Đáp ứng sớm của điều trị xạ trị lập thể định vị thân ở bệnh nhân ung thư phổi không tế bào nhỏ giai đoạn I

2021 ◽  
Vol 16 (DB4) ◽  
Author(s):  
Phạm Văn Luận ◽  
Nguyễn Đình Tiến ◽  
Lê Ngọc Hà ◽  
Bùi Quang Biểu
Keyword(s):  
Recist 1.1 ◽  
Pet Ct ◽  
Percist 1.0

Mục tiêu: Đánh giá đáp ứng sớm điều trị xạ trị lập thể định vị thân ở bệnh nhân ung thư phổi không tế bào nhỏ giai đoạn I (T1-T2aN0M0). Đối tượng và phương pháp: Nghiên cứu tiến cứu, theo dõi dọc 25 bệnh nhân ung thư phổi không tế bào nhỏ giai đoạn T1-T2aN0M0 được điều trị xạ trị lập thể định vị thân và đánh giá mỗi 3 tháng từ tháng 01/2015 đến tháng 12/2020. Đáp ứng điều trị sớm sau 3 tháng được đánh giá theo tiêu chuẩn RECIST 1.1 và PERCIST 1.0, đánh giá tác dụng không mong muốn theo tiêu chuẩn của Viện Ung thư quốc gia Mỹ. Kết quả: Tuổi trung bình là 65,32 tuổi, kích thước trung bình của khối u trên CT ngực là 3,33cm, trên PET/CT 3,21cm, giá trị FDG trung bình 8,01. Giai đoạn của khối u đa số là T2a (56%). Bệnh nhân được chỉ định SBRT do COPD chiếm 60%. Liều điều trị trung bình 4208cGy, 40% điều trị 1 phân liều, còn lại là 3 - 5 phân liều. Theo RECIST, không có đáp ứng hoàn toàn, 44% đáp ứng 1 phần, 36% bệnh ổn định, 5 bệnh nhân có bệnh tiến triển, tỉ lệ đáp ứng khách quan là 44%, tỷ lệ kiểm soát bệnh là 80%. Theo PERCIST, có 1 bệnh nhân đạt đáp ứng hoàn toàn, các tỷ lệ khác lần lượt là 68%, 24%, 8%, 68% và 92%, sự khác biệt giữa 2 tiêu chuẩn có ý nghĩa thống kê với p<0,05. CEA và giá trị SUVmax có mối liên quan đến đáp ứng sau điều trị (p<0,05). Tác dụng không mong muốn hay gặp là viêm phổi do xạ: 11 bệnh nhân, chủ yếu là độ 1, không có viêm phổi do xạ độ 4, 5. Không có sự thay đổi về chức năng hô hấp của bệnh nhân sau điều trị SBRT. Kết luận: SBRT là phương pháp điều trị cho đáp ứng tốt ở bệnh nhân ung thư phổi không tế bào nhỏ giai đoạn I với tỷ lệ kiểm soát bệnh 92%, đồng thời đây là một biện pháp điều trị an toàn cho người bệnh.

Tumor response to neoadjuvant chemotherapy in patients with esophageal cancer assessed with CT and FDG-PET/CT – RECIST 1.1 vs. PERCIST 1.0

2018 ◽  
Vol 101 ◽  
pp. 65-71 ◽  
Author(s):  
Soichi Odawara ◽  
Kazuhiro Kitajima ◽  
Takayuki Katsuura ◽  
Yasunori Kurahashi ◽  
Hisashi Shinohara ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Fdg Pet ◽  
Tumor Response ◽  
Recist 1.1 ◽  
Pet Ct ◽  
Percist 1.0 ◽  
Fdg Pet Ct ◽  
Response To Neoadjuvant Chemotherapy

scholarly journals A method for evaluation of patient-specific lean body mass from limited-coverage CT images and its application in PERCIST: comparison with predictive equation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Jingjie Shang ◽  
Zhiqiang Tan ◽  
Yong Cheng ◽  
Yongjin Tang ◽  
Bin Guo ◽  
...  
Keyword(s):  
Lean Body Mass ◽  
Body Mass ◽  
Whole Body ◽  
Patient Specific ◽  
Predictive Equation ◽  
Reference Standard ◽  
Pet Ct ◽  
Before And After ◽  
Percist 1.0 ◽  
Limited Coverage

Abstract Background Standardized uptake value (SUV) normalized by lean body mass ([LBM] SUL) is recommended as metric by PERCIST 1.0. The James predictive equation (PE) is a frequently used formula for LBM estimation, but may cause substantial error for an individual. The purpose of this study was to introduce a novel and reliable method for estimating LBM by limited-coverage (LC) CT images from PET/CT examinations and test its validity, then to analyse whether SUV normalised by LC-based LBM could change the PERCIST 1.0 response classifications, based on LBM estimated by the James PE. Methods First, 199 patients who received whole-body PET/CT examinations were retrospectively retrieved. A patient-specific LBM equation was developed based on the relationship between LC fat volumes (FVLC) and whole-body fat mass (FMWB). This equation was cross-validated with an independent sample of 97 patients who also received whole-body PET/CT examinations. Its results were compared with the measurement of LBM from whole-body CT (reference standard) and the results of the James PE. Then, 241 patients with solid tumours who underwent PET/CT examinations before and after treatment were retrospectively retrieved. The treatment responses were evaluated according to the PE-based and LC-based PERCIST 1.0. Concordance between them was assessed using Cohen’s κ coefficient and Wilcoxon’s signed-ranks test. The impact of differing LBM algorithms on PERCIST 1.0 classification was evaluated. Results The FVLC were significantly correlated with the FMWB (r=0.977). Furthermore, the results of LBM measurement evaluated with LC images were much closer to the reference standard than those obtained by the James PE. The PE-based and LC-based PERCIST 1.0 classifications were discordant in 27 patients (11.2%; κ = 0.823, P=0.837). These discordant patients’ percentage changes of peak SUL (SULpeak) were all in the interval above or below 10% from the threshold (±30%), accounting for 43.5% (27/62) of total patients in this region. The degree of variability is related to changes in LBM before and after treatment. Conclusions LBM algorithm-dependent variability in PERCIST 1.0 classification is a notable issue. SUV normalised by LC-based LBM could change PERCIST 1.0 response classifications based on LBM estimated by the James PE, especially for patients with a percentage variation of SULpeak close to the threshold.

scholarly journals 18F-PSMA-1007 PET/CT for response assessment in patients with metastatic renal cell carcinoma undergoing tyrosine kinase or checkpoint inhibitor therapy: preliminary results

2020 ◽  
Author(s):  
L. M. Mittlmeier ◽  
M. Unterrainer ◽  
S. Rodler ◽  
A. Todica ◽  
N. L. Albert ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Tyrosine Kinase ◽  
Cell Carcinoma ◽  
Treatment Response ◽  
Renal Cell ◽  
Systemic Treatment ◽  
Response Assessment ◽  
Recist 1.1 ◽  
Psma Pet ◽  
Pet Ct

Abstract Introduction Tyrosine kinase (TKI) and checkpoint inhibitors (CI) prolonged overall survival in metastatic renal cell carcinoma (mRCC). Early prediction of treatment response is highly desirable for the individualization of patient management and improvement of therapeutic outcome; however, serum biochemistry is unable to predict therapeutic efficacy. Therefore, we compared 18F-PSMA-1007 PET imaging for response assessment in mRCC patients undergoing TKI or CI therapy compared to CT-based response assessment as the current imaging reference standard. Methods 18F-PSMA-1007 PET/CT was performed in mRCC patients prior to initiation of systemic treatment and 8 weeks after therapy initiation. Treatment response was evaluated separately on 18F-PSMA-PET and CT. Changes on PSMA-PET (SUVmean) were assessed on a per patient basis using a modified PERCIST scoring system. Complete response (CRPET) was defined as absence of any uptake in all target lesions on posttreatment PET. Partial response (PRPET) was defined as decrease in summed SUVmean of > 30%. The appearance of new, PET-positive lesions or an increase in summed SUVmean of > 30% was defined as progressive disease (PDPET). A change in summed SUVmean of ± 30% defined stable disease (SDPET). RECIST 1.1 criteria were used for response assessment on CT. Results of radiographic response assessment on PSMA-PET and CT were compared. Results Overall, 11 mRCC patients undergoing systemic treatment were included. At baseline PSMA-PET1, all mRCC patients showed at least one PSMA-avid lesion. On follow-up PET2, 3 patients showed CRPET, 3 PRPET, 4 SDPET, and 1 PDPET. According to RECIST 1.1, 1 patient showed PRCT, 9 SDCT, and 1 PDCT. Overall, concordant classifications were found in only 2 cases (2 SDCT + PET). Patients with CRPET on PET were classified as 3 SDCT on CT using RECIST 1.1. By contrast, the patient classified as PRCT on CT showed PSMA uptake without major changes during therapy (SDPET). However, among 9 patients with SDCT on CT, 3 were classified as CRPET, 3 as PRPET, 1 as PDPET, and only 2 as SDPET on PSMA-PET. Conclusion On PSMA-PET, heterogeneous courses were observed during systemic treatment in mRCC patients with highly diverging results compared to RECIST 1.1. In the light of missing biomarkers for early response assessment, PSMA-PET might allow more precise response assessment to systemic treatment, especially in patients classified as SD on CT.

Vai trò của chẩn đoán hình ảnh thông thường và 18F-FDG PET/CT trong đánh giá đáp ứng điều trị ung thư

2021 ◽  
Vol 16 (DB4) ◽  
Author(s):  
Lê Ngọc Hà ◽  
Mai Hồng Sơn
Keyword(s):  
Fdg Pet ◽  
Recist 1.1 ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Mục tiêu của bài viết này là nêu lên các ứng dụng thực hành và những hạn chế của việc đánh giá đáp ứng điều trị của các ung thư dạng đặc dựa trên các tiêu chuẩn chẩn đoán hình ảnh. Hiện nay, có rất nhiều tiêu chuẩn đánh giá bao gồm tiêu chuẩn của Tổ chức Y tế Thế giới (WHO), tiêu chuẩn đánh giá đáp ứng của u dạng đặc (RECIST; RECIST 1.1). Gần đây đánh giá định tính và định lượng dựa vào chuyển hóa FDG trong ung thư sử dụng PET/CT toàn thân, trở nên một phương pháp quan trọng để đánh giá đáp ứng điều trị ung thư dạng đặc (tiêu chuẩn PERCIST phiên bản 1.0). Phương pháp đánh giá dựa vào hình ảnh giải phẫu của WHO, RECIST, RECIST 1.1 được sử dụng rộng rãi những vẫn còn nhiều hạn chế trong đánh giá đáp ứng với điều trị. Tiêu chuẩn RECIST cho thấy sự tiến triển của khối u chậm hơn so với tiêu chuẩn của WHO. RECIST 1.1 có giá trị cao hơn tiêu chuẩn RECIST trong đánh giá đáp ứng điều trị với tổn thương hạch. 18F-FDG PET/CT cho phép đánh giá định tính và định lượng chuyển hóa ở khối u dựa vào chuyển hoá như chỉ số SUV.

scholarly journals Potential and Clinical Significance of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Evaluating Liver Cancer Response to Lenvatinib Treatment

Oncology ◽  
2020 ◽  
pp. 1-8
Author(s):  
Daiki Yamashige ◽  
Yusuke Kawamura ◽  
Masahiro Kobayashi ◽  
Junichi Shindoh ◽  
Yuta Kobayashi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Fluorodeoxyglucose Positron Emission Tomography ◽  
Recist 1.1 ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Fluorodeoxyglucose Positron Emission

<b><i>Background:</i></b> The sensitivity of <sup>18</sup>F-fluorodeoxyglucose positron emission tomography/computed tomography (<sup>18</sup>F-FDG-PET/CT) in hepatocellular carcinoma (HCC) is low; however, clinical evidence demonstrating its prognostic value in patients with HCC has recently been reported. This study aimed to assess the value of <sup>18</sup>F-FDG-PET/CT as a tool for evaluating the response of HCC to lenvatinib treatment. <b><i>Methods:</i></b> We evaluated 11 consecutive patients with HCC diagnosed by dynamic CT or magnetic resonance imaging combined with <sup>18</sup>F-FDG-PET/CT from April 2018 to December 2019. The tumor-to-normal liver ratio (TLR) of the target tumor was measured before and during the course of lenvatinib treatment with <sup>18</sup>F-FDG-PET/CT (pre and post analysis, respectively), with a TLR ≥2 classified as PET-positive HCC. At the time of each evaluation, we also used the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, the modified RECIST (mRECIST), and the tumor marker alfa-fetoprotein (AFP). <b><i>Results:</i></b> Of 11 patients, 3 (27%) and 8 (73%) had an objective response to lenvatinib treatment at the time of post-analysis by RECIST 1.1 and mRECIST, respectively. There were 3 (27%) and 7 (64%) patients with PET-positive HCC at the time of pre- and post-analysis, respectively. There was a significant correlation between the rates of change in AFP and TLR during lenvatinib treatment (<i>r</i> = 0.69, <i>p</i> = 0.019). Based on these results, we were able to perform liver resection on 4 patients with PET-positive HCC as conversion therapy. Three samples from these patients showed poorly differentiated tumors. <b><i>Conclusion:</i></b> <sup>18</sup>F-FDG-PET/CT has potential as an evaluation tool for describing biological tumor behavior and reflecting disease progression, location, and treatment response. This modality may provide useful information for considering prognosis and subsequent therapy.

459P Comparison of predictive value betweenmetabolic tumor volume and RECIST 1.1 assessed by 18F-FDG PET-CT in patients with lung cancer

2016 ◽  
Vol 27 (suppl_9) ◽  
Author(s):  
J-T. Lin ◽  
Q-Y. Hou ◽  
Z-Y. Dong ◽  
W-Z. Zhong ◽  
Y-S. Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Predictive Value ◽  
Fdg Pet ◽  
Tumor Volume ◽  
Recist 1.1 ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Patients with advanced solid cancers treated with ERK inhibitors exhibit pseudo-progession in lymphatic nodes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3138-3138
Author(s):  
Reem Abo-Zahrah ◽  
Daniel D. Karp ◽  
Abha Adat ◽  
Timothy A. Yap ◽  
Siqing Fu ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Mapk Pathway ◽  
Single Agent ◽  
Ct Imaging ◽  
Treatment Discontinuation ◽  
Fdg Uptake ◽  
Recist 1.1 ◽  
Best Response ◽  
Pet Ct ◽  
Pre Treatment

3138 Background: ERK1/2 signaling is often overactivated in cancer, especially in patients with molecular alterations activating the MAPK pathway. MAPK pathway inhibition can result in the increase of CD8+ and CD4+ T-cells and decreased expression of immunosuppressive cytokines. Methods: This is a retrospective study of 52 patients with advanced solid cancers and oncogenic alterations in the MAPK pathway, who were treated in phase I/II clinical trials with five different single agent ERK1/2 inhibitors at MD Anderson Cancer Center. We reviewed serial PET and/or CT imaging obtained before therapy, on therapy, and after therapy completion. We evaluated dynamic changes in the lymphatic nodes (LN) in the context of overall response per RECIST 1.1 and other outcomes. Results: Of the 52 patients, 19 (37%) patients were evaluated with serial PET/CT and 33 (63%) with serial CT imaging only. Of the 19 patients evaluated with PET/CT, 12 (63%) demonstrated increased FDG uptake in LN compared to pre-treatment imaging (LN enlargement, n = 9; no LN enlargement, n = 3) discrepant from the known target and non-target lesions. These 12 patients were on therapy with ERK inhibitors (11 at doses > recommended phase 2 dose [RP2D]) for a median of 3.6 months (range, 1.8-12 months) with a best response per RECIST 1.1. as follows: partial response, n = 1; stable disease (SD), n = 10; progressive disease (PD), n = 1. Of interest, in 6 of those 12 patients, FDG uptake in LN decreased or resolved after treatment discontinuation. Further, one patient had a biopsy of an emerged LN, which showed lymphocytic infiltrate without tumor cells. Of the 33 patients evaluated with CT only, 5 (15%) demonstrated increased size of LN discrepant from the known target and non-target lesions compared to pre-treatment imaging. These 5 patients were on therapy with ERK inhibitors (all at doses < RP2D) for a median of 1.4 months (range, 1.1-3.5 months) with a best response per RECIST 1.1. as follows: SD, n = 2; PD, n = 3. Of interest, in 2 of those 5 patients, size of LN decreased or resolved after treatment discontinuation. In addition, one patient had a biopsy of an emerged LN, which showed lymphoid aggerates without tumor cells. Conclusions: Our data suggest that treatment with ERK inhibitors can result in activation of the lymphatic nodes, which can manifest as pseudo-progression. This can lead to an inconclusive assessment of their therapeutic benefit and further suggests exploration of the potential synergistic effects with immune therapy.

scholarly journals Comparative prognostic implication of treatment response assessments in mCRPC: PERCIST 1.0, RECIST 1.1, and PSA response criteria

Theranostics ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 3254-3262
Author(s):  
Erik M. Velez ◽  
Bhushan Desai ◽  
Lingyun Ji ◽  
David I. Quinn ◽  
Patrick M. Colletti ◽  
...  
Keyword(s):  
Treatment Response ◽  
Response Criteria ◽  
Prognostic Implication ◽  
Recist 1.1 ◽  
Psa Response ◽  
Percist 1.0
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