Post-therapy normalization of brain FDG-PET in Morvan's syndrome

1088 Background: In patients with locally advanced breast cancer (LABC), qualitative FDG positivity following neo-adjuvant chemotherapy (NC) has been shown to be inversely associated with survival (Emmering, Annals Oncol, 2008). We investigated quantitative measures of post-therapy FDG uptake, namely standardized uptake value (SUV) and glycolytic flux (Ki), as predictors of breast cancer survival. Methods: Forty-seven patients with LABC underwent dynamic FDG PET scans close to or at the end of NC and prior to surgical resection. Post-therapy FDG uptake at the primary tumor site was measured by mean SUV from 45-60 minutes after FDG injection, maximum SUV (SUVmax) from 50-55 minutes, and FDG glycolytic flux (Ki). Pathologic response (PR) was assessed for at the time of surgical resection. Cox proportional hazards models were used to estimate associations between log-transformed measures of post-therapy FDG uptake, PR and outcome. Results: Median SUVmax was 1.9 (0.9 – 9.2) and median Ki was 2.2 (0.02 – 47.7) mL/min/g. Median follow-up for relapse was 5.7 years with 11 events and 6.3 years for survival with 10 deaths. PR was not significant for DFS (p = .39) or OS (p= .48). Post-therapy FDG uptake measures showed a statistically significant ability to predict survival. SUVmax predicted DFS (p=0.02) and OS (p=0.01). Ki was associated with DFS (p <0.01) and OS (p <0.01). PET measured hazard ratios were not attenuated in multivariate analysis controlling for known prognostic markers such as primary tumor PR and nodal status. However, multivariate survival models appeared highly influenced by one patient with the shortest survival time (1.3 years) and highest SUVmax and Ki. Without this patient, Ki remained a borderline independent predictor of DFS (p= .08) and OS (p= .07), but SUVmax was no longer significant for DFS (p= .32) or OS (p=0.26). Conclusions: Our analysis suggests that quantitative measures of post-therapy FDG PET provide information beyond PR for predicting which LABC patients are at highest risk for relapse and death. This information may be useful in directing post-surgery treatment. Supported by NIH grants CA42045, CA138293, and CA148131.

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18F-fluorodeoxyglucose (FDG) PET or 18F-fluorothymidine (FLT) PET to assess early response to aromatase inhibitors (AI) in women with ER+ operable breast cancer in a window-of-opportunity study

Breast Cancer Research ◽

10.1186/s13058-021-01464-1 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Perrin E. Romine ◽

Lanell M. Peterson ◽

Brenda F. Kurland ◽

Darrin W. Byrd ◽

Alena Novakova-Jiresova ◽

...

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Pet Imaging ◽

Fdg Pet ◽

Early Stage ◽

Early Response ◽

Window Of Opportunity ◽

Ki 67 ◽

Flt Pet ◽

Post Therapy

Abstract Purpose This study evaluated the ability of 18F-Fluorodeoxyglucose (FDG) and 18F-Fluorothymidine (FLT) imaging with positron emission tomography (PET) to measure early response to endocrine therapy from baseline to just prior to surgical resection in estrogen receptor positive (ER+) breast tumors. Methods In two separate studies, women with early stage ER+ breast cancer underwent either paired FDG-PET (n = 22) or FLT-PET (n = 27) scans prior to endocrine therapy and again in the pre-operative setting. Tissue samples for Ki-67 were taken for all patients both prior to treatment and at the time of surgery. Results FDG maximum standardized uptake value (SUVmax) declined in 19 of 22 lesions (mean 17% (range −45 to 28%)). FLT SUVmax declined in 24 of 27 lesions (mean 26% (range −77 to 7%)). The Ki-67 index declined in both studies, from pre-therapy (mean 23% (range 1 to 73%)) to surgery [mean 8% (range < 1 to 41%)]. Pre- and post-therapy PET measures showed strong rank-order agreement with Ki-67 percentages for both tracers; however, the percent change in FDG or FLT SUVmax did not demonstrate a strong correlation with Ki-67 index change or Ki-67 at time of surgery. Conclusions A window-of-opportunity approach using PET imaging to assess early response of breast cancer therapy is feasible. FDG and FLT-PET imaging following a short course of neoadjuvant endocrine therapy demonstrated measurable changes in SUVmax in early stage ER+ positive breast cancers. The percentage change in FDG and FLT-PET uptake did not correlate with changes in Ki-67; post-therapy SUVmax for both tracers was significantly associated with post-therapy Ki-67, an established predictor of endocrine therapy response.

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Role of Baseline and Post-Therapy 18F-FDG PET in the Prognostic Stratification of Metastatic Castration-Resistant Prostate Cancer (mCRPC) Patients Treated with Radium-223

Cancers ◽

10.3390/cancers12010031 ◽

2019 ◽

Vol 12 (1) ◽

pp. 31 ◽

Cited By ~ 3

Author(s):

Matteo Bauckneht ◽

Selene Capitanio ◽

Maria Isabella Donegani ◽

Elisa Zanardi ◽

Alberto Miceli ◽

...

Keyword(s):

Prostate Cancer ◽

Fdg Pet ◽

Bone Scan ◽

Metabolic Tumor Volume ◽

Radium 223 ◽

Positron Emission ◽

Pet Ct ◽

Prognostic Stratification ◽

Fdg Pet Ct ◽

Post Therapy

Radium-223 dichloride (Ra223) represents the unique bone-directed treatment option that shows an improvement in overall survival (OS) in metastatic castrate resistant prostate cancer (mCRPC). However, there is an urgent need for the identification of reliable biomarkers to non-invasively determine its efficacy (possibly improving patients’ selection or identifying responders’ after therapy completion). 18F-Fluorodeoxyglucose (FDG)-avidity is low in naïve prostate cancer, but it is enhanced in advanced and chemotherapy-refractory mCRPC, providing prognostic insights. Moreover, this tool showed high potential for the evaluation of response in cancer patients with bone involvement. For these reasons, FDG Positron Emission Tomography (FDG-PET) might represent an effective tool that is able to provide prognostic stratification (improving patients selection) at baseline and assessing the treatment response to Ra223. We conducted a retrospective analysis of 28 mCRPC patients that were treated with Ra223 and submitted to bone scan and FDG-PET/CT for prognostic purposes at baseline and within two months after therapy completion. The following parameters were measured: number of bone lesions at bone scan, SUVmax of the hottest bone lesion, metabolic tumor volume (MTV), and total lesion glycolysis (TLG). In patients who underwent post-therapy 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT), (20/28), PET Response Criteria in Solid Tumors (PERCIST), and European Organization for Research and Treatment of Cancer (EORTC) criteria were applied to evaluate the metabolic treatment response. The difference between end of therapy and baseline values was also calculated for Metabolic Tumor Volume (MTV), TLG, prostate-specific antigen (PSA), alkaline phosphatase (AP), and lactate dehydrogenase (LDH) (termed deltaMTV, deltaTLG, deltaPSA, deltaAP and deltaLDH, respectively). Predictive power of baseline and post-therapy PET- and biochemical-derived parameters on OS were assessed by Kaplan–Meier, univariate and multivariate analyses. At baseline, PSA, LDH, and MTV significantly predicted OS. However, MTV (but not PSA nor LDH) was able to identify a subgroup of patients with worse prognosis, even after adjusting for the number of lesions at bone scan (which, in turn, was not an independent predictor of OS). After therapy, PERCIST criteria were able to capture the response to Ra223 by demonstrating longer OS in patients with partial metabolic response. Moreover, the biochemical parameters were outperformed by PERCIST in the post-treatment setting, as their variation after therapy was not informative on long term OS. The present study supports the role of FDG-PET as a tool for patient’s selection and response assessment in mCRPC patients undergoing Ra223 administration.

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An appraisal of 18F-FDG PET imaging in post-therapy surveillance of uterine cancers: Clinical evidence and a research proposal

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200303000-00022 ◽

2003 ◽

Vol 13 (2) ◽

pp. 228-233 ◽

Cited By ~ 4

Author(s):

T. Belhocine

Keyword(s):

Pet Imaging ◽

Fdg Pet ◽

Combined Therapy ◽

Metabolic Imaging ◽

Asymptomatic Patients ◽

Positron Emission ◽

Previously Treated ◽

Uterine Cancers ◽

Post Therapy

Despite important advances in screening for preinvasive forms of uterine cancers and more efficient combined therapy modalities, the surveillance of women previously treated either for a cervical or an endometrial cancer remains problematic. The follow-up protocols commonly applied in practice usually include a physical examination at control visits and clinically oriented morphologic imaging procedures. These routine protocols are, however, not standardized. Moreover, their sensitivity for accurately detecting a recurrent disease is most often suboptimal, especially in asymptomatic patients. On the other hand, the performances of a high-technology imaging such as positron emission tomography (PET) using 18F-fluoro-2-deoxy-D-glucose (18FDG) are nowadays firmly established in the post-treatment monitoring of oncology patients. The purpose of the present paper is to review both the advantages and the limitations of 18FDG PET imaging in the surveillance of women previously treated for uterine cancers. Based on the encouraging literature data, a well-designed research protocol is proposed in order to more objectively assess the contribution of metabolic imaging in the post-therapy management of these gynecological malignancies.

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Post-therapy [18F] FDG PET/CT in cervical cancer: Clinical outcome correlation

Reports of Practical Oncology & Radiotherapy ◽

10.1016/j.rpor.2013.03.237 ◽

2013 ◽

Vol 18 ◽

pp. S232

Author(s):

I. Rodriguez Rodriguez ◽

B. Belinchon Olmeda ◽

D. Mendez Mareque ◽

C. Escabia del Pozo ◽

R. Couto Caro ◽

...

Keyword(s):

Cervical Cancer ◽

Clinical Outcome ◽

Fdg Pet ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Post Therapy

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18F-FDG-PET/CT for Evaluation of treatment response in high grade lymphoma

Nepalese Journal of Cancer ◽

10.3126/njc.v1i1.25631 ◽

2017 ◽

Vol 1 (1) ◽

pp. 42-52

Author(s):

Yadav Ajay Kumar ◽

Kumar Rakesh ◽

Malhotra Arun ◽

Sharma Atul

Keyword(s):

Treatment Response ◽

Fdg Pet ◽

High Grade ◽

Predictive Values ◽

Pet Ct ◽

18F Fdg ◽

Ct Data ◽

Sensitivity Specificity ◽

Fdg Pet Ct ◽

Post Therapy

18F-FDG PET is highly sensitive and specific for evaluation of the treatment response of high-grade lymphomas. The molecular information provided by 18F-FDG-PET identifies the functional content of anatomic finding and helps to categorize their nature as malignant or benign. On the other hand, the CT data obtained in the same setting provides anatomical localization of the 18F-FDG-PET data while also improving the FDG-PET image quality as it is utilized for attenuation correction. Previously, most of the studies were done on this topic by using 18F-FDG-PET alone. Present study was planning to assess the role of 18F-FDG-PET/CT in evaluation of treatment response in patient of HD and NHL. Results showed that 43 patients out of 52 showed no pathologic FDG uptakes, whereas 9 showed persistent uptakes. Among the 43 patients who had negative PET scans, only three relapsed, whereas among the 9 patients who had persistent abnormal 18F-FDG uptakes on post therapy PET/CT scans, two recovered. The sensitivity, specificity, positive and negative predictive values and accuracy of post therapy PET/CT scan was 70%, 95%, 78%, 93%, and 90% respectively.

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