Prognostic Implications of the SUVmax of Primary Tumors and Metastatic Lymph Node Measured by 18F-FDG PET in Patients With Uterine Cervical Cancer

e20549 Background: Total body positron emission tomography (PET) of uExplorer enables imaging of highly quantitative parameters beyond the standardized uptake value (SUV). The aim of this prospective study is to assess the dynamic changes of 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake in characterizing tumor heterogeneity of non-small cell lung cancer (NSCLC). Methods: Sixteen NSCLC patients were prospectively enrolled in a prospective study (NCT04654234, GASTO-1067) between September 2020 and December 2020. All patients underwent a dynamic total-body 18F-FDG PET/CT scan before any treatment. The primary lung tumor, metastatic regional lymph node and inflammatory lymph node were manually delineated by a nuclear medicine physician and a radiation oncologist. Total Body PET was acquired between 0 – 60 mins after the injection of FDG from the subject’s feet. We compared lesion heterogeneity and different image-derived PET metrics including the SUV-mean, Patlak-derived influx rate constant (Ki) and distribution volume (DV). Results: The SUV-mean and Ki-mean of primary lung tumor and metastatic lymph node were significantly higher than inflammatory lymph node (p < 0.001), while there was no significantly different of DV(p > 0.05). By the scatter plot of SUV-mean and Ki-mean of primary lung tumor, 9 patients had been separated into high dynamic FDG metabolic (H-DFM) group and 7 in low DFM(L-DFM) group. The SUV-mean(p = 0.0002) and Ki-mean(p = 0.0002) of primary lung tumor were significantly higher in H-DFM group, whereas there is no difference in metastatic lymph node of both group. Interestingly, the SUV-mean and Ki-mean of primary lung tumor were higher than that of metastatic lymph node(p = 0.0002) in H-DFM group. On the contrast, the SUV-mean and Ki-mean of primary lung tumor were lower than that of metastatic lymph node(p = 0.05) in L-DFM group. There is no significant difference of DV-mean among primary lung tumor, metastatic lymph node and inflammatory lymph node in both arms. Conclusions: The results demonstrated that dynamic parameters from total body PET scan has the potential of providing complementary information of tumor heterogeneity in NSCLC than conventional static SUV imaging. The characteristics of H-DFM and L-DFM group could be taken into account for evaluation of further treatment response.

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Dynamic 18F-FDG Total body PET Imaging as a predictive marker of induction chemo-immunotherapy response in locally advanced non-small cell lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e20551 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e20551-e20551

Author(s):

Hui Liu ◽

Bo Qiu ◽

DaQuan Wang ◽

Xu Zhang ◽

Hui Liu ◽

...

Keyword(s):

Lymph Node ◽

Pet Imaging ◽

Lung Tumor ◽

Metastatic Lymph Node ◽

Locally Advanced ◽

Predictive Marker ◽

Metastatic Lymph ◽

18F Fdg ◽

Primary Lung Tumor ◽

Total Body

e20551 Background: The purpose of this study was to evaluate the efficacy of dynamic 18F-FDG total body PET imaging as a predictive maker of induction chemo-immunotherapy response in locally advanced non-small cell lung cancer(NSCLC) by a prospective study. Methods: Stage IIIA-IIIC NSCLC patients were prospectively enrolled in a prospective total body PETCT study ( NCT04654234, GASTO-1067) and a randomized phase II clinical trial ( NCT04085250) between September 2020 and December 2020. All patients underwent a dynamic total-body 18F-FDG PET/CT scan before any treatment and after 2 cycles of induction chemo-immunotherapy (docetaxel+cisplatin+nivolumab). The primary lung tumor, metastatic regional lymph node and inflammatory lymph node before and after treatment were manually delineated by a nuclear medicine physician and a radiation oncologist. Total Body PET was acquired between 0 – 60 mins after the injection of FDG from the subject’s feet. Patients was separated into high dynamic FDG metabolic (H-DFM) group and low DFM(L-DFM) group by the scatter plot of SUV-mean and Ki-mean of primary lung tumor. We compared lesion heterogeneity and different image-derived PET metrics including the metabolic tumor volume(MTV), SUV total lesion glycolysis(SUV-TLG), Patlak-derived influx rate constant (Ki) TLG (Ki-TLG). Results: Fifteen patients were analyzed, 8 patients was in H-DFM group and 7 in L-DFM group. Patients in H-DFM group had significant decreased levels of MTV(p < 0.001), SUV-TLG(p < 0.001) and Ki-TLG(p < 0.001) both in primary lung tumor and metastatic lymph node by the induction chemo-immuotherapy. However, patients in L-DFM group only had a significant reduction of MTV in primary lung tumor(p < 0.05). There was no significant difference in the MTV of metastatic lymph node(p > 0.5), the SUV-TLG(p > 0.5) and Ki-TLG(p > 0.5) of primary lung tumor and metastatic lymph node, before and after induction chemo-radiotherapy. Conclusions: Patients in H-DFM group had the better treatment response of induction chemo-immunotherapy with significant decreased levels of MTV, SUV-TLG and Ki-TLG. Dynamic 18F-FDG Total body PET Imaging could be regard as a potential predictive marker of induction chemo-immunotherapy response in the setting of LA-NSCLC.

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Metastatic Lymph Node and Osteolytic Skeletal Metastasis Detected by FDG-PET in an Endoscopy-Diagnosed Early-Stage Esophageal Cancer

Clinical Nuclear Medicine ◽

10.1097/01.rlu.0000182280.52207.96 ◽

2005 ◽

Vol 30 (11) ◽

pp. 760-762

Author(s):

Tay-Jiunn Lee ◽

Horng-Yuan Lou ◽

Chi-Ming Lee ◽

Chung-Huei Hsu

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Fdg Pet ◽

Early Stage ◽

Metastatic Lymph Node ◽

Skeletal Metastasis ◽

Metastatic Lymph

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18F-FDG PET/CT can predict nodal metastases but not recurrence in early stage uterine cervical cancer

Gynecologic Oncology ◽

10.1016/j.ygyno.2012.06.041 ◽

2012 ◽

Vol 127 (1) ◽

pp. 131-135 ◽

Cited By ~ 56

Author(s):

Cinzia Crivellaro ◽

Mauro Signorelli ◽

Luca Guerra ◽

Elena De Ponti ◽

Alessandro Buda ◽

...

Keyword(s):

Cervical Cancer ◽

Fdg Pet ◽

Early Stage ◽

Uterine Cervical Cancer ◽

Nodal Metastases ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Does small volume metastatic lymph node disease affect long-term prognosis in early cervical cancer?

Gynecologic Oncology ◽

10.1016/j.ygyno.2020.05.295 ◽

2020 ◽

Vol 159 ◽

pp. 190-191

Author(s):

A.I. Nica ◽

L.T. Gien ◽

S.E. Ferguson ◽

A.L. Covens

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Small Volume ◽

Metastatic Lymph Node ◽

Lymph Node Disease ◽

Metastatic Lymph ◽

Node Disease ◽

Long Term Prognosis ◽

Early Cervical Cancer

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ATL

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e318260a905 ◽

2012 ◽

Vol 22 (7) ◽

pp. 1226-1233 ◽

Cited By ~ 46

Author(s):

Jang Yoo ◽

Joon Young Choi ◽

Seung Hwan Moon ◽

Duk Soo Bae ◽

Soo Bin Park ◽

...

Keyword(s):

Cervical Cancer ◽

Prognostic Factors ◽

Lymph Node ◽

Fdg Pet ◽

Tumor Volume ◽

Metabolic Tumor Volume ◽

Uterine Cervical Cancer ◽

Lymph Node Status ◽

Free Survival ◽

Node Status

ObjectiveWe compared the prognostic value of volume-based metabolic parameters determined using fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) (18F-FDG PET) (with other prognostic parameters in uterine cervical cancer.MethodsThe subjects were 73 female patients who had an initial diagnosis of uterine cervical cancer and who underwent 18F-FDG PET. Various metabolic or volume-based PET parameters including maximum and average standardized uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) were measured in primary cervical tumors. Survival analysis for disease-free survival or progression-free survival was performed with a Kaplan-Meier method using PET parameters and other clinical variables. For determining independent prognostic factors, Cox regression analysis was performed.ResultsRecurrence or disease progression occurred in 23 patients (31.5%). In univariate analysis, patient age (cutoff, 57 years, P < 0.05), International Federation of Gynecology and Obstetrics stage (P = 0.07), primary tumor size (cutoff, 6.7 cm; P < 0.05), lymph node status on PET (P < 0.005), treatment method (P < 0.01), metabolic tumor volume (cutoff, 82 cm3; P = 0.001), and TLG (cutoff, 7600; P = 0.005) were significant predictors of recurrence or progression. In multivariate analysis, both lymph node status on PET (hazard ratio, 1.042 [negative vs intrapelvic metastasis only], 7.008 [negative vs extrapelvic metastasis]; P < 0.001) and TLG (cutoff, 7600; hazard ratio, 2.981; P < 0.05) were independent prognostic factors for predicting recurrence.ConclusionsIn uterine cervical cancer, TLG, a volume-based metabolic parameter, and lymph node status on PET may be significant independent prognostic factors for event-free survival.

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