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Spanier G, Weidt D, Hellwig D, Meier JKH, Reichert TE, Grosse J. Total lesion glycolysis in oral squamous cell carcinoma as a biomarker derived from pre-operative FDG PET/CT outperforms established prognostic factors in a newly developed multivariate prediction model. Oncotarget 2021; 12:37-48. [PMID: 33456712 PMCID: PMC7800778 DOI: 10.18632/oncotarget.27857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Retrospective study to investigate the impact of image derived biomarkers from [18F]FDG PET/CT prior to surgical resection in patients with initial diagnosis of oral squamous cell carcinoma (OSCC), namely SUVmax, SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary tumor to predict overall survival (OS). MATERIALS AND METHODS 127 subsequent patients with biopsy-proven OSCC were included who underwent [18F]FDG PET/CT before surgery. SUVmax, SUVmean, MTV and TLG of the primary tumor were measured. OS was estimated according to Kaplan-Meier and compared between median-splitted groups by the log-rank test. Prognostic parameters were analyzed by uni-/multivariate Cox-regression. RESULTS During follow-up 52 (41%) of the patients died. Median OS was longer for patients with lower MTV or lower TLG. SUVmax and SUVmean failed to be significant predictors for OS. Univariate Cox-regression identified MTV, TLG, lymph node status and UICC stage as prognostic factors. By multivariate Cox-regression MTV and TLG turned out to be independent prognostic factors for OS. CONCLUSIONS The pre-therapeutic [18F]FDG PET/CT parameters MTV and TLG in the primary tumor are prognostic for OS of patients with an initial diagnosis of OSCC. TLG is the strongest independent prognostic factor for OS and outperforms established prognostic parameters in OSCC.
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Affiliation(s)
- Gerrit Spanier
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Daniela Weidt
- Department of Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Dirk Hellwig
- Department of Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Johannes K H Meier
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Torsten E Reichert
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Jirka Grosse
- Department of Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
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Kedves A, Tóth Z, Emri M, Fábián K, Sipos D, Freihat O, Tollár J, Cselik Z, Lakosi F, Bajzik G, Repa I, Kovács Á. Predictive Value of Diffusion, Glucose Metabolism Parameters of PET/MR in Patients With Head and Neck Squamous Cell Carcinoma Treated With Chemoradiotherapy. Front Oncol 2020; 10:1484. [PMID: 32983984 PMCID: PMC7492555 DOI: 10.3389/fonc.2020.01484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose: This study aims to evaluate the predictive value of the pretreatment, metabolic, and diffusion parameters of a primary tumor assessed with PET/MR on patient clinical outcomes. Methods: Retrospective evaluation was performed using PET/MR image data sets acquired using the single tracer injection dual imaging of 68 histologically proven head and neck cancer patients 4 weeks before receiving definitive chemoradiotherapy (CRT). PET/MR was performed before the CRT and 12 weeks after the CRT for response evaluation. Image data (PET and MRI diffusion-weighted imaging [DWI]) was used to specify the maximum standard uptake value, the peak lean body mass corrected, SUVmax, the metabolic tumor volume, the total lesion glycolysis (SUVmax, SULpeak, MTV, and TLG), and the mean apparent diffusion coefficient (ADCmean) of the primary tumor. Based on the results of the therapeutic response evaluation, two patient subgroups were created: one with a viable tumor and another without. Metabolic and diffusion data, from the pretreatment PET/MR and the therapeutic response, were correlated using Spearman's correlation coefficient and Wilcoxon's test. Results: After completing the CRT, a viable residual tumor was detected in 36/68 (53%) cases, and 32/68 (47%) patients showed complete remission. However, no significant correlation was found between the pretreatment parameter, ADCmean (p = 0.88), and the therapeutic success. The PET parameters, SUVmax and SULpeak, MTV, and TLG (p = 0.032, p = 0.01, p < 0.0001, p = 0.0004) were statistically significantly different between the two patient subgroups. Conclusion: This study found that MRI-based (ADCmean) data from FDG PET/MR pretreatment could not be used to predict therapeutic response although the PET parameters SUVmax, SULpeak, MTV, and TLG proved to be more useful; thus, their inclusion in risk stratification may also be of additional value.
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Affiliation(s)
- András Kedves
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary.,Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.,Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary
| | - Zoltán Tóth
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary.,MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Miklós Emri
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary.,Department of Medical Imaging, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Krisztián Fábián
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Dávid Sipos
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary.,Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.,Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary
| | - Omar Freihat
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - József Tollár
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.,Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary
| | - Zsolt Cselik
- Oncoradiology, Csolnoky Ferenc County Hospital, Veszprém, Hungary
| | - Ferenc Lakosi
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary
| | - Gábor Bajzik
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary
| | - Imre Repa
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Kaposvár, Hungary
| | - Árpád Kovács
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary.,Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.,Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Nakahara T, Owaki Y, Shindou T, Nakajima K, Jinzaki M. Bone SPECT-based segmented attenuation correction for quantitative analysis of bone metastasis (B-SAC): comparison with CT-based attenuation correction. EJNMMI Res 2019; 9:27. [PMID: 30888521 PMCID: PMC6424988 DOI: 10.1186/s13550-019-0501-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/12/2019] [Indexed: 01/08/2023] Open
Abstract
Background Evidence has shown the clinical usefulness of measuring the metastatic tumor burden of bone for prognostic assessment especially in prostate cancer; quantitative evaluation by dedicated SPECT is difficult due to the lack of attenuation correction (AC) method. We developed a novel method for attenuation correction using bone SPECT emission data (bone SPECT-based segmented attenuation correction; B-SAC) where emission data were virtually segmented into three tissues (i.e., bone, soft tissue, and air). Then, the pixel values in SPECT were replaced by 50 for the virtual soft tissue, and − 1000 for the virtual air. The replaced pixel values for the virtual bone were based on the averaged CT values of the normal vertebrae (B-SACN) or the metastatic bones (B-SACM). Subsequently, the processed SPECT data (i.e., SPECT value) were supposed to realize CT data (i.e., CT value) that were used for B-SAC. The standardized uptake values (SUVs) of 112 metastatic bone tumors in 15 patients with prostate cancer were compared between CTAC with scatter correction (SC) and resolution recovery (RR) and the following reconstruction conditions: B-SACN (+)SC(+)RR(+), B-SACM (+)SC(+)RR(+), uniform AC(UAC)(+)SC(+)RR(+), AC(−)SC(+)RR(+), and no correction (NC). Results The SUVs in the five reconstruction conditions were all correlated with those in CTAC(+)SC(+)RR(+) (p < 0.01), and the correlations between B-SACN or B-SACM and CTAC images were excellent (r > 0.94). Bland-Altman analysis showed that the mean SUV differences between CTAC (+)SC(+)RR(+) and the other five reconstructions were 0.85 ± 2.25 for B-SACN (+)SC(+)RR(+), 1.61 ± 2.36 for B-SACM (+)SC(+)RR(+), 1.54 ± 3.84 for UAC(+)SC(+)RR(+), − 3.12 ± 4.97 for AC(−)SC(+)RR(+), and − 5.96 ± 4.59 for NC. Compared to CTAC(+)SC(+)RR(+), B-SACN (+)SC(+)RR(+) showed a slight but constant overestimation (approximately 17%) of the metastatic tumor burden of bone when the same threshold of metabolic tumor volume was used. Conclusions The results of this preliminary study suggest the potential for B-SAC to improve the quantitation of bone metastases in bone SPECT when X-ray CT or transmission CT data are not available. Considering the small but unignorable differences of lesional SUVs between CTAC and B-SAC, SUVs obtained with the current version of B-SAC seem difficult to be directly compared with those obtained with CTAC.
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Affiliation(s)
- Tadaki Nakahara
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Yoshiki Owaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tsubasa Shindou
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kiyotaka Nakajima
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Devriese J, Beels L, Maes A, Van de Wiele C, Pottel H. Impact of PET reconstruction protocols on quantification of lesions that fulfil the PERCIST lesion inclusion criteria. EJNMMI Phys 2018; 5:35. [PMID: 30523429 PMCID: PMC6283809 DOI: 10.1186/s40658-018-0235-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/22/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The aim of this study was to compare liver and oncologic lesion standardized uptake values (SUV) obtained through two different reconstruction protocols, GE's newest clinical lesion detection protocol (Q.Clear) and the EANM Research Ltd (EARL) harmonization protocol, and to assess the clinical relevance of potential differences and possible implications for daily clinical practice using the PERCIST lesional inclusion criteria. NEMA phantom recovery coefficients (RC) and SUV normalized for lean body mass (LBM), referred to as SUV normalized for LBM (SUL), of liver and lesion volumes of interest were compared between the two reconstruction protocols. Head-to-toe PET/CT examinations and raw data from 64 patients were retrospectively retrieved. PET image reconstruction was carried out twice: once optimized for quantification, complying with EARL accreditation requirements, and once optimized for lesion detection, according to GE's Q.Clear reconstruction settings. RESULTS The two reconstruction protocols showed different NEMA phantom RC values for different sphere sizes. Q.Clear values were always highest and exceeded the EARL accreditation maximum for smaller spheres. Comparison of liver SULmean showed a statistically significant but clinically irrelevant difference between both protocols. Comparison of lesion SULpeak and SULmax showed a statistically significant, and clinically relevant, difference of 1.64 and 4.57, respectively. CONCLUSIONS For treatment response assessment using PERCIST criteria, the harmonization reconstruction protocol should be used as the lesion detection reconstruction protocol using resolution recovery systematically overestimates true SUL values.
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Affiliation(s)
- Joke Devriese
- Department of Public Health and Primary Care @ Kulak, KU Leuven campus Kulak, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium
| | - Laurence Beels
- Department of Nuclear Medicine, AZ Groeninge, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Christophe Van de Wiele
- Department of Nuclear Medicine, AZ Groeninge, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care @ Kulak, KU Leuven campus Kulak, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium.
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Metabolic Tumor Volume and Total Lesion Glycolysis in Oropharyngeal Cancer Treated With Definitive Radiotherapy: Which Threshold Is the Best Predictor of Local Control? Clin Nucl Med 2017; 42:e281-e285. [PMID: 28288042 DOI: 10.1097/rlu.0000000000001614] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE In the context of oropharyngeal cancer treated with definitive radiotherapy, the aim of this retrospective study was to identify the best threshold value to compute metabolic tumor volume (MTV) and/or total lesion glycolysis to predict local-regional control (LRC) and disease-free survival. METHODS One hundred twenty patients with a locally advanced oropharyngeal cancer from 2 different institutions treated with definitive radiotherapy underwent FDG PET/CT before treatment. Various MTVs and total lesion glycolysis were defined based on 2 segmentation methods: (i) an absolute threshold of SUV (0-20 g/mL) or (ii) a relative threshold for SUVmax (0%-100%). The parameters' predictive capabilities for disease-free survival and LRC were assessed using the Harrell C-index and Cox regression model. RESULTS Relative thresholds between 40% and 68% and absolute threshold between 5.5 and 7 had a similar predictive value for LRC (C-index = 0.65 and 0.64, respectively). Metabolic tumor volume had a higher predictive value than gross tumor volume (C-index = 0.61) and SUVmax (C-index = 0.54). Metabolic tumor volume computed with a relative threshold of 51% of SUVmax was the best predictor of disease-free survival (hazard ratio, 1.23 [per 10 mL], P = 0.009) and LRC (hazard ratio: 1.22 [per 10 mL], P = 0.02). CONCLUSIONS The use of different thresholds within a reasonable range (between 5.5 and 7 for an absolute threshold and between 40% and 68% for a relative threshold) seems to have no major impact on the predictive value of MTV. This parameter may be used to identify patient with a high risk of recurrence and who may benefit from treatment intensification.
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Romesser PB, Lim R, Spratt DE, Setton J, Riaz N, Lok B, Rao S, Sherman EJ, Schöder H, Lee NY. The relative prognostic utility of standardized uptake value, gross tumor volume, and metabolic tumor volume in oropharyngeal cancer patients treated with platinum based concurrent chemoradiation with a pre-treatment [(18)F] fluorodeoxyglucose positron emission tomography scan. Oral Oncol 2014; 50:802-8. [PMID: 25043882 DOI: 10.1016/j.oraloncology.2014.06.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study compared the relative prognostic utility of the Gross Tumor Volume (GTV), maximum Standardized Uptake Value (SUVmax), and Metabolic Tumor Volume (MTV) in a uniform cohort of oropharyngeal squamous cell carcinoma (OPSCC) patients treated with platinum-based concurrent chemoradiation therapy (CCRT). METHODS AND MATERIALS One-hundred OPSCC with a pretreatment [(18)F] fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) were treated with CCRT. Kaplan-Meier curves and Cox proportional hazard models were generated. RESULTS When dichotomized by the median, a smaller MTV correlated with improved 5year locoregional control (LRC) (98.0% versus 87.0%, p=0.049), freedom from distant metastasis (FDM) (91.7% versus 65.0%, p=0.005), progression-free survival (PFS) (80.3% versus 56.7%, p=0.015), and overall survival (OS) (84.1% versus 57.8%, p=0.008), whereas a smaller GTV correlated with improved PFS (80.3% versus 57.4%, p=0.040) and OS (82.1% versus 60.1%, p=0.025). SUVmax failed to correlate with any outcome. On multivariate analysis, when adjusted for GTV, T-stage, and N-stage a smaller MTV remained independently correlated with improved FDM, PFS, and OS. GTV failed to reach significance in the multivariate model. CONCLUSIONS A smaller MTV correlates with improved LRC, FDM, PFS, and OS in OPSCC patients undergoing platinum-based CCRT.
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Affiliation(s)
- Paul B Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Remy Lim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeremy Setton
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Benjamin Lok
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shyam Rao
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric J Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Robustness of intratumour 18F-FDG PET uptake heterogeneity quantification for therapy response prediction in oesophageal carcinoma. Eur J Nucl Med Mol Imaging 2013; 40:1662-71. [DOI: 10.1007/s00259-013-2486-8] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/10/2013] [Indexed: 11/24/2022]
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Van de Wiele C, Kruse V, Smeets P, Sathekge M, Maes A. Predictive and prognostic value of metabolic tumour volume and total lesion glycolysis in solid tumours. Eur J Nucl Med Mol Imaging 2012; 40:290-301. [PMID: 23151913 DOI: 10.1007/s00259-012-2280-z] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/10/2012] [Indexed: 12/13/2022]
Abstract
Data available in patients suffering from squamous cell carcinoma of the head and neck, lung carcinoma, oesophageal carcinoma and gynaecological malignancies suggest that metabolic tumour volume and to a lesser extent total lesion glycolysis have the potential to become valuable in the imaging of human solid tumours as prognostic biomarkers for short- to intermediate-term survival outcomes, adding value to clinical staging, for assessment of response to treatment with neoadjuvant and concurrent chemotherapy, and for treatment optimization; for example, based on early treatment response assessment using changes in metabolic tumour volume over time, it might be possible to select patients who require a more aggressive treatment to improve their outcome. Prospective studies enrolling consecutive patients, adopting standardized protocols for FDG PET acquisition and processing, adjusting for potential confounders in the analysis (tumour size and origin) and determining the optimal methodology for determination of these novel markers are mandatory.
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Affiliation(s)
- Christophe Van de Wiele
- Department of Nuclear Medicine, P7, University Hospital Ghent, De Pintelaan 185-B, 9000 Ghent, Belgium.
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