Timothy Akhurst

Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

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Publications (68)332.26 Total impact

  • ANZ Journal of Surgery 11/2014; · 1.50 Impact Factor
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    ABSTRACT: Increased glycolytic activity on FDG PET/CT defines a subgroup of patients with metastatic gastroenteropancreatic neuroendocrine tumour (NET) with a poor prognosis. A limited range of systemic treatment options exist for more aggressive NET. The role of peptide receptor chemoradionuclide therapy (PRCRT) in such patients is, however, unclear. This retrospective study assessed the outcomes of patients with FDG-avid NET treated with PRCRT.
    European journal of nuclear medicine and molecular imaging 09/2014; · 5.11 Impact Factor
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    ABSTRACT: Objective. Increased glycolytic activity on FDG PET/CT is an adverse prognostic indicator in metastatic gastro-entero-pancreatic neuroendocrine tumor (GEP-NET). A range of systemic treatment options exist for more aggressive GEP-NET, including chemotherapy and targeted agents such as everolimus and sunitinib, particularly for pancreatic primaries. Peptide receptor radionuclide therapy (PRRT) has mainly been applied in patients with low grade GEP-NET but can also be used in patients with higher grade NET if there is sufficient somatostatin expression (SSTR) to enable targeted therapy. This retrospective study assesses the outcomes of patients with FDG-avid GEP-NET treated with peptide receptor chemo-radionuclide therapy (PRCRT). Materials and Methods: Clinical, biochemical and imaging response was assessed after completion of induction treatment of PRCRT with Lu-177 octreotate and infusional 5-fluorouracil chemotherapy in 52 patients. To be eligible, we required tumour uptake intensity of greater than liver on SSTR SPECT/CT or PET/CT, and no sites of spatially discordant FDG-avid disease. Ki,67 was available in 36 patients, with the 78% having ENETS Grade II or III disease. Prior chemotherapy had been received in 67% of the cohort . Overall survival (OS) and progression free survival (PFS) were analysed. Results: The median induction administered activity was 33 GBq over a median of 4 cycles. PRCRT was well tolerated with negligible Grade 3-4 hematologic toxicity. After a median follow-up period of 36 months, the median OS was not achieved with median PFS of 48 months. At 3 months post completion of PRCRT there was a complete anatomic response in 2%, a partial response in 28%, stable disease in 68%, and progression in only 2%. On FDG PET/CT, 27% achieved a complete metabolic response in the follow-up period. Biochemical response (>25% fall in Chromogranin-A levels) occurred in 45%. Conclusions: PRCRT is a highly effective treatment in patients with FDG-avid GEP-NET, even in patients who have failed conventional therapies. Given apparently higher response rates than alternative therapeutic options and low toxicity, further research is needed to establish whether PRCRT should be used as a first-line treatment modality.
    11th Congress of the World Federation in Nuclear Medicine and Biology World Federation in Nuclear Medicine and Biology (WFNMB), Cancún, Mexico; 08/2014
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    ABSTRACT: Advances in the management of rectal cancer have resulted in an increased application of multimodal therapy with the aim of tailoring therapy to individual patients. Complete pathological response (pCR) is associated with improved survival and may be potentially managed without radical surgical resection. Over the last decade, there has been increasing interest in the ability of functional imaging to predict complete response to treatment. The aim of this review was to assess the role of (18)F-flurordeoxyglucose positron emission tomography (FDG-PET) in prediction of pCR and prognosis in resectable locally advanced rectal cancer. A search of the MEDLINE and Embase databases was conducted, and a systematic review of the literature investigating positron emission tomography (PET) in the prediction of pCR and survival in rectal cancer was performed. Seventeen series assessing PET prediction of pCR were included in the review. Seven series assessed postchemoradiation SUVmax, which was significantly different between response groups in all six studies that assessed this. Nine series assessed the response index (RI) for SUVmax, which was significantly different between response groups in seven series. Thirteen studies investigated PET response for prediction of survival. Metabolic complete response assessed by SUV2max or visual response and RISUVmax showed strong associations with disease-free survival (DFS) and overall survival (OS). SUV2max and RISUVmax appear to be useful FDG-PET markers for prediction of pCR and these parameters also show strong associations with DFS and OS. FDG-PET may have a role in outcome prediction in patients with advanced rectal cancer.
    Annals of Surgical Oncology 05/2014; · 4.12 Impact Factor
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    ABSTRACT: Ga-1,4,7,10-Tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid (DOTA)-F(ab')2-trastuzumab [Ga-DOTA-F(ab')2-trastuzumab] has been developed at our institution as a positron imaging reagent for assessing human epidermal growth factor receptor 2 (HER2) expression status by in-vivo imaging. Initial studies on animals demonstrated promising results in the monitoring of treatment response to heat shock protein 90-targeted drugs that inhibit the client protein HER2. We report here our initial clinical experience in the assessment of the toxicity, pharmacokinetics, biodistribution, and dosimetry profile of Ga-DOTA-F(ab')2-trastuzumab with PET/computed tomography using a mean of 236 MBq/5 mg administered intravenously. A group of 16 women with breast cancer were enrolled in this study. The one patient who did not receive Ga-DOTA-F(ab')2-trastuzumab was excluded from analysis. Both HER2-negative (n=7) and HER2-positive (n=8) cases were studied. Among the latter, seven had undergone trastuzumab treatment previously and one had not. It was determined that Ga-DOTA-F(ab')2-trastuzumab was well tolerated, with a T ½ of ∼3.6±0.9 h; the critical organ was the kidney, with a mean dose of 0.383 cGy/37 MBq; and tumor targeting was seen in 4/8 patients with HER2-positive disease. The reagent is safe, and assessments through additional studies in a better-defined group of patients, using larger administered masses of antibodies, with a better immunoreactive fraction are needed.
    Nuclear Medicine Communications 10/2013; · 1.38 Impact Factor
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    ABSTRACT: OBJECTIVE:: To prospectively compare the ability of flourodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) to identify a pathological complete response (pCR) in patients with rectal cancer treated by chemoradiation. BACKGROUND:: A major obstacle in pursuing nonoperative management in patients with rectal cancer after chemoradiation is the inability to identify a pCR preoperatively. METHODS:: A total of 121 patients with rectal cancer were prospectively enrolled. FDG-PET scans and helical CT scans were obtained before and after neoadjuvant chemoradiation. Consensus readings of PET and CT scans were used to classify certainty of disease (5-point confidence rating scale). The ability of PET and CT scans to accurately distinguish a pCR (ypT0) from an incomplete response (ypT1-4) was estimated using the area under the receiver operating characteristic curve (AUC). RESULTS:: Of the 121 patients, 26 (21%) had a pCR. PET and CT scans were equally inadequate at distinguishing a pCR from an incomplete response (AUC = 0.64 for both, P = 0.97). Among the 26 patients with a pCR, 14 (54%) and 5 (19%) were classified as complete responders on PET and CT scans, respectively. Among the 95 patients with an incomplete pathological response, 63 (66%) and 90 (95%) were classified as incomplete responders on PET and CT scans, respectively. None of the individual PET parameters, including visual response score, mean standard uptake value (SUVmean), maximum SUV (SUVmax), and total lesion glycolysis, accurately distinguished a pCR (AUCs = 0.57-0.73). CONCLUSIONS:: Neither PET nor CT scans have adequate predictive value to be clinically useful in distinguishing a pCR from an incomplete response and, therefore, should not be obtained for the purpose of attempting to predict a pCR after neoadjuvant chemoradiation for rectal cancer.
    Annals of surgery 11/2012; · 7.90 Impact Factor
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    ABSTRACT: At present there is no defined role for routine FDG-PET in the preoperative evaluation of nonmetastatic rectal cancer. The primary objective of this study was to evaluate the ability of FDG-PET to predict long-term prognosis based on the response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. This was a prospective study. This study was performed at an academic, tertiary care, comprehensive cancer center. One hundred twenty-seven patients with locally advanced rectal cancer were enrolled between September 1999 and December 2005. All patients underwent FDG-PET scans before and after neoadjuvant chemoradiotherapy. FDG-PET parameters were evaluated by at least 2 study board-certified nuclear medicine physicians, and included mean standard uptake value, maximum standard uptake value, total lesion glycolysis, and visual response score. The main outcome measures were time to recurrence and disease-specific survival. Of 127 patients, 82 (65%) were men, the median age was 60 years (range, 27-82), 110 patients had stage II/III disease, and 17 patients had stage IV disease. Median follow-up among survivors was 77 months (range, 1-115 months). Nine patients had unresectable metastatic disease and were excluded from the time-to-recurrence analysis. At 5 years, 74% (95% CI = 66%-81%) of patients had not had recurrences (locally and/or distantly). The 5-year disease-specific survival was 89% (95% CI = 81%-93%). On univariate analysis, visual response score and time to recurrence came closest to having an association (HR = 0.83, 95% CI = 0.68-1.01, p = 0.06). On multivariate analysis, the visual response score was not significant (p = 0.85). No FDG-PET parameter was associated with disease-specific survival. Assessment of rectal cancer response to neoadjuvant chemoradiotherapy by FDG-PET provides no prognostic information. Therefore, serial FDG-PET before and after neoadjuvant chemoradiotherapy should not be performed for this purpose.
    Diseases of the Colon & Rectum 04/2012; 55(4):378-86. · 3.34 Impact Factor
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    ABSTRACT: Early identification of inadequate response to preoperative chemoradiotherapy (CRT) may spare rectal cancer patients the toxicity of ineffective treatment. We prospectively evaluated tumor response with (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) early in the course of preoperative CRT. A total of 27 prospectively accrued patients with locally advanced rectal cancer (T(3-4)/N(1)) received preoperative CRT (5040 cGy + 5FU-based chemotherapy). Patients underwent PET scanning before and 8-14 days after commencement of CRT. Scans were interpreted using 3 standard parameters: SUV(max), SUV(avg), and total lesion glycolysis (TLG) as well as an investigational parameter: visual response score (VRS). Percent pathologic response was quantified as a continuous variable. All PET parameters were correlated with pathology. Pathologic complete/near-complete response was defined as ≥95% tumor destruction, suboptimal response as <95%. Statistical analysis was performed using the Wilcoxon rank sum test and receiver operating characteristic (ROC) curve analysis. Of the 27 patients, 11 (41%) had pathologic complete/near-complete response; 16 (59%) had suboptimal response. SUV(max), SUV(avg), and TLG did not discriminate between responders and nonresponders. Visual response score (VRS) was statistically significantly higher for complete/near-complete responders than for suboptimal responders (65 vs. 33%, P = 0.02). Suboptimal responders were identified with 94% sensitivity and 78% accuracy using a VRS cut-off of 50%. In this pilot study, FDG-PET at 8-14 days after the beginning of preoperative CRT was unsuccessful at predicting pathological response with enough accuracy to justify an early change in therapy.
    Annals of Surgical Oncology 04/2011; 18(10):2783-9. · 4.12 Impact Factor
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    ABSTRACT: An asymptomatic 11-week-old male received no treatment after he was classified as having a suspected atypical form of MYCN-nonamplified hyperdiploid stage 4S neuroblastoma (NB), with masses in an adrenal gland, subcutaneous tissues, and the falx cerebri. Within 2 months, however, disease progressed in dura and bone marrow. Two cycles of low-dose chemotherapy achieved a partial response; treatment was discontinued. Complete remission was documented 24 weeks post-cycle 2, and has continued >6 years. The falx cerebri probably does not represent an atypical site for stage 4S NB, but stage 4 NB with favorable biology is sometimes curable with minimal therapy.
    Pediatric Blood & Cancer 09/2009; 53(7):1340-2. · 2.35 Impact Factor
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    ABSTRACT: To facilitate future direct correlations between fluorine 18 fluorodeoxyglucose (FDG)-avid colonic lesions and immunohistochemical assay findings, the authors tested the feasibility of ex vivo FDG positron emission tomography (PET) of the colon resected from humans. In this institutional review board-approved, HIPAA-compliant study, the authors, after obtaining informed patient consent, injected FDG intraoperatively in five patients with neoplasms and imaged their resected colons approximately 3 hours later. The colon could be imaged during this fairly limited time interval, and polyps and cancers could be identified. No biologic tissue degradation occurred. The authors concluded that ex vivo FDG PET of the colon is feasible and, when combined with careful histologic and immunohistochemical analyses, may serve as a research tool to determine the mechanisms of the normal colonic uptake of FDG and the localization of FDG in polyps and cancers.
    Radiology 08/2009; 252(1):232-9. · 6.34 Impact Factor
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    ABSTRACT: We have previously shown that in early clinical stage esophageal adenocarcinoma, a positron emission tomography standardized uptake values (PET SUVmax) of <4.5 is associated with earlier pathologic stage and predicts better survival. In this study, we analyze the impact of the pretreatment PET SUVmax in patients with locally advanced esophageal adenocarcinoma who undergo preoperative chemoradiotherapy. We performed a retrospective analysis, selecting patients with adenocarcinoma of the esophagus who had a pretreatment PET scan and who received chemoradiotherapy before esophagectomy. Data recorded included demographics, PET SUVmax, treatment details, pathologic details, and survival data. Comparison of categorical variables was done by chi analysis, continuous variables by t test, survival analysis by the Kaplan-Meier method, and comparisons of survival using the log-rank test. Between January 1996 and September 2007, 189 patients were appropriate for this analysis. The initial PET SUVmax was <4.5 in 28 patients and >or=4.5 in 161 patients. The two groups were similar with regards to demographics and treatment details. Patients in the low SUV group were less likely to show evidence of treatment response after chemoradiotherapy, including a higher likelihood of residual nodal disease and a lower likelihood of a pathologic complete response and estimated treatment response. However, both groups had similar survival. Although the initial PET SUVmax does not predict survival in patients with locally advanced esophageal adenocarcinoma who receive preoperative chemoradiotherapy, patients with a high initial SUVmax respond better to preoperative therapy. These results can be used to better select esophageal cancer patients for combined modality treatment.
    Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 07/2009; 4(7):875-9. · 4.55 Impact Factor
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    ABSTRACT: PURPOSE To evaluate the potential benefit of continuous daily dosing sunitinib in patients with advanced nongastrointestinal stromal tumor (GIST) sarcomas. PATIENTS AND METHODS A total of 53 patients with advanced non-GIST soft tissue sarcomas received sunitinib 37.5 mg daily. Primary end point was Response Evaluation Criteria in Solid Tumors defined response. Secondary end points were stable disease at 16 and 24 weeks. [(18)F]-fluorodeoxyglucose positron emission tomography was performed on a subset of 24 patients at baseline and after 10 to 14 days of therapy. Results Forty-eight patients were eligible for response. One patient (desmoplastic round cell tumor [DSRCT]) achieved a confirmed partial response (PR) and remained on study for 56 weeks. Ten patients (20%) achieved stable disease for at least 16 weeks. Metabolic PR was seen in 10 (47%) of 21 of patients. Metabolic stable disease was seen in 11 (52%) of 21. There were no unexpected toxicities observed. CONCLUSION Sunitinib demonstrated notable evidence of metabolic response in several patients with non-GIST sarcoma. The relevance of disease control observed in subtypes with an indolent natural history is unknown, however, the durable disease control observed in DSRCT, solitary fibrous tumor, and giant cell tumor of bone suggests that future evaluation of sunitinib in these subtypes may be warranted.
    Journal of Clinical Oncology 06/2009; 27(19):3154-60. · 18.04 Impact Factor
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    ABSTRACT: To determine the accuracy of [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) in the diagnosis of vertebral metastases in patients with cancer using needle-biopsy results and patient follow-up data. A retrospective chart review of all patients who underwent a needle biopsy of a spinal lesion and underwent FDG-PET within 6 weeks of the biopsy was performed. Biopsy results and magnetic resonance imaging and computed tomographic appearance of the biopsied lesion, as well as long-term clinical follow-up data, were recorded for each patient. A total of 82 patients with solid tumors and hematological spine metastases were included in this study. The mean standardized uptake values of lesions with active cancer were 7.1 and 2.1 in benign lesions (P < 0.02). In patients with metastatic solid tumors, the mean standardized uptake value was 7.3. Stratification of solid tumor lesions according to whether they had a sclerotic appearance on computed tomographic scans showed that FDG-PET was a significantly better predictor of cancer status in lytic or mixed lesions. In patients with a history of solid tumors, there was 100% concordance between the FDG-PET and needle-biopsy diagnoses in nonsclerotic lesions, when the standardized uptake value cutoff of 2 was used. FDG-PET is an accurate screening test for vertebral metastases in cancer patients. It is especially accurate in patients with nonsclerotic vertebral lesions and a history of solid malignancy.
    Neurosurgery 01/2009; 64(1):107-13; discussion 113-4. · 2.53 Impact Factor
  • Medical Physics - MED PHYS. 01/2009; 36(6).
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    ABSTRACT: After preoperative chemoradiotherapy of rectal cancer, the number of retrievable and metastatic lymph nodes is decreased. The current TNM classification is based on number and not location of lymph node metastases and may understage disease after chemoradiotherapy. The aim of this study was to examine the prognostic significance of location of involved lymph nodes in rectal cancer patients after preoperative chemoradiotherapy. We prospectively examined whole-mount specimens from 121 patients with uT3-4 and/or N+ rectal cancer who received preoperative chemoradiotherapy followed by resection. Location of involved lymph nodes was compared with median number of lymph nodes involved as well as presence of distant metastasis at presentation. Lymph node metastases were detected in 37 patients (31%). Thirteen patients with lymph node involvement along major supplying vessels (proximal lymph node metastases) had a significantly higher rate of distant metastatic disease at time of surgery than patients without proximal lymph node involvement (P < .001); median number of lymph nodes involved was two for patients with proximal lymph node metastases and 1.5 for patients with mesorectal lymph node involvement alone. Our data suggest that, after preoperative chemoradiotherapy, proximal lymph node involvement is associated with a high incidence of metastatic disease at time of surgery. Because the median number of involved lymph nodes is low after preoperative chemoradiotherapy, the TNM staging system may not provide an accurate assessment of metastatic disease. Therefore, the ypTNM staging system should incorporate distribution as well as number of lymph node metastases after preoperative chemoradiotherapy for rectal cancer.
    Journal of Clinical Oncology 06/2008; 26(13):2106-11. · 18.04 Impact Factor
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    ABSTRACT: Patients with locally advanced rectal cancer may present with synchronous distant metastases. Choice of optimal treatment--neoadjuvant chemoradiation versus systemic chemotherapy alone--depends on accurate assessment of distant disease. We prospectively evaluated the ability of [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) to detect distant disease in patients with locally advanced rectal cancer who were otherwise eligible for combined modality therapy (CMT). Ninety-three patients with locally advanced rectal cancer underwent whole-body [18F]FDG PET scanning 2-3 weeks before starting CMT. Sites other than the rectum, mesorectum, or the area along the inferior mesenteric artery were considered distant and were divided into nine groups: neck, lung, mediastinal lymph node (LN), abdomen, liver, colon, pelvis, peripheral LN, and soft tissue. Two nuclear medicine physicians blinded to clinical information used PET images and a five-point scale (0-4) to determine certainty of disease. A score greater than 3 was considered malignant. Confirmation was based on tissue diagnosis, surgical exploration, and subsequent imaging. At a median follow-up of 34 months, the overall accuracy, sensitivity, and specificity of PET in detecting distant disease were 93.7%, 77.8%, and 98.7% respectively. Greatest accuracy was demonstrated in detection of liver (accuracy = 99.9%, sensitivity = 100%, specificity = 98.8%) and lung (accuracy = 99.9%, sensitivity = 80%, specificity = 100%) disease; PET detected 11/12 confirmed malignant sites in liver and lung. A total of 10 patients were confirmed to have M1 stage disease. All 10 were correctly staged by pre-CMT PET; abdominopelvic computed tomography (CT) scans accurately detected nine of them. Baseline PET in patients with locally advanced rectal cancer reliably detects metastatic disease in liver and lung. PET may play a significant role in defining extent of distant disease in selected cases, thus impacting the choice of neoadjuvant therapy.
    Annals of Surgical Oncology 04/2008; 15(3):704-11. · 4.12 Impact Factor
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    ABSTRACT: Although (18)F-fluorodeoxyglucose positron emission tomography (PET) has widespread clinical use, its role in cancers of the biliary tract is ill-defined. The aim of this study was to determine if preoperative PET provided additional staging information in patients with biliary tract cancer, beyond that obtained through conventional anatomic imaging. The role of PET in detecting disease recurrence after resection was also examined. Between March 2001 and October 2003, 126 patients with biopsy-proved or presumed biliary tract cancer (intrahepatic or extrahepatic cholangiocarcinoma and gallbladder carcinoma) underwent PET in addition to standard imaging evaluation. Histologic confirmation of the diagnosis was used as the reference standard with which PET results were compared. Patient followup information and serial imaging were reviewed for progression of lesions detected by PET. Of the 126 study patients, 93 (74%) underwent preoperative staging PET scans, the results of which changed the stage and treatment in 22 patients (24%): 15 of 62 (24%) with cholangiocarcinoma and 7 of 31 (23%) with gallbladder carcinoma. When used to assess for cancer recurrence (n=33), PET identified disease in 86% of patients but altered treatment in only 9%. So, of the entire study group, the findings of PET influenced management in 20% of patients (24% preoperative staging and 9% cancer recurrence). The sensitivity of PET for identifying the primary tumor was 80% overall: 78% for cholangiocarcinoma, 86% for gallbladder carcinoma. Most biliary tract cancers are (18)F-fluorodeoxyglucose avid tumors. In patients with potentially resectable tumors based on conventional imaging, PET identified occult metastatic disease and changed management in nearly one-fourth of all patients. PET also helped confirm recurrent cancer after resection.
    Journal of the American College of Surgeons 02/2008; 206(1):57-65. · 4.50 Impact Factor
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    ABSTRACT: This study was conducted to evaluate the clinical utility of a Positron Emission Tomography/Computed Tomography (PET/CT) analysis module of a picture archiving communication system (PACS) workstation in comparison to a dedicated PET/CT interpretation workstation. The study included 32 consecutive patients referred for an [(18)F] Fluro-2-Deoxy-D: -Glucose ((18)F-FDG) PET/CT at our institution. Images were reviewed at dedicated PET/CT and at PACS-integrated workstations. Mean standardized uptake values (SUVs) were calculated for the liver and the lung. Maximum SUVs were recorded for the bladder and an index lesion with the highest FDG uptake. The time spent for SUV measurements was recorded. Correlation of the SUV measurements was calculated with the Pearson coefficient. Pearson coefficients between the workstations ranged from 0.96 to 0.99 for bladder and lesion maximum SUVs. For liver and lung average SUVs, the coefficients varied from 0.53 to 0.98. The mean time spent to perform the four SUV measurements was 122.6 s for the dedicated workstations and 134.6 s for the PACS-integrated system. The correlation of SUV measurements between dedicated PET/CT and PACS-integrated workstations is very good, especially for maximum SUVs. For routine reading of PET/CT scans, a PACS workstation with a PET/CT analysis module offers an excellent alternative to the use of a dedicated PET/CT workstation.
    Journal of Digital Imaging 10/2007; 20(3):307-13. · 1.10 Impact Factor
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    ABSTRACT: To determine the accuracy of (18)FDG PET in identifying sites of metastatic disease prior to pelvic exenteration or radical resection in patients (pts) with recurrent cervical or vaginal cancers. Pts with recurrent cervical or vaginal cancer being evaluated for surgical resection were enrolled in a prospective study approved by the institutional human subjects review board. All patients underwent (18)FDG PET scans as well as CT and/or MRI scans and were required to have pathologic confirmation of any sites suggestive of tumor recurrence. Between 1998 and 2002 a total of 27 pts were enrolled on the study. Seven patients did not complete all study requirements and are excluded from further analysis. All pts had undergone prior pelvic radiation therapy and five patients had also received chemotherapy. CT/MRI scans identified three patients with possible metastatic disease in the following sites: (1) iliac nodes (2 pts) and (2) lungs (1 pt). After surgical and pathological evaluation, only one of these sites, the lungs, was confirmed to have metastatic disease. PET scans identified possible metastatic disease in nine patients and included the following sites: (1) pelvic nodes (4 pts), (2) para-aortic nodes (2 pts), (3) axillary node (1 pt), (4) bowel wall (1 pt) and (5) lungs (1 pt). After surgical and pathologic evaluation metastatic disease was identified in five of these pts at the following sites: iliac nodes, 2; para-aortic nodes, 1; bowel wall, 1; and lungs, 1. Of the sites identified by PET scan as areas of metastasis CT scan only identified the pulmonary metastasis. (18)FDG PET was found to have a sensitivity of 100% and a specificity of 73% in detecting sites of extra-pelvic metastasis and may be the most accurate test to determine eligibility for pelvic exenteration.
    Gynecologic Oncology 08/2007; 106(1):177-80. · 3.93 Impact Factor
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    ABSTRACT: Positron emission tomographic maximal standardized uptake value has been shown to predict survival after resection of non-small cell lung cancer. The relative prognostic benefit of maximal standardized uptake value with respect to other clinical/pathologic variables has not been defined. We reviewed patients who had positron emission tomographic imaging and an R0 resection for non-small cell lung cancer between January 1, 2000, and December 31, 2004, without induction or adjuvant therapy. The associations between overall survival, histology, pathologic TNM stage, pathologic tumor diameter, and standardized uptake value were tested. Four hundred eighty-seven patients met the study criteria. Median follow-up was 25.8 months. By using the median values for tumor size (2.5 cm) and standardized uptake value (5.3), standardized uptake value was an independent predictor of survival (P = .03), adjusting for tumor size (P = .02) and histology (P < .01). The optimal standardized uptake value for stratification was identified as 4.4, and this value was identified as an independent predictor of survival (P = .03) after adjusting for clinical TNM stage. Standardized uptake value was not an independent predictor of survival (P = .09), adjusting for pathologic TNM stage (stage IA vs IB vs stage II-IV, P < .01). Standardized uptake value does not add to the prognostic significance of pathologic TNM stage. Standardized uptake value was an independent prognostic factor from clinical TNM stage.
    The Journal of thoracic and cardiovascular surgery 06/2007; 133(6):1419-27. · 3.41 Impact Factor

Publication Stats

3k Citations
332.26 Total Impact Points


  • 2014
    • Peter MacCallum Cancer Centre
      Melbourne, Victoria, Australia
  • 2013
    • Weill Cornell Medical College
      New York City, New York, United States
  • 1998–2012
    • Memorial Sloan-Kettering Cancer Center
      • • Department of Surgery
      • • Colorectal Service
      • • Thoracic Service
      • • Department of Radiology
      • • Department of Nuclear Medicine
      New York City, NY, United States
  • 2000
    • Gracie Square Hospital, New York, NY
      New York City, New York, United States