Early metabolic response evaluation on PET-CT after a single cycle of chemotherapy in patients with cT3-4N0/+ oesophageal or GE-junction cancer subsequently treated by neoadjuvant chemoradiotherapy.

Abstract Objective In malignant melanoma patients treated with immune checkpoint inhibitor (ICI) therapy, three different FDG-PET criteria, European Organization for Research and Treatment of Cancer (EORTC), PET Response Criteria in Solid Tumors (PERCIST), immunotherapy-modified PERCIST (imPERCIST), were compared regarding response evaluation and prognosis prediction using standardized uptake value (SUV) harmonization of results obtained with various PET/CT scanners installed at different centers. Materials and methods Malignant melanoma patients (n = 27) underwent FDG-PET/CT examinations before and again 3 to 9 months after therapy initiation (nivolumab, n = 21; pembrolizumab, n = 6) with different PET scanners at five hospitals. EORTC, PERCIST, and imPERCIST criteria were used to evaluate therapeutic response, then concordance of the results was assessed using Cohen’s κ coefficient. Log-rank and Cox methods were employed to determine progression-free (PFS) and overall (OS) survival. Results Complete metabolic response (CMR)/partial metabolic response (PMR)/stable metabolic disease (SMD)/progressive metabolic disease (PMD) with harmonized EORTC, PERCIST, and imPERCIST was seen in 3/5/4/15, 4/5/3/15, and 4/5/5/13 patients, respectively. Nearly perfect concordance between each pair of criteria was noted (κ = 0.939–0.972). Twenty patients showed progression and 14 died from malignant melanoma after a median 19.2 months. Responders (CMR/PMR) showed significantly longer PFS and OS than non-responders (SMD/PMD) (harmonized EORTC: p < 0.0001 and p = 0.011; harmonized PERCIST: p < 0.0001 and p = 0.0012; harmonized imPERCIST: p < 0.0001 and p = 0.0012, respectively). Conclusions All harmonized FDG-PET criteria (EORTC, PERCIST, imPERCIST) showed accuracy for response evaluation of ICI therapy and prediction of malignant melanoma patient prognosis. Additional studies to determine their value in larger study populations will be necessary.

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Early Metabolic Response Assessed Using 18F-FDG-PET/CT for Image-Guided Intracavitary Brachytherapy Can Better Predict Treatment Outcomes in Patients with Cervical Cancer

Cancer Research and Treatment ◽

10.4143/crt.2020.1251 ◽

2020 ◽

Author(s):

Nalee Kim ◽

Won Park ◽

Won Kyung Cho ◽

Duk-Soo Bae ◽

Byoung-Gie Kim ◽

...

Keyword(s):

Cervical Cancer ◽

Treatment Outcomes ◽

Fdg Pet ◽

Metabolic Response ◽

Intracavitary Brachytherapy ◽

Image Guided ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Early Metabolic Response

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Early metabolic response assessment of breast cancer liver metastases: 4-week posttreatment FDG PET predicts survival after 90Y microsphere radioembolization

Nuklearmedizin ◽

10.1055/a-0891-7650 ◽

2019 ◽

Vol 58 (03) ◽

pp. 242-248 ◽

Cited By ~ 1

Author(s):

Amir Sabet ◽

Martin Ries ◽

Yamen Al-Khalaf ◽

Carsten Meyer ◽

Christian Rudlowski ◽

...

Keyword(s):

Breast Cancer ◽

Liver Metastases ◽

Fdg Pet ◽

Metabolic Response ◽

Response Assessment ◽

Tumor Burden ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Early Metabolic Response

Abstract Aim To evaluate the feasibility of early metabolic response assessment with 18F-FDG PET/CT in patients with breast cancer liver metastases 4 weeks after radioembolization with Yttrium-90 labeled microspheres. Methods 25 patients (mean age 58y, range 40–74) with advanced stage liver metastases of breast cancer were treated with 1.9 ± 0.4 GBq of 90Y-microspheres in the salvage setting and underwent 18F-FDG PET/CT at baseline and 4 weeks post-radioembolization. 14 patients (56 %) had an excessive hepatic tumor burden (> 50 % of total liver volume), 21 patients (84 %) had extrahepatic disease. Liver lesions with the highest SUVmax were selected as target lesions and a cut-off was set at 50 % reduction to separate responders from non-responders. The predictive impact of metabolic response on overall survival (OS) was investigated along with other prognostic factors. Results The median OS in this highly advanced metastatic cohort was 7 months (95 % CI, 5–9). All patients had a reduction in SUVmax (mean ΔSUVmax: –49 ± 26 %) at 4 weeks post-treatment. Patients with > 50 % SUVmax reduction survived longer (median OS 13 mo, 95 % CI 8–18) than the remaining patients (median OS 4 mo, 95 % CI 2–6; p = 0.001). From all investigated baseline factors including age, performance status, and presence of extra-hepatic disease, only the hepatic tumor burden had a significant impact on OS (p = 0.02). Conclusions This is the first preliminary evidence in breast cancer that early post-radioembolization molecular response assessment of treated liver metastases – as early as 4 weeks posttreatment – may predict survival. If confirmed by larger series, FDG PET/CT could be considered for early response-adapted treatment modifications.

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Interrater Agreement and Reliability of PERCIST and Visual Assessment When Using 18F-FDG-PET/CT for Response Monitoring of Metastatic Breast Cancer

Diagnostics ◽

10.3390/diagnostics10121001 ◽

2020 ◽

Vol 10 (12) ◽

pp. 1001

Author(s):

Jonas S. Sørensen ◽

Mie H. Vilstrup ◽

Jorun Holm ◽

Marianne Vogsen ◽

Jakob L. Bülow ◽

...

Keyword(s):

Fdg Pet ◽

Metabolic Response ◽

Metastatic Breast ◽

Visual Assessment ◽

Interrater Agreement ◽

Qualitative Assessment ◽

Response Evaluation ◽

Substantial Agreement ◽

Pet Ct ◽

Fdg Pet Ct

Response evaluation at regular intervals is indicated for treatment of metastatic breast cancer (MBC). FDG-PET/CT has the potential to monitor treatment response accurately. Our purpose was to: (a) compare the interrater agreement and reliability of the semi-quantitative PERCIST criteria to qualitative visual assessment in response evaluation of MBC and (b) investigate the intrarater agreement when comparing visual assessment of each rater to their respective PERCIST assessment. We performed a retrospective study on FDG-PET/CT in women who received treatment for MBC. Three specialists in nuclear medicine categorized response evaluation by qualitative assessment and standardized one-lesion PERCIST assessment. The scans were categorized into complete metabolic response, partial metabolic response, stable metabolic disease, and progressive metabolic disease. 37 patients with 179 scans were included. Visual assessment categorization yielded moderate agreement with an overall proportion of agreement (PoA) between raters of 0.52 (95% CI 0.44–0.66) and a Fleiss kappa estimate of 0.54 (95% CI 0.46–0.62). PERCIST response categorization yielded substantial agreement with an overall PoA of 0.65 (95% CI 0.57–0.73) and a Fleiss kappa estimate of 0.68 (95% CI 0.60–0.75). The difference in PoA between overall estimates for PERCIST and visual assessment was 0.13 (95% CI 0.06–0.21; p = 0.001), that of kappa was 0.14 (95% CI 0.06–0.21; p < 0.001). The overall intrarater PoA was 0.80 (95% CI 0.75–0.84) with substantial agreement by a Fleiss kappa of 0.74 (95% CI 0.69–0.79). Semi-quantitative PERCIST assessment achieved significantly higher level of overall agreement and reliability compared with qualitative assessment among three raters. The achieved high levels of intrarater agreement indicated no obvious conflicting elements between the two methods. PERCIST assessment may, therefore, give more consistent interpretations between raters when using FDG-PET/CT for response evaluation in MBC.

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