Positron Emission Tomography Scans in the Evaluation of Postchemotherapy Residual Masses in Patients With Seminoma

1999 ◽  
Vol 17 (11) ◽  
pp. 3457-3460 ◽  
Author(s):  
Kristen N. Ganjoo ◽  
Rebecca J. Chan ◽  
Matt Sharma ◽  
Lawrence H. Einhorn
Keyword(s):  
Positron Emission Tomography ◽  
Residual Disease ◽  
Pet Scan ◽  
Emission Tomography ◽  
Positron Emission ◽  
Group A ◽  
Residual Masses ◽  
Group B ◽  
Pet Scans

PURPOSE: To assess the ability of positron emission tomography (PET) scans in differentiating between necrosis and viable seminoma in postchemotherapy (PC) residual disease. PATIENTS AND METHODS: We conducted a prospective study of 29 patients with seminoma at Indiana University. All patients had PC residual disease. Computed tomography and PET scans were performed for 19 patients after primary chemotherapy (group A) and for 10 patients after salvage chemotherapy (group B). RESULTS: In group A, the PC masses were ≥ 3 cm in 14 patients, less than 3 cm in three patients, and not quantified in two patients. All of the patients in group A had negative PET scan results and have had stable or decreasing residual mass size (median follow-up duration, 11.5 months; range, 6 to 26 months). In group B, the PC masses were ≥ 3 cm in four patients, less than 3 cm in five patients, and not quantified in one patient. One patient had a positive PET scan result for a posterior mediastinal mass. Pathologic diagnosis of the PET-positive mass showed only necrotic tissue. The same patient had a negative PET scan of the retroperitoneal mass but relapsed in that area. Overall, of patients in group B, five have stable or decreasing mass (median follow-up duration, 8 months; range, 7 to 22 months), and five had relapsed disease. CONCLUSION: PET scans have no apparent benefit in PC evaluation of residual masses in bulky seminoma.

A positron emission tomography study of cerebrovascular reserve before and after shunt surgery in patients with idiopathic chronic hydrocephalus

1999 ◽  
Vol 91 (4) ◽  
pp. 605-609 ◽  
Author(s):  
Petra M. Klinge ◽  
Georg Berding ◽  
Thomas Brinker ◽  
Wolfram H. Knapp ◽  
Madjid Samii
Keyword(s):  
Positron Emission Tomography ◽  
Emission Tomography ◽  
Chronic Hydrocephalus ◽  
Content Type ◽  
Cerebrovascular Reserve ◽  
Shunt Placement ◽  
Positron Emission ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. In this study the authors use positron emission tomography (PET) to investigate cerebral blood flow (CBF) and cerebrovascular reserve (CVR) in chronic hydrocephalus.Methods. Ten patients whose mean age was 67 ± 10 years (mean ± standard deviation [SD]) were compared with 10 healthy volunteers who were 25 ± 3 years of age. Global CBF and CVR were determined using 15O—H2O and PET prior to shunt placement and 7 days and 7 months thereafter. The CVR was measured using 1 g acetazolamide. Neurological status was assessed based on a score assigned according to the methods of Stein and Langfitt.Seven months after shunt placement, five patients showed clinical improvement (Group A) and five did not (Group B). The average global CBF before shunt deployment was significantly reduced in comparison with the control group (40 ± 8 compared with 61 ± 7 ml/100 ml/minute; mean ± SD, p < 0.01). In Group A the CBF values were significantly lower than in Group B (36 ± 7 compared with 44 ± 8 ml/100 ml/minute; p < 0.05). The CVR before surgery, however, was not significantly different between groups (Group A = 43 ± 21%, Group B = 37 ± 29%). After shunt placement, there was an increase in the CVR in Group A to 52 ± 37% after 7 days and to 68 ± 47% after 7 months (p < 0.05), whereas in Group B the CVR decreased to 14 ± 18% (p < 0.05) after 7 days and returned to the preoperative level (39 ± 6%) 7 months after shunt placement.Conclusions. The preliminary results indicate that a reduced baseline CBF before surgery does not indicate a poor prognosis. Baseline CBF before shunt placement and preoperative CVR are not predictive of clinical outcome. A decrease in the CVR early after shunt placement, however, is related to poor late clinical outcome, whereas early improvement in the CVR after shunt placement indicates a good prognosis.

scholarly journals Detection of Lymphoma in Bone Marrow by Whole-Body Positron Emission Tomography

Blood ◽  
1998 ◽  
Vol 91 (9) ◽  
pp. 3340-3346 ◽  
Author(s):  
Robert Carr ◽  
Sally F. Barrington ◽  
Bella Madan ◽  
Michael J. O'Doherty ◽  
Catherine A.B. Saunders ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Disease Status ◽  
Pet Scan ◽  
Emission Tomography ◽  
Whole Body ◽  
Whole Body Imaging ◽  
Visual Interpretation ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Scans

Abstract Positron emission tomography (PET) is a whole-body imaging technique using 18 fluorine-fluorodeoxyglucose (FDG), whose uptake is increased in tumor cells. Published studies have shown PET to be an effective method of staging lymphoma and to be more sensitive than CT at detecting extranodal disease. The purpose of this study was to determine whether the increased marrow uptake of FDG observed in some lymphoma patients during routine staging PET scans represented marrow involvement by disease. PET scans of 50 patients with Hodgkin's (12) and non-Hodgkin's (38) lymphoma were analyzed by three independent observers and the marrow graded as normal or abnormal using a visual grading system. Unilateral iliac crest marrow aspirates and biopsies were performed on all patients. The PET scan and marrow histology agreed in 39 patients (78%), being concordant positive in 13 and concordant negative in 26 patients. In 8 patients the PET scan showed increased FDG uptake but staging biopsy was negative; in 4 of these 8 patients the PET scan showed a normal marrow background with focal FDG “hot spots” distant from the site biopsied. In 3 patients the marrow biopsy specimen was positive but the PET scan normal; 2 of these 3 patients had non-Hodgkin's lymphoma whose malignant cells did not take up FDG at lymph node or marrow disease sites. Therefore, there were only 5 patients (10%) in whom there was a difference between the PET scan and biopsy result which could not be fully explained. Visual interpretation of marrow FDG uptake during whole-body staging PET scans can correctly assess marrow disease status in a high proportion of lymphoma patients. PET has the potential to reduce the need for staging marrow biopsy.

scholarly journals A positron emission tomography study of cerebrovascular reserve before and after shunt surgery in patients with idiopathic chronic hydrocephalus

2000 ◽  
Vol 8 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Petra M. Klinge ◽  
Georg Berding ◽  
Thomas Brinker ◽  
Wolfram H. Knapp ◽  
Madjid Samii
Keyword(s):  
Positron Emission Tomography ◽  
Clinical Outcome ◽  
Emission Tomography ◽  
Control Group ◽  
Chronic Hydrocephalus ◽  
Cerebrovascular Reserve ◽  
Shunt Placement ◽  
Positron Emission ◽  
Group A ◽  
Group B

Object In this study the authors use positron emission tomography (PET) to investigate cerebral blood flow (CBF) and cerebrovascular reserve (CVR) in chronic hydrocephalus. Methods Ten patients whose mean age was 67 ± 10 years (mean ± standard deviation [SD]) were compared with 10 healthy volunteers who were 25 ±3 years of age. Global CBF and CVR were determined using 15O–H2O and PET prior to shunt placement and 7 days and 7 months thereafter. The CVR was measured using 1 g acetazolamide. Neurological status was assessed based on a score assigned according to the methods of Stein and Langfitt. Seven months after shunt placement, five patients showed clinical improvement (Group A) and five did not (Group B). The average global CBF before shunt deployment was significantly reduced in comparison with the control group (40 ± 8 compared with 61 ± 7 ml/100 ml/minute; mean ± SD, p < 0.01). In Group A the CBF values were significantly lower than in Group B (36 ± 7 compared with 44 ± 8 ml/100 ml/minute; p < 0.05). The CVR before surgery, however, was not significantly different between groups (Group A = 43 ± 21%, Group B = 37 ± 29%). After shunt placement, there was an increase in the CVR in Group A to 52 ± 37% after 7 days and to 68 ± 47% after 7 months (p < 0.05), whereas in Group B the CVR decreased to 14 ± 18% (p < 0.05) after 7 days and returned to the preoperative level (39 ± 6%) 7 months after shunt placement. Conclusions The preliminary results indicate that a reduced baseline CBF before surgery does not indicate a poor prognosis. Baseline CBF before shunt placement and preoperative CVR are not predictive of clinical outcome. A decrease in the CVR early after shunt placement, however, is related to poor late clinical outcome, whereas early improvement in the CVR after shunt placement indicates a good prognosis.

Prognostic Value of Positron Emission Tomography (PET) Scan in Patients with Relapsed Hodgkin Lymphoma or Aggressive Non-Hodgkin Lymphoma Receiving Salvage Chemotherapy Followed by Reduced-Intensity Allogeneic Stem Cell Transplantation.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3039-3039 ◽  
Author(s):  
Anna Dodero ◽  
Roberto Crocchiolo ◽  
Francesca Patriarca ◽  
Fabio Ciceri ◽  
Nicolo’ Frungillo ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Hodgkin Lymphoma ◽  
Prognostic Value ◽  
Pet Scan ◽  
Emission Tomography ◽  
Non Hodgkin Lymphoma ◽  
Positron Emission ◽  
18F Fdg ◽  
Pet Scans ◽  
Reduced Intensity

Abstract Positron emission tomography (PET) scan using 18-fluorodeoxyglucose [18F-FDG] has a prognostic value in patients (pts) with Hodgkin Lymphoma (HL) or aggressive Non-Hodgkin lymphoma (NHL) receiving chemotherapy. Chemosensitive disease is a critical prognostic factor for the success of both autologous and allogeneic stem cell transplantation (allo-SCT). We have recently shown a lower risk of death or progression for pts in CR versus those in PR before reduced-intensity conditioning (RIC) allo-SCT (Corradini P, Leukemia 2007). Thus, to better assess the value of pre-transplant disease response, we retrospectively assessed the prognostic role of PET scan before allotransplant. Between 2000 and 2007, 64 consecutive patients with a histologically proven diagnosis of aggressive NHL [n=30: diffuse large B cell lymphoma (n=18), peripheral T-cell lymphomas (n=11), Burkitt lymphoma (n=1)] or HL [n=34], responding to salvage therapy, were evaluated with a PET scan before and after allo-SCT. PET scans were performed at 3 different Nuclear Medicine Units. Presence (PET-positive) or absence (PET-negative) of abnormal 18F-FDG uptake was correlated to progression-free survival (PFS) and overall survival (OS) curves. Patients’ median age was 37 years (range, 17–65 years). Thirty-three pts (52%) were allografted from a HLA-identical sibling donor, 14 from a haploidentical donor and 17 from an unrelated donor. Pts had relapsed disease: 52 pts (81%) had failed autologous SCT, the median number of prior chemotherapy regimens was 3 (range, 1–6). All pts received a RIC regimen followed by allo-SCT. PET scans were performed at a median of 30 days prior to allograft (range, 3–90 days): 34 out of 64 pts showed an abnormal 18F-FDG uptake [NHL (n=16), HL (n=18)] whereas 30 were completely negative [NHL (n=14), HL (n=16)]. Patients with PET-positive or PET-negative scans were balanced in terms of diagnosis, previous treatments, and type of donor. At a median follow-up of 24 months (range, 6–86 months), 41 pts are alive and 23 died [toxicity n=10 (n= 5 NHL, n=5 HL), disease n=13 (n=8 NHL, n=5 HL)]. Overall, the estimated 3-year PFS in pts with negative or positive PET scans were 64% (95% CI, 42%–86%) versus 28% (95% CI, 8%–48%), respectively (p<0.005). A statistically significant higher cumulative risk of relapse was observed in pts with a positive PET scan before allografting as compared to the PET negatives (53% versus 21%, p< 0.022). The estimated 3-year OS in pts with negative or positive PET scans were 69% (95% CI; 51%–87%) versus 44% (95% CI;23%-65%), respectively (p=0.05). For NHL pts, the estimated 3-year PFS was 59% for PET-negative as compared to 38% for PET-positive (p<0.04). For HL pts, the estimated 3-year PFS was 70% for PET-negative as compared to 23% for PET-positive (p<0.05). PET scan has a clinical relevance before allo-SCT. Pts with a positive PET scan have a worse outcome, and should receive experimental therapies to target chemoresistant tumor cells.

Prognostic significance of positron emission tomography using fluorine-18-fluorodeoxyglucose in patients treated for malignant lymphoma

2001 ◽  
Vol 40 (01) ◽  
pp. 23-30 ◽  
Author(s):  
U. Fabry ◽  
J. Neuerburg ◽  
M. Zimny ◽  
R. Bares ◽  
R. Osieka ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Malignant Lymphoma ◽  
Fdg Pet ◽  
Prognostic Value ◽  
Prognostic Significance ◽  
Emission Tomography ◽  
True Negative ◽  
Positron Emission ◽  
Residual Masses

Summary Aim: To evaluate the prognostic significance of positron emission tomography (PET) using fluorine-18-[2]-fluoro-2-deoxyglucose (FDG) in patients treated for Hodgkin’s disease (HD) or nori-Hodgkin’s lymphoma (NHL) compared to conventional restaging (CRS). Methods: Fifty-six patients with either HD (ç = 22), high-grade NHL (n = 26) or centrocyfic-centroblastic NHL (n = 8) were included. PET was performed in 41 patients for treatment reevaluation up to three months after therapy and in patients with persisting residual masses (n = 10) or suspected relapse (n = 5) four to twelve months after treatment. The scans were evaluated qualitatively and quantitatively using standardised uptake values (SUV). Progression-free survival (PFS) was estimated to assess the prognostic value of FDG PET and clinical follow-up was taken as gold standard. Results: PET was positive in nineteen of 41 patients studied for treatment reevaluation. Progression was observed after a median interval of two months (range 0-15) in sixteen of 19 patients after a positive PET scan and in three of 22 patients after a negative scan (p <.001). Median duration of follow-up in progression-free patients was 21 months (range 6-72). In patients with a partial remission in CRS progression was more common in PET-positive than in PET-negative patients (5 of 7 vs. 1 of 14; ñ <.01) and positivity with PET was associated with poorer PFS (p <.0025). PET studies performed four to twelve months after treatment were true negative in seven, true positive in five and false-positive in three patients. SUV > 11.35 of lymphoma lesions was associated with poorer PFS than SUV <11.35 (p <0.025). Conclusion: We conclude that FDG PET after treatment of malignant lymphoma has a high prognostic value and should be recommended in patients with persistence of residual masses.

Predictive Impact of 2-18Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography for Residual Postchemotherapy Masses in Patients With Bulky Seminoma

2001 ◽  
Vol 19 (17) ◽  
pp. 3740-3744 ◽  
Author(s):  
Maria De Santis ◽  
Carsten Bokemeyer ◽  
Alexander Becherer ◽  
Franz Stoiber ◽  
Karin Oechsle ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Tumor Tissue ◽  
Emission Tomography ◽  
Viable Tumor ◽  
Positron Emission ◽  
Viable Tumor Tissue ◽  
Pet Scans ◽  
Residual Lesions

PURPOSE: To establish the predictive potential of 2-18fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) for detecting viable tumor tissue in residual postchemotherapy masses of seminoma patients. PATIENTS AND METHODS: In this prospective multicenter trial, results of FDG PET studies in seminoma patients with postchemotherapy masses ≥ 1 cm were correlated with either the histology of the resected lesion or the clinical outcome on follow-up without resection. Negative PET scans of residual lesions that were devoid of viable tumor tissue on resection or disappeared, shrunk, or remained stable in size for at least 2 years were rated as true-negative (TN). Positive scans without histologic or clinical evidence of tumor tissue were classified as false-positive. In patients with histologically positive or progressive lesions, positive PET scans were defined as true-positive (TP) and negative scans, false-negative (FN). RESULTS: Thirty-seven PET scans of 33 patients were assessable at a median follow-up time of 23 months (range, 2 to 46 months). Histologic data were available from nine patients who had undergone resection. Twenty-eight patients were followed-up clinically and radiologically. Twenty-eight scans were TN, eight were TP, and one was FN. All 14 residual lesions more than 3 cm and 22 (96%) of the 23 ≤ 3 cm were correctly predicted by FDG PET. The specificity (100%; 95% confidence interval [CI], 87.7% to 100%), sensitivity (89%; 95% CI, 51.7% to 99.7%), positive predictive value (100%), and the negative predictive value (97%) of FDG PET were superior to data obtained by assessing residual tumor size (≤ or > 3 cm). CONCLUSION: FDG PET is a clinically useful predictor of viable tumor in postchemotherapy residuals of pure seminoma, especially those greater than 3 cm.

Prognostic Value of Positron Emission Tomography (PET) With Fluorine-18 Fluorodeoxyglucose ([18F]FDG) After First-Line Chemotherapy in Non-Hodgkin’s Lymphoma: Is [18F]FDG-PET a Valid Alternative to Conventional Diagnostic Methods?

2001 ◽  
Vol 19 (2) ◽  
pp. 414-419 ◽  
Author(s):  
Karoline Spaepen ◽  
Sigrid Stroobants ◽  
Patrick Dupont ◽  
Steven Van Steenweghen ◽  
José Thomas ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Residual Disease ◽  
Emission Tomography ◽  
First Line ◽  
Positron Emission ◽  
18F Fdg ◽  
Fluorine 18 Fluorodeoxyglucose ◽  
Line Chemotherapy

PURPOSE: A complete remission (CR) after first-line therapy is associated with longer progression-free survival (PFS). However, defining CR is not always easy because of the presence of residual masses. Metabolic imaging with fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) offers the ability to differentiate between viable and fibrotic inactive tissue. In this study, we evaluated the value of PET in detecting residual disease and, hence, predicting relapse after first-line treatment in patients with non-Hodgkin’s lymphoma (NHL). PATIENTS AND METHODS: Ninety-three patients with histologically proven NHL, who underwent a whole-body [18F]FDG-PET study after completion of first-line chemotherapy and who had follow-up of at least 1 year, were included. Persistence or absence of residual disease on PET was related to PFS using Kaplan-Meier survival analysis. RESULTS: Sixty-seven patients showed a normal PET scan after first-line chemotherapy; 56 of 67 remained in CR, with a median follow-up of 653 days. Nine of these patients with a residual mass considered as unconfirmed CR received additional radiotherapy. Only 11 of 67 patients relapsed (median PFS, 404 days). Persistent abnormal [18F]FDG uptake was seen in 26 patients, and all of them relapsed (median PFS, 73 days). Because standard restaging also suggested residual disease, 12 patients received immediate secondary treatment. In 14 of 26 patients, only PET predicted persistent disease. From these patients, relapse was proven either by biopsy (n = 8) or by progressive disease on computed tomography or magnetic resonance imaging (n = 6). CONCLUSION: Persistent abnormal [18F]FDG uptake after first-line chemotherapy in NHL is highly predictive for residual or recurrent disease. In relapsing patients, PFS was significantly shorter after a positive scan than after a negative scan.

[18F]Fluorodeoxyglucose Positron Emission Tomography for Detection of Bone Marrow Involvement in Children and Adolescents With Hodgkin's Lymphoma

2011 ◽  
Vol 29 (26) ◽  
pp. 3523-3528 ◽  
Author(s):  
Sandra Purz ◽  
Christine Mauz-Körholz ◽  
Dieter Körholz ◽  
Dirk Hasenclever ◽  
Antje Krausse ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Bone Marrow ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Fluorodeoxyglucose Positron Emission Tomography ◽  
Positron Emission ◽  
Pet Scans ◽  
Initial Staging ◽  
Fluorodeoxyglucose Positron Emission

Purpose Currently, a routine bone marrow biopsy (BMB) is performed to detect bone marrow (BM) involvement in pediatric Hodgkin's lymphoma (HL) stage greater than IIA. [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) is increasingly used for the initial staging of HL. The value of using FDG-PET to detect BM involvement has not been sufficiently defined. We compared the results of BMBs and FDG-PET for the diagnosis of BM involvement in a large pediatric group with HL. Patients and Methods The initial staging of 175 pediatric patients with newly diagnosed classical HL stage greater than IIA was determined by using BMB, FDG-PET, chest computed tomography (CT), and magnetic resonance imaging (MRI) or CT of the neck, abdomen, and pelvis. Staging images were prospectively evaluated by a central review board. Skeletal regions that were suggestive of BM involvement by either method were re-evaluated by using different imaging modalities. In suspicious cases, bone scintigraphy was performed. If follow-up FDG-PET scans were available, the remission of skeletal lesions during treatment was evaluated. Results BMB results were positive in seven of 175 patients and were identified by FDG-PET. FDG-PET scans showed BM involvement in 45 patients. In addition, the lesions of 32 of these 45 patients had a typical multifocal pattern. In 38 of 39 follow-up positron emission tomography scans, most of the skeletal lesions disappeared after chemotherapy. There was no patient with skeletal findings suggestive of BM involvement by MRI or CT with a negative FDG-PET. Conclusion FDG-PET is a sensitive and specific method for the detection of BM involvement in pediatric HL. The sensitivity of a BMB appears compromised by the focal pattern of BM involvement. Thus, FDG-PET may safely be substituted for a BMB in routine staging procedures.

scholarly journals Detection of Lymphoma in Bone Marrow by Whole-Body Positron Emission Tomography

Blood ◽  
1998 ◽  
Vol 91 (9) ◽  
pp. 3340-3346 ◽  
Author(s):  
Robert Carr ◽  
Sally F. Barrington ◽  
Bella Madan ◽  
Michael J. O'Doherty ◽  
Catherine A.B. Saunders ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Disease Status ◽  
Pet Scan ◽  
Emission Tomography ◽  
Whole Body ◽  
Whole Body Imaging ◽  
Visual Interpretation ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Scans

Positron emission tomography (PET) is a whole-body imaging technique using 18 fluorine-fluorodeoxyglucose (FDG), whose uptake is increased in tumor cells. Published studies have shown PET to be an effective method of staging lymphoma and to be more sensitive than CT at detecting extranodal disease. The purpose of this study was to determine whether the increased marrow uptake of FDG observed in some lymphoma patients during routine staging PET scans represented marrow involvement by disease. PET scans of 50 patients with Hodgkin's (12) and non-Hodgkin's (38) lymphoma were analyzed by three independent observers and the marrow graded as normal or abnormal using a visual grading system. Unilateral iliac crest marrow aspirates and biopsies were performed on all patients. The PET scan and marrow histology agreed in 39 patients (78%), being concordant positive in 13 and concordant negative in 26 patients. In 8 patients the PET scan showed increased FDG uptake but staging biopsy was negative; in 4 of these 8 patients the PET scan showed a normal marrow background with focal FDG “hot spots” distant from the site biopsied. In 3 patients the marrow biopsy specimen was positive but the PET scan normal; 2 of these 3 patients had non-Hodgkin's lymphoma whose malignant cells did not take up FDG at lymph node or marrow disease sites. Therefore, there were only 5 patients (10%) in whom there was a difference between the PET scan and biopsy result which could not be fully explained. Visual interpretation of marrow FDG uptake during whole-body staging PET scans can correctly assess marrow disease status in a high proportion of lymphoma patients. PET has the potential to reduce the need for staging marrow biopsy.

scholarly journals Clinical significance of the post-radiotherapy 18F-fludeoxyglucose positron emission tomography response in nasopharyngeal carcinoma

2019 ◽  
Vol 92 (1102) ◽  
pp. 20180045 ◽  
Author(s):  
Yuri Jeong ◽  
In-hye Jung ◽  
Jae Seung Kim ◽  
Sei Kyung Chang ◽  
Sang-wook Lee
Keyword(s):  
Positron Emission Tomography ◽  
Treatment Outcomes ◽  
Clinical Significance ◽  
Fdg Pet ◽  
Residual Disease ◽  
Nasopharyngeal Cancer ◽  
Emission Tomography ◽  
Free Survival ◽  
Positron Emission

Objective: The aim of the present study was to evaluate the clinical significance of the post-radiotherapy 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) response for detecting residual disease and predicting survival outcome in patients with nasopharyngeal cancer. Methods: We reviewed 143 patients with nasopharyngeal cancer who underwent 18F-FDG PET within 6 months after completion of radiotherapy between 2001 and 2012. 18F-FDG PET findings at the primary tumor (T–) and regional lymph nodes (N–) were separately assessed and considered negative [PET (–)] or positive [PET (+)] depending on the remaining focal increased uptake of 18F-FDG that was greater than that of the surrounding muscle or blood vessels. The standard of reference was histopathological confirmation or clinical/imaging follow-up. Overall survival (OS), distant metastasis-free survival (DMFS), and locoregional recurrence-free survival (LRRFS) rates were estimated from the date of the start of radiotherapy. Results: The median follow-up period was 73 months (range, 9–182 months). Overall, 83 and 66% of patients achieved T–PET (-) and N–PET (-) responses, and the negative-predictive values (NPVs) for T– and N– were 100 and 99%, respectively. The sensitivity, specificity, and positive-predictive value were 100, 84, and 8% for T–, and 67, 80, and 7% for N–, respectively. The 5-year OS, DMFS, and LRRFS rates were 83, 83, and 87%, respectively, and patients with N–PET (+) with SUVmax >2.5 showed significantly inferior 5-year OS and DMFS rates than patients with N–PET (-) or N–PET (+) with SUVmax ≤2.5 (44 vs 86%, p = 0.004; 36 vs 85%, p < 0.001). Conclusion: In patients that have received definitive (chemo)radiotherapy for nasopharyngeal cancer, 18F-FDG PET within 6 months of completion of treatment has a high NPV for predicting residual disease and is prognostic for long-term treatment outcomes. Patients with remaining focal increased uptake of 18F-FDG at lymph nodes may benefit from more aggressive treatments, and further studies are needed to validate the clinical significance of post-radiotherapy 18F-FDG PET. Advances in knowledge: We found that post-radiotherapy 18F-FDG PET findings have a high NPV for detecting residual disease and are a significant prognostic factor for treatment outcomes.

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