Early prediction of response in patients with advanced/metastatic non-small cell lung cancer during chemotherapy with FDG-PET-CT

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 13154-13154
Author(s):  
D. Lee ◽  
S. Kim ◽  
H. Kim ◽  
J. Choo ◽  
J. Song ◽  
...  
Keyword(s):  
Predictive Value ◽  
Fdg Pet ◽  
Standard Treatment ◽  
Metabolic Response ◽  
Response To Therapy ◽  
Prediction Of Response ◽  
Fdg Uptake ◽  
Standardized Uptake Values ◽  
Best Response ◽  
Pet Ct

13154 Background: To evaluate the use of 18-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) for prediction of response and survival early during the course of treatment in patients with advanced/metastatic NSCLC. Methods: Between May 2004 and November 2005, 31 patients (gender, 23M, 8F; stage, 2IIIB/29IV, histology, 6 squamous cell ca, 22 adenoca, 3 NOS; age median 57 (30–73 y)) with histopathologically proven NSCLC stage IIIB/IV were enrolled into this study. PET-CT was performed prior to and after one cycle of treatment. Early changes of primary tumor FDG-uptake measured by standardized uptake values (SUV) were correlated with best response to therapy as assessed by CT scan according to WHO response criteria. Results: Patients underwent standard treatment with gemcitabine/vinorelbine (15), gemcitabine/cisplatin (1) gemcitabine/vinorelbine/cisplatin (1), irinotecan/cisplatin (9) or gefitinib (5). In the 25 patients evaluable for response, other 6 patients ongoing, 9 patients achieved a partial response (36%), 5 showed stable diseases and 11 were progressive. Using a cut-off value of 20% reduction of FDG-uptake as a criterion for a response in PET-CT, subsequent best response was predicted with a sensitivity of 88.9% and a specificity of 87.5%. The positive predictive value of a metabolic response was 80.0% and the negative predictive value 93.3%, respectively. There was a significant correlation between the decrease of tumor metabolic activity and subsequent best response (p< 0.001). The median time to progression for PET-CT responder was 10.1 months when compared with that of non-responders with 2.6 months (log-rank p=0.009). Conclusions: Using FDG-PET best response to standard treatment and patient outcome can be predicted very early and therefore, the use of PET-CT may allow to reduce side effects and costs of ineffective therapy in non-responding patients No significant financial relationships to disclose.

Abstract 12920: The Value of 18 FDG PET/CT in the Diagnostic Work-Up of Patients With Possible Infective Endocarditis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Fabio Chirillo ◽  
Franco Boccaletto ◽  
Paola Pantano ◽  
Alessandro De Leo ◽  
Marta Possamai ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Clinical Judgment ◽  
Predictive Value ◽  
Fdg Pet ◽  
Blood Cultures ◽  
Fdg Uptake ◽  
Duke Criteria ◽  
Pet Ct ◽  
Fdg Pet Ct

The diagnosis of infective endocarditis (IE) is sometimes difficult when there are discrepancies between blood cultures, transesophageal echocardiography (TEE) and clinical judgment. The aim of this study was to assess the incremental diagnostic value of 18 F-FDG-PET/CT in 45 consecutive patients (73% male, mean age 61 ± 26 years) with suspected IE and inconclusive tests at admission. In 28 patients (19 with a cardiac valvular (15) or nonvalvular (4) device) with blood cultures positive for germs typically involved in IE the initial TEE was negative or inconclusive. In 10 patients presenting with fever TEE identified cardiac lesion possibly related to IE (ruptured mitral chordae, thickened valve leaflet, thickened prosthetic annulus), but blood cultures were persistently negative. Finally, 7 patients had metastatic or embolic lesions and a predisposing cardiac condition, but TEE was negative. When previous unknown lesions detected by PET/CT were confirmed by succeeding examinations, they were considered true positives. When PET/CT was negative, it was compared with the final diagnosis that was defined according to the modified Duke criteria determined during a 6-month follow-up. Thirty patients had definite IE at the end of the follow-up, 3 had possible IE, and in 12 patients the diagnosis was rejected. Twenty-seven patients (60%) exhibited abnormal FDG uptake around the cardiac valves, and 12 (27%) had extracardiac accumulation. In 5 patients the initial negative TEE became positive a mean 5 ±7 days after PET/CT had been performed The sensitivity, specificity, positive predictive value, and negative predictive value of PET/CT were as follows (95% confidence interval): 87% (68% to 95%), 67% (38% to 87%), 84% (65% to 94%), and 71% (42% to 92%), respectively. Adding abnormal FDG uptake as a new major criterion significantly increased the sensitivity of the modified Duke criteria at admission (68% [53% to 82%] vs. 96% [88% to 99%], p = 0.01). This result was due to a significant reduction (p < 0.001) in the number of possible IE cases. In conclusion PET/CT increases the diagnostic accuracy for IE in the subset of patients with possible IE and may help to manage a challenging situation.

scholarly journals PET/CT and the Response to Immunotherapy in Lung Cancer

2020 ◽  
Vol 13 (3) ◽  
pp. 177-184 ◽  
Author(s):  
Laura Evangelista ◽  
Matteo Sepulcri ◽  
Giulia Pasello
Keyword(s):  
Lung Cancer ◽  
Clinical Trials ◽  
Cancer Patients ◽  
Fdg Pet ◽  
Response To Therapy ◽  
Prediction Of Response ◽  
Lung Cancer Patients ◽  
Pet Ct ◽  
Fdg Pet Ct

Objective: In recent years, the introduction of immune checkpoint inhibitors has significantly changed the outcome of patients affected by lung cancer and cutaneous melanoma. Although the clinical advantages, the selection of patients and the evaluation of response to immunotherapy remain unclear, the immune-related Response Evaluation Criteria in Solid Tumor (irRECIST) was proposed as an update of the RECIST criteria for the assessment of response to immunotherapy. However, morphological images cannot predict early response to therapy that represents a challenge in clinical practice. 18F-FDG PET/CT before and after immunotherapy has an indeterminate role, demonstrating ambiguous results due to inflammatory effects secondary to activation of the immune system. The aim of the present review was to analyze the role of PET/CT as a guide for immunotherapy, by analyzing the current status and future perspectives. Methods: A literature search was conducted in order to select all papers that discussed the role of PET/CT with FDG or other tracers in the evaluation or prediction of response to immunotherapy in lung cancer patients. Results: Many papers are now available. Many clinical trials have demonstrated the efficacy of immunotherapy in lung cancer patients. FDG PET/CT can be used for the prediction of response to immunotherapy, while its utility for the evaluation of response is not still clearly reported. Moreover, the standardization of FDG PET/CT interpretation is missing and different criteria, such as information, have been investigated until now. Conclusions: The utility of FDG PET/CT for patients with lung cancer undergoing immunotherapies is still preliminary and not well addressed. New agents for PET are promising, but large clinical trials are mandatory.

Does incidental FDG PET uptake in the prostate have significance?

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 115-115
Author(s):  
Anna Mary Brown ◽  
Maria Liza Lindenberg ◽  
Sandeep Sankineni ◽  
Linda M Johnson ◽  
Suneha Pruthy ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Fdg Pet ◽  
Final Analysis ◽  
Multiple Comparisons ◽  
Dynamic Contrast Enhancement ◽  
Predictive Values ◽  
Fdg Uptake ◽  
Standardized Uptake Values ◽  
Pet Ct ◽  
Fdg Pet Ct

115 Background: 18F-FDG PET/CT is widely used to diagnose malignancy, but is not recommended for localized prostate cancer. This study explores the value of multi-parametric MRI (mpMRI) in characterizing incidentally detected prostate FDG uptake. Methods: Thirty-one patients who underwent FDG PET/CT and prostate MRI were eligible for this study. 14 patients were excluded (n=8 insufficient histopathology, n=6 radical prostatectomy before PET), with final analysis of 17 patients. The mpMRI sequences included T2-weighted, dynamic contrast enhancement (DCE), apparent diffusion coefficient (ADC), and MR spectroscopy (MRS). Nuclear medicine physicians, blinded to clinicopathologic findings, identified suspicious areas and maximum standardized uptake values (SUVmax) on FDG PET/CT. The lesion and sector-based imaging findings were correlated with annotated histopathology from whole-mount or MRI/TRUS fusion biopsy samples. Positive predictive values (PPVs) were estimated using generalized estimating equations with logit link. Results were evaluated with Kruskal-Wallis and Dunn’s multiple comparisons tests. Results: The PPV of FDG PET alone in detecting prostate cancer was 0.56. Combining FDG (base parameter) with mpMRI modalities (T2, DCE, ADC, MRS) increased the sector-based PPV to 0.79, 0.82, 0.80, and 0.89, respectively. All benign lesions had SUVmax < 5, and malignant lesions had higher mean SUVmax values that correlated with Gleason scores [Table]. This relationship between SUVmax and Gleason score was significant, with p=0.012 on the Kruskal-Wallis test and p=0.015 on the Dunn’s multiple comparisons test for Gleason 0 vs Gleason ≥ 4+5. Conclusions: Incidental prostate FDG uptake has low clinical utility alone, but these areas may harbor high-grade prostate cancer, especially if the SUVmax is greater than 5. [Table: see text]

scholarly journals AML with Renal Infiltration Manifesting as Acute Renal Failure, Diagnosed with FDG-PET CT Scan: Case Report

2021 ◽  
Vol 8 (10) ◽  
Author(s):  
Chauhan P ◽  
◽  
Gupta A ◽  
Ora M ◽  
Agrawal S ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Ct Scan ◽  
Fdg Pet ◽  
Myeloid Leukemia ◽  
Metabolic Response ◽  
Response To Therapy ◽  
Extramedullary Disease ◽  
Pet Ct ◽  
Pet Ct Scan ◽  
Acute Myeloid

Extramedullary disease in acute myeloid leukemia is a known phenomenon with reported incidence of 2.5-9.1 %. However, acute kidney injury due to direct infiltration of malignant cells is reported in only 1% cases of acute leukemia. We report a case of acute myeloid leukemia who developed acute kidney failure at presentation, was diagnosed with renal and pancreatic infiltration by FDG-PET scan and was treated successfully with hypomethylating agent and venetoclax. PET-CT scan can be a non-invasive modality for diagnosing extramedullary disease in acute myeloid leukemia and monitoring of response to therapy in these cases. Early initiation of anti-leukemia therapy in our case lead to complete metabolic response with normalization of the renal functions.

scholarly journals Usefulness of 18F-FDG PET/CT in Patients with Cardiac Implantable Electronic Device Suspected of Late Infection

2020 ◽  
Vol 9 (7) ◽  
pp. 2246
Author(s):  
Giuseppe Rubini ◽  
Cristina Ferrari ◽  
Domenico Carretta ◽  
Luigi Santacroce ◽  
Rossella Ruta ◽  
...  
Keyword(s):  
Predictive Value ◽  
Fdg Pet ◽  
Large Scale ◽  
Electronic Device ◽  
High Sensitivity ◽  
Roc Curves ◽  
Standardized Uptake Values ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

The presence of a cardiovascular implantable electronic device (CIED) can be burdened by complications such as late infections that are associated with significant morbidity and mortality and require immediate and effective treatment. The aim of this study was to evaluate the role of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in patients with suspected CIED infection. Fifteen patients who performed a 18F-FDG PET/CT for suspicion of CIED infection were retrospectively analyzed; 15 patients, with CIED, that underwent 18F-FDG PET/CT for oncological reasons, were also evaluated. Visual qualitative analysis and semi-quantitative analysis were performed. All patients underwent standard clinical management regardless 18F-FDG PET/CT results. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) resulted as 90.91%, 75%, 86.67%, 90.91% and 75% respectively. Maximum standardized uptake values (SUVmax) and semi-quantitative ratio (SQR) were collected and showed differences statistically significant between CIED infected patients and those who were not. Exploratory cut-off values were derived from receiver operating characteristic (ROC) curves for SUVmax (2.56) and SQR (4.15). This study suggests the clinical usefulness of 18F-FDG PET/CT in patients with CIED infection due to its high sensitivity, repeatability and non-invasiveness. It can help the clinicians in decision making, especially in patients with doubtful clinical presentation. Future large-scale and multicentric studies should be conducted to establish precise protocols about 18F-FDG PET/CT performance.

Prediction of response to chemotherapy using sequential F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in patients with metastatic colorectal cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 2536-2536 ◽  
Author(s):  
J. Kim ◽  
S. Choi ◽  
H. Yi ◽  
J. Lim ◽  
M. Lee ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metabolic Disease ◽  
Clinical Response ◽  
Fdg Pet ◽  
Metabolic Response ◽  
Metastatic Lesion ◽  
Prediction Of Response ◽  
Response To Chemotherapy ◽  
Pet Ct

2536 Background: Clinical response is determined after 2 or 3 cycles of chemotherapy by changes in tumor size as assessed by conventional imaging procedures such as computed tomography (CT). The aim of this study was to evaluate the use of sequential F-18 FDG PET to predict response to standardized chemotherapy for metastatic colorectal cancer (mCRC). Methods: Clinical response, as assessed by RECIST criteria, served as the reference. Investigators were free to choose chemotherapy regimen. F-18 FDG PET images after every second cycles of chemotherapy were analyzed semiquantitatively for each metastatic lesion using standardized uptake values (SUVs) normalized to patients’ blood glucose levels. PET responses were prospectively assessed as either complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), or progressive metabolic disease (PMD). In addition, sum of SUV of all metastatic lesions (sSUV) and a maximal SUV (mSUV) were recorded each PET-CT scan. Results: Twenty-four patients underwent 73 PET-CT scans since March 2005. The response to chemotherapy included CR in 1 (4.2%), PR in 10 (42%) by RECIST criteria. Median duration of follow- up was 8.3 months (range, 1.7 - 16.2) and median progression free survival (PFS) time was 6.4 months. At the baseline evaluation, PET-CT was the more sensitive test to find metastatic lesion than conventional assessment in 12 (50.0%). Baseline sSUV and mSUV was not significantly different between clinical responders and non-responders. After 2 cycles of chemotherapy, sSUV and mSUV was more decreased in clinical responder with significance (P=.023 and .020, respectively). In the 22 evaluable patients, PET responses were as followed: CMR in 1 (4.5%), PMR in 11 (50.0%), SMD in 7 (31.8%) and PMD in 3 (12.0%). Estimated median PFS was significantly prolonged in metabolic responders: PMR 8.3 months, SMD 4.7 months and PMD 2.3 months (P=.040). Patient with CMR had no evidence of progression for 14.7 month follow-up. Conclusions: In patients with mCRC, sequential FDG-PET predicted PFS and was more accurate than clinical response criteria. FDG- PET appears to be a promising tool for early prediction of response to chemotherapy. No significant financial relationships to disclose.

Role of 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography(18F-FDG PET/CT) in malignant ovarian germ cell tumors: a single-center experience with long term follow-up

2019 ◽  
Vol 29 (8) ◽  
pp. 1298-1303
Author(s):  
Carlotta Dolci ◽  
Lorenzo Ceppi ◽  
Luca Guerra ◽  
Cinzia Crivellaro ◽  
Maria Lamanna ◽  
...  
Keyword(s):  
Germ Cell ◽  
Predictive Value ◽  
Fdg Pet ◽  
Germ Cell Tumors ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Staging Surgery ◽  
Fdg Pet Ct

Introduction18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a diagnostic tool widely used in oncology, but to date there are no established recommendations for its use in malignant ovarian germ cell tumors. The aim of this study was to evaluate the role of 18F-FDG PET/CT in the clinical management of patients with malignant ovarian germ cell tumors.MethodsThis was a retrospective review of 18F-FDG PET/CT scans performed in patients diagnosed with malignant ovarian germ cell tumors treated at the gynecology department of San Gerardo Hospital (Monza, Italy) from June 2006 to December 2016. Data collected included clinical history, radiological, biochemical and pathological evaluation, treatment, follow-up, outcome, and clinical indication for the PET/CT scan. PET/CT findings were categorized as negative/normal (no abnormal FDG uptake or physiological uptake), positive/abnormal (FDG uptake considered to indicate active germ cell malignancy), or equivocal (FDG uptake of uncertain significance, not clearly correlated to neoplastic disease).ResultsA total of 69 PET/CT scans in 37 patients were evaluated. The mean age at diagnosis was 25 years (range 20–48). The majority of patients had International Federation of Gynecology and Obstetrics (FIGO) stage I (22/37) disease and had a diagnosis of dysgerminomas (18/37). Imaging indications were initial staging before treatment (4/69, 6%), staging after inadequate staging surgery (24/69, 35%), restaging after adjuvant chemotherapy (17/69, 25%), relapse suspect (9/69, 13%), and follow-up (15/69, 21%). Pathology confirmation of PET/CT results was available in 28/69 (40.5%) studies. All negative PET/CT (15/28) cases were confirmed with laparoscopy as true negative; among 13/28 positive PET cases, histopathology confirmed 7 (54%) as true positive and 6 (46%) as false positive (5 inflammatory and 1 mature teratoma implants). Patient-based analysis showed 100% sensitivity, 71% specificity, 54% positive predictive value, 100% negative predictive value, and 79% accuracy. Clinical follow-up was available in 41 (59.4%) of 69 PET/CT images: 28/41 studies were negative and 13/41 positive. A mean follow-up of 28 months (median 15, range 5–102) confirmed negative PET/CT studies. A total of 13 positive PET/CT patients underwent chemotherapy with subsequent evidence of disease response.DiscussionPET/CT in malignant ovarian germ cell tumors was mainly performed for staging after inadequate staging surgery or for restaging after adjuvant chemotherapy. PET/CT was associated with high sensitivity and negative predictive value.

Early Interim Negative FDG-PET/CT Is a High Predictive Factor for Progression-Free Survival in Hodgkin Lymphoma.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4589-4589
Author(s):  
Eldad J. Dann ◽  
Rachel Bar-Shalom ◽  
Ada Tamir ◽  
Nissim Haim ◽  
Irit Avivi ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Predictive Value ◽  
Fdg Pet ◽  
Response To Therapy ◽  
Study Group ◽  
Free Survival ◽  
Positive Study ◽  
Interim Pet ◽  
Pet Ct ◽  
Negative Study

Abstract The treatment of patients with Hodgkin lymphoma (HL) is currently based on pretreatment risk stratification aimed at reducing late therapy-related toxicity. Functional Gallium67 scintigraphy was previously used for an interim assessment of response to therapy. Recently, an interim FDG-PET was suggested as a prognostic parameter for a failure-free survival. Reported here is the significance of an interim PET when integrated into a therapeutic protocol and used for an interim risk assessment. A cohort of 89 patients with Hodgkin lymphoma treated in a single medical center since 2001 was evaluated. Three patients had stage I disease, 48 - stage II, 15 - stage III and 23 - had stage IV. Assessment of the patients using the International Prognostic Score (IPS) showed that 20% had early disease with no score evaluable, in 18% the score was 0–2 and 62% of patients had a score of 3–6. Twenty eight patients were treated with 6 cycles of ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) and 61 patients received BEACOPP combinations (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) for 6 cycles. Baseline PET/CT was performed in 87 patients while following 1st, 2nd or 3rd cycle of chemotherapy this test was repeated in 15, 70 and 4 patients, respectively. The 3-year failure-free survival (FFS) and the overall survival (OS) for patients with an interim negative study compared to those with an interim positive study were 95% versus 79% and 98% versus 89%, respectively. A subgroup of 11 patients who received escalated therapy following a positive interim PET had a 73% FFS. Three of these patients had primary progressive disease despite interim escalation of therapy. The 3-year negative predictive value of PET/CT was independent of patient risk group or chemotherapy used. Assessing the positive predictive value is difficult owing to the relatively small number of patients (19) as well as the dilemma of interpreting outcome therapy that was intensified based on the interim positive scintigraphy. Never-the-less, the data indicate that at least 27% of patients with a positive interim PET/CT will not be disease free at 3 years. The hazard ratio for a positive interim PET study is 6.2 CI (1.5–26), p=0.012. In conclusion, an interim negative PET/CT is highly predictive of prolonged FFS and OS. Prospective studies are needed to determine whether such an interim negative scan can be used to further reduce the dose intensity. An interim positive scan portends a poorer prognosis although the precise degree of predictability cannot be assessed from this study where therapy was escalated as a result of such scintigraphic findings. Interim PET 3-yr FFS 3-yr OS Median follow up - months n % Negative study: Group A (n=70) 67/70 95.3% 98.1% 29 (5–55) Positive study: Group B: Residual uptake (n=19) 14/19 79.0% 89.2% 36 (7–66) Escalation of therapy post positive study: Group C: (n=11) 8/11 72.7% 81.8% 37 Log rank test: Groups A vs B: 0.004 Groups A vs B: 0.05 Groups A vs C: 0.007 Groups A vs C: 0.008

Predictive Value of Interim 18F-FDG-PET in Patients with Non-Small Cell Lung Cancer Treated with Definitive Radiation Therapy

2020 ◽  
Author(s):  
Nalee Kim ◽  
Jin Sung Kim ◽  
Chang Geol Lee
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Predictive Value ◽  
Fdg Pet ◽  
Metabolic Response ◽  
Small Cell ◽  
Small Cell Lung ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Background We evaluated that early metabolic response determined by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) during radiotherapy (RT), predicts outcomes in non-small cell lung cancer. Methods Twenty-eight patients evaluated using pretreatment 18 F-FDG-PET/CT (PET pre ) and interim 18 F-FDG-PET/CT (PET interim ) after 11 fractions of RT were retrospectively reviewed. Maximum standardized uptake value (SUV max ) was calculated for primary lesion. Predictive value of gross tumor volume (△GTV) and SUV max (△SUV max ) changes was evaluated for locoregional control (LRC), distant failure (DF), and overall survival (OS). Metabolic responders were patients with △SUV max >40%. Results Metabolic responders showed better trends in 1-year LRC (90.9%) than non-responders (47.1%) (p=0.086). Patients with large GTV pre (≥120 cc) demonstrated poor LRC (hazard ratio 4.14, p = 0.022), while metabolic non-responders with small GTV pre (<120 cc) and metabolic responders with large GTV pre both had 1-year LRC rates of 75.0%. Reduction of 25% in GTV was not associated with LRC; however, metabolic responders without a GTV response showed better 1-year LRC (83.3%) than metabolic non-responders with a reduction in GTV (42.9%). Metabolic responders showed lower 1-year DF (16.7%) than non-responders (50.0%) (p=0.025). An ΔSUV max threshold of 40% yielded accuracy of 64% for predicting LRC, 75% for DF, and 54% for OS. However, ΔGTV > 25% demonstrated inferior diagnostic values than metabolic response. Conclusions Changes in tumor metabolism diagnosed using PET interim during RT better predicted treatment responses, recurrences, and prognosis than other factors historically used.

scholarly journals Dual time point imaging fluorine-18 flourodeoxyglucose positron emission tomography for evaluation of large loco-regional recurrences of breast cancer treated with electrochemotherapy

2013 ◽  
Vol 47 (4) ◽  
pp. 358-365 ◽  
Author(s):  
Louise Wichmann Matthiessen ◽  
Helle Hjorth Johannesen ◽  
Kristin Skougaard ◽  
Julie Gehl ◽  
Helle Westergren Hendel
Keyword(s):  
Breast Cancer ◽  
Fdg Pet ◽  
Metabolic Response ◽  
Post Injection ◽  
Response Evaluation ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Uptake Pattern ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Background. Electrochemotherapy is a local anticancer treatment very efficient for treatment of small cutaneous metastases. The method is now being investigated for large cutaneous recurrences of breast cancer that are often confluent masses of malignant tumour with various degrees of inflammation. To this end 18-Flourine- Flourodeoxyglucose-Positron Emission Tomography/Computed Tomography (FDG-PET/CT) could be a method for response evaluation. However, a standard FDG-PET/CT scan cannot differentiate inflammatory tissue from malignant tissue. Dual point time imaging (DTPI) FDG-PET has the potential of doing so. The purpose of this study was to investigate if DTPI FDG-PET/CT could assess response to electrochemotherapy and to assess the optimal timing of imaging. Patients and methods. Within a phase II clinical trial 11 patients with cutaneous recurrences had FDG-PET/CT scans at three time points: 60 min, 120 min and 180 min after FDG injection. The scans were performed before and 3 weeks after electrochemotherapy. Results. A significant reduction in maximum standard uptake value at 60 min post injection was seen after treatment. Furthermore a change in the FDG uptake pattern was observed; from increasing uptake in up to 180 min post injection before treatment to stabilization of FDG uptake at 120 min post injection after treatment. The change in FDG uptake pattern over time lead to change of response in three target lesions; two lesions changed from stable metabolic disease to partial metabolic response and one lesion changed from partial metabolic response to stable metabolic disease. To ensure detection of the change in uptake pattern, scanning 60 and 180 min post injection seems optimal. Conclusions. The present study shows that FDG-PET/CT 60 and 180 min after tracer injection is a promising tool for response evaluation of cutaneous recurrences of breast cancer treated with electrochemotherapy.

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