SUV_max/SUV_max liver ratio were not.ConclusionsT-SUV_max is an independent predictor for survival in NSCLC patients undergoing surgery and might be helpful in guiding adjuvant treatment strategies. SUV_max of primary tumor normalized by SUV blood pool or SUV liver does not provide additional prognostic information.     

Intensity-modulated radiation therapy versus conventional radiation therapy for squamous cell carcinoma of the anal canal

BACKGROUND:

The purpose of this study was to compare outcomes in patients with anal canal squamous cell carcinoma (SCCA) who were treated with definitive chemoradiotherapy by either intensity‐modulated radiation therapy (IMRT) or conventional radiotherapy (CRT).

METHODS:

Forty‐six patients who received definitive chemoradiotherapy from January 1993 to August 2009 were included. Forty‐five patients received 5‐fluorouracil with mitomycin C (n = 39) or cisplatin (n = 6). Seventeen (37%) were treated with CRT and 29 (63%) with IMRT. The median dose was 54 Gy in both groups. Median follow‐up was 26 months (CRT) and 32 months (IMRT). T3‐T4 stage (P = .18) and lymph node‐positive disease (P = .6) were similar between groups.

RESULTS:

The CRT group required longer treatment duration (57 days vs 40 days, P < .0001), more treatment breaks (88% vs 34.5%, P = .001), and longer breaks (12 days vs 1.5 days, P < .0001) than patients treated with IMRT. Eleven (65%) patients in the CRT group experienced grade >2 nonhematologic toxicity compared with 6 (21%) patients in the IMRT group (P = .003). The 3‐year overall survival (OS), locoregional control (LRC), and progression‐free survival were 87.8%, 91.9%, and 84.2%, respectively, for the IMRT groups and 51.8%, 56.7%, and 56.7%, respectively, for the CRT group (all P < .01). On multivariate analysis, T stage, use of IMRT, and treatment duration were associated with OS, and T stage and use of IMRT were associated with LRC.

CONCLUSIONS:

The use of IMRT was associated with less toxicity, reduced need for treatment breaks, and excellent LRC and OS compared with CRT in patients with SCCA of the anal canal. Cancer 2011. © 2011 American Cancer Society.     

Treatment of oropharyngeal squamous cell carcinoma with IMRT: patterns of failure after concurrent chemoradiotherapy and sequential therapy

Background The optimal management of oropharyngeal squamous cell carcinoma (OPSCC) is controversial. Modern radiotherapy typically employs intensity-modulated radiation therapy (IMRT), and herein, we report the Dana-Farber Cancer Institute (DFCI) experience with IMRT-based treatment of OPSCC. Design Retrospective study of all patients treated at DFCI for OPSCC with definitive or adjuvant IMRT between 8/04 and 8/09. The primary end point was overall survival (OS); secondary end points were locoregional control (LRC) and freedom from distant metastases (FFDM). Propensity score matching was used to create concurrent chemoradiotherapy (CCRT) and sequential therapy (ST) cohorts equally balanced for patient and disease characteristics. Results One hundred and sixty-three patients were included with 75% presenting with stage IV disease. Fifty-six patients (34%) were treated with ST. The three-year actuarial OS, LRC, and FFDM rates for the entire cohort/ST subset were 86%/89%, 86%/87%, and 88%/93%, respectively. There were no differences in OS, LRC, or FFDM between CCRT and ST in the propensity-matched cohort. Conclusions IMRT was associated with excellent OS, LRC, and FFDM. Although the results following ST were superb, there was no obvious benefit to ST after adjustment for selection bias. We recommend that ST be reserved for medically fit patients with a high risk of distant metastases.