PET-Based Primary Tumor Volumetric Parameters and Survival of Patients With Non-Small Cell Lung Carcinoma.
ABSTRACT The purpose of the study was to assess metabolic tumor volume and total glycolytic activity of the primary tumor as prognostic parameters for outcome in patients with non-small cell lung carcinoma (NSCLC).
Thirty-nine patients who had undergone a baseline staging PET/CT examination at our institution for the diagnosis of NSCLC were retrospectively identified. The maximum standardized uptake value (SUV(max)), metabolic tumor volume, and total glycolytic activity were segmented from PET using the gradient method; 12-month survival and overall survival at the end of follow-up were used as outcome measures. Multivariate logistic regression, receiver operating characteristic curve analysis, and Kaplan-Meier curves for survival analysis were generated and compared using the Mantel-Cox log-rank test.
The mean gradient-based metabolic tumor volume and gradient-based total glycolytic activity were significantly greater in the patients who died (93.3 mL and 597.5 g) than in those who survived (19.3 mL and 193.9 g, respectively) (p < 0.003 and p < 0.031). There was no statistically significant difference in the mean SUV(max) between the patients who survived (12.7) at 12 months and those who had died (13.1) (p = 0.85). On multivariate analysis, gradient-based metabolic tumor volume was the only variable associated with 12-month mortality when adjusted for all other factors.(.) The area under the curve (AUC) for gradient-based metabolic tumor volume was 0.77 (p < 0.006). A significant difference in the time to survival was observed between high and low gradient-based metabolic tumor volume (log-rank p < 0.05) cohorts using the median gradient-based metabolic tumor volume (9.7 mL) as the cut point.
PET-based volumetric imaging parameters are potential prognostic markers of outcome in patients with NSCLC.
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ABSTRACT: We investigated the prognostic role of volume-based parameters measured on 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) scans in patients with locally advanced pancreatic cancer (LAPC) treated with chemoradiation therapy (CRT).Yonsei Medical Journal 11/2014; 55(6):1498-506. · 1.26 Impact Factor
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ABSTRACT: The aim of the present study was to evaluate the predictive value of a novel quantitative measure for the spatial heterogeneity of FDG uptake, the asphericity (ASP) in patients with non-small cell lung cancer (NSCLC). FDG-PET/CT had been performed in 60 patients (15 women, 45 men; median age, 65.5 years) with newly diagnosed NSCLC prior to therapy. The FDG-PET image of the primary tumor was segmented using the ROVER 3D segmentation tool based on thresholding at the volume-reproducing intensity threshold after subtraction of local background. ASP was defined as the relative deviation of the tumor's shape from a sphere. Univariate and multivariate Cox regression as well as Kaplan-Meier (KM) analysis and log-rank test with respect to overall (OAS) and progression-free survival (PFS) were performed for clinical variables, SUVmax/mean, metabolically active tumor volume (MTV), total lesion glycolysis (TLG), ASP and "solidity", another measure of shape irregularity. ASP, solidity and "primary surgical treatment" were significant independent predictors of PFS in multivariate Cox regression with binarized parameters (HR, 3.66; p < 0.001, HR, 2.11; p = 0.05 and HR, 2.09; p = 0.05), ASP and "primary surgical treatment" of OAS (HR, 3.19; p = 0.02 and HR, 3.78; p = 0.01, respectively). None of the other semi-quantitative PET parameters showed significant predictive value with respect to OAS or PFS. Kaplan-Meier analysis revealed a probability of 2-year PFS of 52% in patients with low ASP compared to 12% in patients with high ASP (p < 0.001). Furthermore, it showed a higher OAS rate in the case of low versus high ASP (1-year-OAS, 91% vs. 67%: p = 0.02). The novel parameter asphericity of pretherapeutic FDG uptake seems to provide better prognostic value for PFS and OAS in NCSLC compared to SUV, metabolic tumor volume, total lesion glycolysis and solidity.BMC Cancer 12/2014; 14(1):896. · 3.32 Impact Factor
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ABSTRACT: The center for Medicare and Medicaid Services recently ruled that only three post therapy follow up FDG PET/CT scans are funded for a tumor type per patient and any additional follow up PET/CT scans will be funded at the discretion of local Medicare administrator. The purpose of this study was to evaluate the added value of a fourth and subsequent follow-up PET/CT scans to clinical assessment and impact on patient management. This is an institutional review board approved, retrospective study. A total of 1171 patients with biopsy-proven lung cancer, who had a FDG PET/CT, were identified at a single tertiary center from 2001 to 2013. Among these, 85 (7.3%) patients had four or more follow up PET/CT scans with a total of 285 fourth and subsequent follow up PET/CT scans. Median follow up from the fourth follow up PET/CT scan was 31.4 months (range, 0-155.2 months). The follow up PET/CT scan results were correlated with clinical assessment and treatment changes. Of the 285 fourth and subsequent follow up PET/CT scans, 149 (52.28%) were interpreted as positive and 136 (47.7%) were interpreted as negative for recurrence or metastasis. A total of 47 (55.3%) patients died during the study period. PET/CT identified recurrence or metastasis in 44.3% of scans performed without prior clinical suspicion and ruled out recurrence or metastasis in 24.2% of scans performed with prior clinical suspicion. The PET/CT scan resulted in treatment change in 28.1% (80/285) of the patients. New treatment was initiated in 20.4% (58/285) scan times, treatment was changed in 5.6% (16/285) scan times and on-going treatment was stopped in 2.1% (6/285) scan times. The fourth and subsequent FDG PET/CT scans performed in follow-up after primary treatment completion, added value to clinical assessment and changed management 28.1% of times a PET/CT scan was done. Copyright © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 01/2015;