18F-FDG PET/CT as a Potential Predictor of Lung Inflammation After Arc-Based Radiotherapy for Esophageal Cancer: A Pilot Study

Abstract PurposeFluorine-18-fuorodeoxyglucose (18F-FDG) positron emission tomography/computerized tomography (PET/CT) scan serves as a useful tool not only for tumor detection, radiotherapy (RT) target volume delineation but also for the assessment of the inflammatory changes in normal organs. Previously we proposed the volume-based algorithm (VBA) method to reduce low dose-volume of lung by improving the arc angle in dynamic arc-based RT. The aim of this study was to assess lung inflammation by integrating 18F-FDG PET/CT with VBA before and after arc-based RT for esophageal cancer (EC).MethodsThirty EC patients underwent 18F-FDG PET/CT imaging before RT (pre-RT) and after RT (post-RT) on a retrospective pilot study. The VBA was used to define the high dose (HD) (≧ 5 Gy) region and the low dose (LD) (< 5 Gy) region in the lungs. The maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and global lung glycolysis (GLG) of the HD and LD regions in the lungs were quantified. The pre-RT and post-RT SUVmax, SUVmean, and GLG of HD and LD regions in lungs were analyzed in radiation pneumonitis (RP) ≧ grade 1 and non-radiation pneumonitis (nRP) lungs. The mean lung dose (MLD), V5, V10, V15, V20, V25, V30 in lungs were analyzed. Vx indicates the organ volume percentage exceeding a radiation dose of x (Gy). Receiver-operating characteristic curves were used to identify optimal cut-off values for RP after RT.ResultsIn RP lungs (n = 30), the SUVmax, SUVmean and GLG of the HD region between pre-RT and post-RT showed significant increases (all p < 0.05). Whereas there were no significant differences in those of the HD and LD regions in nRP lungs (n = 22). The post-RT SUVmax (2.78 vs. 2.07, p = 0.000) and post-RT SUVmean (0.64 vs. 0.52, p = 0.015) of the HD region in RP lungs were significantly higher than those in nRP lungs. The MLD (10.15 Gy vs. 8.11 Gy, p = 0.041), lung V5 (49.78% vs. 38.07%, p = 0.010) and lung V10 (32.25% vs. 24.71%, p = 0.017) in the RP lungs were significantly higher than those in nRP lungs. The area under the curve (AUC) of post-RT SUVmax of the HD regions was 0.852, and the AUC of the lung V5 was 0.727. For predicting RP, the optimal cut-off values of post-RT SUVmax and lung V5 were > 2.28 and > 47.14%. respectively. ConclusionThis study successfully integrated 18F-FDG PET/CT with VBA to assess RP in EC patients undergoing dynamic arc-based RT. The post-RT SUVmax and post-RT SUVmean of HD (≧5 Gy) regions can be used to evaluate RP. The post-RT SUVmax > 2.28 of HD regions and lung V5 > 47.14% may be a potential predictor of RP. 18F-FDG PET/CT is a promising tool to detect RP for EC patients treated with arc-based RT.

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Quantitative assessment of global lung inflammation following radiation therapy using FDG PET/CT: a pilot study

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-013-2579-4 ◽

2013 ◽

Vol 41 (2) ◽

pp. 350-356 ◽

Cited By ~ 36

Author(s):

Sarah Abdulla ◽

Ali Salavati ◽

Babak Saboury ◽

Sandip Basu ◽

Drew A. Torigian ◽

...

Keyword(s):

Radiation Therapy ◽

Pilot Study ◽

Fdg Pet ◽

Lung Inflammation ◽

Quantitative Assessment ◽

Pet Ct ◽

Fdg Pet Ct

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Prognostic Value of Lymph Node to Primary Tumor Standardized Uptake Value Ratio in Unresectable Esophageal Cancer

10.21203/rs.3.rs-25249/v1 ◽

2020 ◽

Author(s):

Po-Jui Chen ◽

Wing-Keen Yap ◽

Yu-Chuan Chang ◽

Chen-Kan Tseng ◽

Yin-Kai Chao ◽

...

Keyword(s):

Esophageal Cancer ◽

Prognostic Factor ◽

Treatment Outcomes ◽

Distant Metastasis ◽

Primary Tumor ◽

Fdg Pet ◽

Roc Analysis ◽

Standardized Uptake Value ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Background Unresectable esophageal cancer harbors high mortality despite chemoradiotherapy. Better patient selection for more personalized management may result in better treatment outcomes. We presume the ratio of maximum standardized uptake value (SUV) of metastatic lymph nodes to primary tumor (NTR) in 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (FDG PET/CT) may provide prognostic information and further stratiﬁcation of these patients. Methods The patients with non-metastatic and unresectable esophageal squamous cell carcinoma (SCC) receiving FDG PET/CT staging and treated by chemoradiotherapy were retrospectively reviewed. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-off value for NTR. Kaplan-Meier method and Cox regression model were used for survival analyses and multivariable analyses, respectively.Results From 2010 to 2016, 96 eligible patients were analyzed. The median follow-up time was 10.2 months (range 1.6 to 83.6 months). Using ROC analysis, the best NTR cut-off value was 0.46 for prediction of distant metastasis. The median distant metastasis-free survival (DMFS) was significantly lower in the high-NTR group (9.5 vs. 22.2 months, p = 0.002) and median overall survival (OS) (9.5 vs. 11.6 months, p = 0.013) was also signiﬁcantly worse. Multivariable analysis revealed that NTR was an independent prognostic factor for DMFS (hazard ratio [HR] 1.81, p = 0.023) and OS (HR 1.77, p = 0.014).Conclusions High pretreatment NTR predicts worse treatment outcomes and could be an easy-to-use and helpful prognostic factor to provide more personalized treatment for patients with non-metastatic and unresectable esophageal SCC.

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The role of FDG PET/CT or PET/MRI in assessing response to neoadjuvant therapy for patients with borderline or resectable pancreatic cancer: a systematic literature review

Annals of Nuclear Medicine ◽

10.1007/s12149-021-01629-0 ◽

2021 ◽

Author(s):

Laura Evangelista ◽

Pietro Zucchetta ◽

Lucia Moletta ◽

Simone Serafini ◽

Gianluca Cassarino ◽

...

Keyword(s):

Neoadjuvant Therapy ◽

Fdg Pet ◽

Standardized Uptake Value ◽

Response To Therapy ◽

Ductal Adenocarcinoma ◽

Resectable Pancreatic Cancer ◽

Number Of Patients ◽

Pet Ct ◽

Fdg Pet Ct

AbstractThe aim of the present systematic review is to examine the role of fluorodeoxyglucose (FDG) positron emission tomography (PET) associated with computed tomography (CT) or magnetic resonance imaging (MRI) in assessing response to preoperative chemotherapy or chemoradiotherapy (CRT) for patients with borderline and resectable pancreatic ductal adenocarcinoma (PDAC). Three researchers ran a database query in PubMed, Web of Science and EMBASE. The total number of patients considered was 488. The most often used parameters of response to therapy were the reductions in the maximum standardized uptake value (SUVmax) or the peak standardized uptake lean mass (SULpeak). Patients whose SUVs were higher at the baseline (before CRT) were associated with a better response to therapy and a better overall survival. SUVs remaining high after neoadjuvant therapy correlated with a poor prognosis. Available data indicate that FDG PET/CT or PET/MRI can be useful for predicting and assessing response to CRT in patients with resectable or borderline PDAC.

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Role of 18F-PET-CT to predict pathological response after neoadjuvant treatment of rectal cancer

Discover Oncology ◽

10.1007/s12672-021-00405-w ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Riccardo Caruso ◽

Emilio Vicente ◽

Yolanda Quijano ◽

Hipolito Duran ◽

Isabel Fabra ◽

...

Keyword(s):

Rectal Cancer ◽

Fdg Pet ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Standardized Uptake Value ◽

Tumour Regression Grade ◽

Pet Ct ◽

Significant Difference ◽

18F Fdg ◽

Fdg Pet Ct

Abstract Objectives Neoadjuvant chemoradiation (nCRT) is universally considered to be a valid treatment to achieve downstaging, to improve local disease control and to obtain better resectability in locally advanced rectal cancer (LARC). The aim of this study is to correlate the change in the tumour 18F-FDG PET-CT standardized uptake value (SUV) before and after nCRT, in order to obtain an early prediction of the pathologic response (pR) achieved in patients with LARC. Data description We performed a retrospective analysis of patients with LARC diagnosis who underwent curative resection. All patients underwent a baseline 18F-FDG PET-CT scan within the week prior to the initiation of the treatment (PET-CT SUV1) and a second scan (PET-CT SUV2) within 6 weeks of the completion of nCRT. We evaluated the prognostic value of 18F-FDG PET-CT in terms of disease-free survival (DFS) and overall survival (OS) in patients with LARC.A total of 133 patients with LARC were included in the study. Patients were divided in two groups according to the TRG (tumour regression grade): 107 (80%) as the responders group (TRG0-TRG1) and 26 (25%) as the no-responders group (TRG2-TRG3). We obtained a significant difference in Δ%SUV between the two different groups; responders versus no-responders (p < 0.012). The results of this analysis show that 18F-FDG PET-CT may be an indicator to evaluate the pR to nCRT in patients with LARC. The decrease in 18F-FDG PET-CT uptake in the primary tumour may offer important information in order for an early identification of those patients more likely to obtain a pCR to nCRT and to predict those who are unlikely to significantly regress.

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Head and neck tumors angiogenesis imaging with 68Ga-NODAGA-RGD in comparison to 18F-FDG PET/CT: a pilot study

EJNMMI Research ◽

10.1186/s13550-020-00638-w ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Steve Durante ◽

Vincent Dunet ◽

François Gorostidi ◽

Periklis Mitsakis ◽

Niklaus Schaefer ◽

...

Keyword(s):

Pilot Study ◽

Head And Neck ◽

Fdg Pet ◽

Head And Neck Tumors ◽

Neck Tumors ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Splenic uptake on FDG PET/CT correlates with Kikuchi-Fujimoto disease severity

Scientific Reports ◽

10.1038/s41598-021-90350-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hye Seong ◽

Yong Hyu Jeong ◽

Woon Ji Lee ◽

Jun Hyoung Kim ◽

Jung Ho Kim ◽

...

Keyword(s):

Disease Severity ◽

Fdg Pet ◽

Tertiary Care ◽

Clinical Manifestations ◽

Standardized Uptake Value ◽

Total Lesion Glycolysis ◽

Positron Emission ◽

Pet Ct ◽

Systemic Symptoms ◽

Fdg Pet Ct

AbstractKikuchi-Fujimoto disease (KFD) is usually self-limiting, but prolonged systemic symptoms often result in frequent hospital visits, long admission durations, or missed workdays. We investigated the role of fluorine-18 fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing KFD severity. We reviewed the records of 31 adult patients with pathologically confirmed KFD who underwent 18F-FDG PET/CT between November 2007 and April 2018 at a tertiary-care referral hospital. Disease severity was assessed using criteria based on clinical manifestations of advanced KFD. Systemic activated lymph nodes and severity of splenic activation were determined using semi-quantitative and volumetric PET/CT parameters. The median of the mean splenic standardized uptake value (SUVmean) was higher in patients with severe KFD than those with mild KFD (2.38 ± 1.18 vs. 1.79 ± 0.99, p = 0.058). Patients with severe KFD had more systemically activated volume and glycolytic activity than those with mild KFD (total lesion glycolysis: 473.5 ± 504.4 vs. 201.6 ± 363.5, p = 0.024). Multivariate logistic regression showed that myalgia (odds ratio [OR] 0.035; 95% confidence interval [CI] 0.001–0.792; p = 0.035), total lymph node SUVmax (cutoff 9.27; OR 24.734; 95% CI 1.323–462.407; p = 0.032), and spleen SUVmean (cutoff 1.79; OR 37.770; 95% CI 1.769–806.583; p = 0.020) were significantly associated with severe KFD. 18F-FDG PET/CT could be useful in assessing KFD severity.

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18F-FDG PET/CT Parameters for Predicting Prognosis in Esophageal Cancer Patients Treated With Concurrent Chemoradiotherapy

Technology in Cancer Research & Treatment ◽

10.1177/15330338211024655 ◽

2021 ◽

Vol 20 ◽

pp. 153303382110246

Author(s):

Seokmo Lee ◽

Yunseon Choi ◽

Geumju Park ◽

Sunmi Jo ◽

Sun Seong Lee ◽

...

Keyword(s):

Esophageal Cancer ◽

Cancer Patients ◽

Fdg Pet ◽

Concurrent Chemoradiotherapy ◽

Curative Intent ◽

Squamous Cell Esophageal Cancer ◽

Pet Ct ◽

Significant Difference ◽

Fdg Pet Ct

Background and Aims: This study evaluated the prognostic value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (18F-FDG PET/CT) performed before and after concurrent chemoradiotherapy (CCRT) in esophageal cancer. Methods: We analyzed the prognosis of 50 non-metastatic squamous cell esophageal cancer (T1-4N0-2) patients who underwent CCRT with curative intent at Inje University Busan Paik Hospital and Haeundae Paik Hospital from 2009 to 2019. Median total radiation dose was 54 Gy (range 34-66 Gy). Our aim was to investigate the relationship between PET/CT values and prognosis. The primary end point was progression-free survival (PFS). Results: The median follow-up period was 9.9 months (range 1.7-85.7). Median baseline maximum standard uptake value (SUVmax) was 14.2 (range 3.2-27.7). After treatment, 29 patients (58%) showed disease progression. The 3-year PFS and overall survival (OS) were 24.2% and 54.5%, respectively. PFS was significantly lower ( P = 0.015) when SUVmax of initial PET/CT exceeded 10 (n = 22). However, OS did not reach a significant difference based on maximum SUV ( P = 0.282). Small metabolic tumor volume (≤14.1) was related with good PFS ( P = 0.002) and OS ( P = 0.001). Small total lesion of glycolysis (≤107.3) also had a significant good prognostic effect on PFS ( P = 0.009) and OS ( P = 0.025). In a subgroup analysis of 18 patients with follow-up PET/CT, the patients with SUV max ≤3.5 in follow-up PET/CT showed longer PFS ( P = 0.028) than those with a maximum SUV >3.5. Conclusion: Maximum SUV of PET/CT is useful in predicting prognosis of esophageal cancer patients treated with CCRT. Efforts to find more effective treatments for patients at high risk of progression are still warranted.

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18F-FDG-PET/CT in radiation therapy-induced parotid gland inflammation

European Journal of Hybrid Imaging ◽

10.1186/s41824-020-00091-x ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Alaa Mouminah ◽

Austin J. Borja ◽

Emily C. Hancin ◽

Yu Cheng Chang ◽

Thomas J. Werner ◽

...

Keyword(s):

Parotid Gland ◽

Fdg Pet ◽

Standardized Uptake Value ◽

Post Treatment ◽

Parotid Glands ◽

Positron Emission ◽

Pet Ct ◽

Average Maximum ◽

Pre Treatment ◽

Fdg Pet Ct

Abstract Background 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used in the clinical management of oncologic and inflammatory pathologies. It may have utility in detecting radiotherapy (RT)-induced damage of oral tissues. Thus, the aim of the present study was to use FDG-PET/CT to evaluate parotid gland inflammation following RT in patients with head and neck cancer (HNC). Methods This retrospective study included patients with HNC treated with photon, proton, or combined photon/proton RT, in addition to chemotherapy. All patients received FDG-PET/CT imaging pre-treatment and 3 months post-treatment. The average mean standardized uptake value (Avg SUVmean) and the average maximum standardized uptake value (Avg SUVmax) of the left and right parotid glands were determined by global assessment of FDG activity using OsiriX MD software. A two-tailed paired t test was used to compare Avg SUVmean and Avg SUVmax pre- and post-RT. Results Forty-seven HNC patients were included in the study. Parotid gland Avg SUVmean was significantly higher at 3 months post-treatment than pre-treatment (p < 0.05) in patients treated with photon RT, but no significant differences were found between pre- and post-treatment Avg SUVmean in patients treated with proton RT or combined photon/proton RT. Conclusion Our results suggest that photon RT may cause radiation-induced inflammation of the parotid gland, and that proton RT, which distributes less off-target radiation, is a safer treatment alternative.

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