Role Of FDG-PET Research Articles

18FDG-PET metabolic response of non-small-cell lung cancer to chemoradiotherapy with long-term follow-up

AbstractAim18Fluorodeoxyglucose-positron emission tomography (FDG-PET) can indicate the presence or absence of non-small-cell lung cancer (NSCLC) after treatment. We present a description of the FDG-PET results following the contemporary management of locally advanced NSCLC including long-term outcomes.MethodologyThe study participants were eight long-term survivors with metabolic tumour response (MTR) shown on FDG-PET following chemoradiotherapy for locally advanced stage NSCLC between June 2005 and April 2009.ResultsAfter therapy, MTR was complete in five patients; four subjects were free of cancer, and one patient experienced progression of disease at the time of last follow-up. Of the three individuals with incomplete MTRs, distant metastases developed in two patients, and one subject remained disease-free. Long-term survival ranged from 37 to 75 months.ConclusionAlthough the number of cases is small, our observations confirm the diagnostic role of FDG-PET as well as its value for predicting prognosis in the clinical practice of oncology.

The role of FDG-PET in Hodgkin lymphoma.

18-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) is currently the most valuable imaging technique in Hodgkin lymphoma. Since its first use in lymphomas in the 1990s, it has become the gold standard in the staging and end-of-treatment remission assessment in patients with Hodgkin lymphoma. The possibility of using early (interim) PET during first-line therapy to evaluate chemosensitivity and thus personalize treatment at this stage holds great promise, and much attention is now being directed toward this goal. With high probability, it is believed that in the near future, the result of interim PET-CT would serve as a compass to optimize treatment. Also the role of PET in pre-transplant assessment is currently evolving. Much controversy surrounds the possibility of detecting relapse after completed treatment with the use of PET in surveillance in the absence of symptoms suggestive of recurrence and the results of published studies are rather discouraging because of low positive predictive value. This review presents current knowledge about the role of 18-FDG-PET/CT imaging at each point of management of patients with Hodgkin lymphoma.

Erratum to: Long-term follow-up and role of FDG PET in advanced pancreatic neuroendocrine patients treated with 177Lu-D OTATATE.

Lu-DOTATATE (Lu-PRRT) is a valid therapeutic option in differentiated pancreatic neuroendocrine tumors (P-NETs). FDG PET seems to be an important prognostic factor in P-NETs. We evaluated the efficacy of Lu-PRRT and the role of FDG PET in 60 patients with advanced P-NETs. From March 2008 to June 2011, 60 consecutive patients with P-NETs were enrolled in the study. Follow-up lasted until March 2016. Eligible patients were treated with two different total cumulative activities (18.5 or 27.8 GBq in 5 cycles every 6–8 weeks), according to kidney and bone marrow parameters. Twenty-eight patients received a mean full activity (FA) of 25.9 GBq and 32 a mean reduced activity (RA) of 18.5 GBq. The disease control rate (DCR), defined as the sum of CR+PR+SD was 85.7 % in the FA group and 78.1 % in the RA group. Median progression-free survival (mPFS) was 53.4 months in the FA group and 21.7 months in the RA group (P = 0.353). Median overall survival (mOS) was not reached (nr) in FA patients and was 63.8 months in the RA group (P = 0.007). Fifty-five patients underwent an FDG PET scan before Lu-PRRT, 32 (58 %) showing an increased FDG uptake in tumor sites. mPFS was 21.1 months in FDG PET-positive patients and 68.7 months in the FDG PET-negative group (P < 0.0002), regardless of the total activity administered. Both FA and RA are active in patients undergoing Lu-PRRT. However, an FA of 27.8 GBq of Lu-PRRT prolongs PFS and OS compared to an RA of 18.5 GBq. Our results indicate that FDG PET is an independent prognostic factor in this patient setting.

925P - Role of FDG-PET in detecting bone marrow involvement in mature T-/NK-cell neoplasms

925P - Role of FDG-PET in detecting bone marrow involvement in mature T-/NK-cell neoplasms

EP-1070: Prognostic role of FDG-PET performed before or during radiotherapy in head and neck cancer

EP-1070: Prognostic role of FDG-PET performed before or during radiotherapy in head and neck cancer

Evens AM, Kostakoglu L. The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease. Hematology Am Soc Hematol Educ Program. 2014;2014:135-143.

Evens AM, Kostakoglu L. The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease. Hematology Am Soc Hematol Educ Program. 2014;2014:135-143.

The Role of FDG-PET in the Diagnosis and Staging of Ocular Adnexal Lymphoproliferative Disease

Purpose: To further evaluate fluorine 18 fluoro-deoxyglucose positron emission tomography (FDG PET) in the staging of ocular adnexal lymphoproliferative disease (OALD).Methods: Retrospective and prospective case series with review of clinical and imaging records including computed tomography (CT), FDG PET (±PET/CT) and/or magnetic resonance imaging (MRI).Results: Thirty-four patients had FDG PET and CT scans at initial staging. Eleven were retrospectively reviewed and 23 were prospectively enrolled. Of 34 patients, 17 (50%) had primary disease, 17 (50%) had secondary and of these, 13 patients (38%) had OALD as their initial manifestation. Sixteen patients had active systemic disease in conjunction with their orbital disease. Systemic disease was demonstrated by FDG PET (± CT) in 15 of 16 (94%) patients and 11 of 16 (69%) patients with CT. FDG PET found orbital disease in 27 of 34 patients (79%) versus 33 of 34 patients with orbital CT (97%). Four of 16 patients in which FDG-PET detected systemic disease where CT did not were upstaged and their management changed significantly in 5 cases.Conclusions: This study reaffirms FDG PET as an important part of initial staging. Our study suggests FDG PET detects systemic disease more reliably than CT alone and results in significant changes in management. Our findings suggest FDG PET detection for local OALD is less sensitive than CT. MRI is helpful in augmenting other imaging modalities in further identifying disease. Given the prevalence of simultaneous systemic presentations of OALD, FDG PET in this regard is especially important and highlights the need for coordinated multidisciplinary care.

FDG-PET(CT)-adapted trials in non-Hodgkin lymphoma

18-F-fluorodeoxyglucose (FDG)-positron emission tomography (PET), is identified as a strong diagnostic and prognostic tool in patients with diffuse large B cell lymphomas (DLBCL), primary mediastinal B cell lymphomas and follicular lymphomas (FL), and its routine use has been recommended in the recently updated criteria for staging and response assessment in lymphomas. Evidences on the role of FDG-PET in foreseeing the outcome of patients with aggressive, and lately FL, have paved the way for several prospective trials that are underway to evaluate either escalation or de-escalation approaches based on the results of both interim and end-of-treatment FDG-PET. These trials are trying to answer important questions that represent real challenges for the management of patients with non-Hodgkin lymphomas. These range from the utility of radiotherapy after induction immunochemotherapy (ICT) in patients with residual masses, to the need and modality for treatment intensification in high-risk patients with DLBCL, to the real need of maintenance therapy in patients with FL responding to initial ICT.

Role of FDG PET–CT (Positron Emission Tomography and Computed Tomography) scan in the staging of locally advanced/recurrent breast cancer as a single modality in comparison to multiple organs directed conventional investigations.

e11508 Background: Multiple organs directed imaging has been the conventional way of assessing the distant metastasis in locally advanced/ recurrent breast cancer. This study is designed to evaluat...

Monitoring of the Formation and Development Process for Infection and Inflammation Using F-18 FDG, PET/CT

Objective: Many radiopharmaceuticals have been evaluated extensively in both preclinical and clinical studies as potential diagnostic agents to identify the sites of infection. There is a definite role of FDG-PET in diagnosis, extent of assessing the disease, evaluation of treatment response and disease activity in patients with infections and inflammation. The aim of the study, the process of formation and development of infection and inflammation is monitored using (18 F) 2’-deoxy-2-fluoroD-glucose (F-18 FDG) by Positron Emission Computed Tomography (PET-CT). Methods: In this study, sterile abscess was induced by using turpentine and infected abscess was induced by using Staphylococcus aureus atcc 25923 strain on rats. In the abscess formation on rats, three grups rats were used as sterile, infected and control grups. There were examined male White Wistar Rats, the clinical healthy animals were 150-220 gr body weight. Bacterial strain and rat model for abscess formation for infected abscess formation on rats (n=7), S. aureus 0.5 ml 107 CFU/ml was inoculated in the right arm of the rats as subcutaneous. For sterile abscess formation on rats (n=7) 0.2-0.4 ml turpentine (sigma-aldrich) was injected into the right arm of the rats as subcutaneous. In control group (n=6), 0.5 ml 0.9% NaCl was injected into the right arm of the rats as subcutaneous. First day imsaging was acquired 24 hours after inoculation of S.aureus and turpentine. 1 mCi 18F-FDG was injected intravenously via the tail vein. Prior to 18F-FDG injection, rats fasted at least 4 hours and well hydrated. Imaging was done using PET-CT (PHILIPS Gemini TF), beginning 1 hour following injection of 18F-FDG IV in the first day and at intervals of 24 hours for five days. First day imaging was performed 1. hour after IV injection of 18F-FDG to obtain optimum imaging time. PET/CT images were visually and semiquantitatively assessed. For semiquantitative analysis of the PET images, a region of interest (ROI) was drawn around the abscess area in the right arm and the noninfected contralateral for control as background. Results: SUVmaxs were obtained from the images for evaluation glucose meatabolism of infection and inflammation detected by 18F-FDG, PET/CT. A soft tissue infection developed in the right arm site of the rats within 24 hours after bacterial inoculation. Swelling and redness of the abscess area was apparently seen in all rats. Abscess in rats were visualized by 18F-FDG, PET/CT. The higher abscess/ background rate was seen 1. hour than 2. hour after injection 18F-FDG. Imaging time was chosen as 1. hour post injection 18F-FDG for the following days. In the first day of the formation of S.aureus abscess SUVmax was about 3.9±0.9 while SUVmax was 1.5±0.2 in the control site. In sterile abscess, SUVmax of the first day was 2.2±0.8, while the SUVmax was 1.3±0.5 for control site. First day 2. hours following the injection of 18F-FDG SUVmax values were 2.8±0.6 for infected abscess, 1.2±0.09 for infected abscess control site and 1.9±0.9 for sterile abscess, 1.3±0.3 for sterile abscess control site. Conclusion: Steril and infected abscess differantiation can be evaulated by imaging with 18F-FDG PET. The rate of SUV(max) explores the correlation between sterile abscess and infected abscess. 18F-FDG PET is also useful technique to understand the extent of the infection and inflammation process. In addition 18F- FDG PET imaging method has rapid diagnosis and local availability of equipment and labeled agent.

放射線治療におけるPET/CTの意義―早期肺癌に対する体幹部定位放射線治療を中心に―

放射線治療におけるPET/CTの意義―早期肺癌に対する体幹部定位放射線治療を中心に―

Current role of FDG-PET in Bone and Soft tissue tumors

Current role of FDG-PET in Bone and Soft tissue tumors

The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease.

Given the excellent survival rates for early-stage Hodgkin lymphoma (HL), the young age of many patients, and concerns regarding acute and late treatment-related toxicities, there is a desire to have a predictive tool that enables therapy to be tailored toward the individual patient. Early (or interim) (18)F-fluorodeoxyglucose positron emission tomography with computerized tomography (FDG-PET/CT), as a test of tumor sensitivity to ongoing/planned therapy, has been shown to be prognostic for survival in HL. Based on results of interim FDG-PET/CT, therapy may be subsequently modified through minimization or via intensification for low- and high-risk patient populations, respectively (ie, response-adapted therapy). Important data have been generated to standardize the interpretability and reproducibility of interim FDG-PET/CT (eg, the Deauville 5-point system), and observational and noncontrolled prospective studies have produced evidence supporting the hypothesis that response-adapted therapy may potentially serve as a predictive tool. Furthermore, results from noninferiority phase 3 clinical trials randomizing early-stage HL patients with negative interim FDG-PET/CT to combined modality therapy versus chemotherapy alone have been reported. The current collective findings from these randomized early-stage HL studies have shown that acute relapse rates are lower with combined modality therapy, even in patients with negative interim FDG-PET/CT. Additional randomized response-adapted studies are ongoing and novel FDG-PET/CT applications involving quantitative techniques and innovative imaging modalities are being investigated to identify more robust imaging biomarkers. Treatment of early-stage HL remains a clinical management choice for physicians and patients to make with consideration of acute and long-term outcomes.

The Role of18F-FDG-PET and PET/CT in Patients with Colorectal Liver Metastases Undergoing Selective Internal Radiation Therapy with Yttrium-90: A First Evidence-Based Review

Purpose. To provide a first evidence-based review of the literature on the role of fluorine-18-fluorodeoxyglucose positron emission tomography and positron emission tomography/computed tomography (FDG-PET and PET/CT) in patients with colorectal liver metastases (CRLM) undergoing selective internal radiation therapy (SIRT) with yttrium-90 (90Y) microspheres. Methods. A comprehensive computer literature search was conducted to find relevant published articles on whole-body FDG-PET or PET/CT in patients with CRLM undergoing SIRT. Results. We identified 19 studies including 833 patients with CRLM undergoing SIRT. The role of FDG-PET or PET/CT was analysed in treatment planning, treatment response evaluation, and as prognostic tool. Conclusion. FDG-PET and PET/CT provide additional information in treatment evaluation of CRLM patients treated with SIRT and may have a role in treatment planning and patient selection. FDG-PET/CT is emerging as good prognostic tool in these patients.

The role of FDG PET in the diagnosis of occult primary with cervical lymph node metastases: A meta-analysis study

BackgroundDetection of the primary tumor has a key role in the management of patients with unknown primary tumors (UPT). PurposeThe aim of this study is to assess the efficacy of 18F-FDG PET in locating occult primary lesions in patients with metastatic cervical lymphadenopathy. MethodsA systematic search was performed by the PubMed/MEDLINE to identify and select the relevant studies published within the last 20years (up to 25/08/2011). Reported detection rates, sensitivities and specificities were metaanalyzed. Subgroup analyses were performed if results of individual studies were heterogeneous. ResultsThirty studies met the inclusion criteria. The overall sensitivity, specificity and accuracy rates of FDG-PET in detecting unknown primary tumors were 80.6%, 82.1% and 81.5% respectively.Furthermore, FDG-PET detected 33.5% of tumors that were not apparent after conventional workup. Whereas PET/CT scans’ overall sensitivity, specificity and accuracy were 82.5%, 80.2% and 81.4% respectively. Furthermore, PET/CT detected 30.7% of tumors that were not apparent after conventional workup. There were no significant differences between the diagnostic accuracies of FDGPET and PET/CT scans. Conclusions18F-FDG PET could be useful in patients with UPT for the detection of the primary tumor. 18F-FDG PET has high sensitivity, indicating the existence of few false-negative results, an important feature in the management of oncologic patients that could suggest its utility in the initial stages of the management process.

Is There a Role for FDG-PET for the Assessment of Treatment Efficacy in Wilms’ Tumor? A Case Report and Literature Review

Background: The role of FDG-PET in Wilms’ tumor has not been well established. The aim of this report is to describe the role of FDG-PET to assess chemotherapy efficacy and to show potential correlations between different Standardized Uptake Values (SUVs) and histopatological features in a patient with persisting metastatic disease. CASE description: A 3-year-old boy was diagnosed with Wilms’ tumor without anaplasia. The patient underwent treatment as according to the AIEOP-TW-2003 protocol, for stage III tumors. Therapy was discontinued with no evidence of disease, yet 9 months later thorax metastases were found. Although second and third line treatments were administered, conventional imaging demonstrated stable disease. Metronomic chemotherapy as well was employed for 44 months and FDG-PET was annually performed basing on responsible local physician choice trying to better describe the disease status. Four months after fourth line treatment was stopped, the patient manifested clinical symptoms; lesions began to increase their metabolic activity inhomogeneously. Therapy was hence restarted and SUVs decreased. Metastasectomies were then performed and histology revealed a correlation between viable disease shown by higher FDG-PET uptake and viable tumor areas. Conclusions: Our case discussion demonstrates that FDG-PET is potentially valuable in Wilms' tumor correlating SUV values and histological features of the tumor after chemotherapy. This case suggests that FDG-PET is a valid tool to assess chemotherapy response in relapsed Wilms' tumor even in case of no evidence of significant dimensional changes under conventional imaging.

Desk of the Editor

The successful completion of third year of the journal, and I deemed it as a great honor to inform all our readers that the journal is in the right direction to help oncologists. The editorial board meeting along with executive committee of IASO met at Goa. It was very useful and inputs from all the members was taken into consideration for the future. And they were exemplary. The participation and presentation from Springer represented by Dr. Naren Aggarwal provided useful information on functioning of the journal, and utility of the articles by the various people across the globe. By the time this fourth issue has been published we have already received large number of submissions indicating a good response from surgical oncologist. Editorial board, associate editor, joint editors are working hard to get the reviews fast and complete the process so that contributing authors will find it useful. This year we have made progress indicated by accreditation of our journal by archive PubMed, PubMedCentral, EMBASE, Google Scholar, OCLC, and Summon by Serial Solutions. The vol.3 issue 2 highlighted Uro Oncology in the subcontinent and usefulness of robotic surgery by renowned authors across the globe. The Issue 3 was dedicated to Dr. R.S. Rao past president of IASO & his special contribution to thyroid we also to published articles on thyroid cancer. The scientific meeting at Goa was well organized and appreciated hopefully we will be able to generate more contributions from the presenters to the future issues. My special thanks to Dr. Manoj Pande, Secretary IASO who worked closely with me sharing the administrative aspect of the Journal so that all statutory formalities are maintained. The dedicated work by Dr. K. Harish associate editor, Joint editor Dr. Chintamani in streamlining the indexing process by Govt. of India needs special mention. I have to thank the administrative staff Mr. J. Suresh (Dayananda Sagar Institution), Dr. Shivananda Swamy and other staff members at Ambuja Health Care who helped in carrying successful publication of IJSO. The efficient functioning of Springer’s staff in publishing the journal is highly appreciated. This issue contains multifaceted articles on various subjects with role of FDG-PET in Esophageal cancer to nutritional support in pancreatic malignancies and how to do it. I sincerely thank all the authors, reviewers and Springer publication.

Potential Usefulness of FDG PET/CT in Patients with Sepsis of Unknown Origin

PurposeThe role of FDG PET in the evaluation of patients with sepsis of unknown origin remains unclear. We sought to assess the value of FDG PET/CT in patients with sepsis of unknown cause and to define its priority in this group of subjects.MethodsA total of 53 patients with sepsis of unknown origin underwent FDG PET/CT within two weeks of diagnosis. All of the patients were followed up for at least 3 months after discharge to determine the clinical outcomes. The impact of FDG PET/CT was assessed according to the number of cases who had their treatment modified on the basis of the imaging results. Logistic regression analysis was used to identify the independent predictors of positive FDG PET/CT findings.ResultsOf the 53 study patients, 35 (66%) had positive FDG PET/CT findings, and 13 (25%) had their treatment modified on the basis of the imaging results. Logistic regression analysis identified normal serum aspartate aminotransferase (odds ratio [OR] = 6.134; 95% confidence interval [CI] = 1.443–26.076, P = 0.014) and increased serum alkaline phosphatase levels (OR = 5.813; 95% CI = 1.386–24.376, P = 0.016) at diagnosis as independent predictors of positive FDG PET/CT findings. A scoring system using these two covariates was developed, which defined three distinct priority groups for FDG PET/CT imaging.ConclusionOur findings suggest that FDG PET/CT may be clinically useful for the detection of occult foci of infection in patients with sepsis of unknown origin.

The role of 18F-fluorodeoxyglucose positron emission tomography at response assessment after autologous stem cell transplantation in T-cell non-Hodgkin’s lymphoma patients

Although a few studies have evaluated the utility of ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) in treatment-naive T-cell non-Hodgkin's lymphomas (T-NHLs), a few studies had been conducted to evaluate the role of FDG-PET in patients after treatment. A total of 41 patients with T-NHLs were included who underwent post-autologous stem cell transplantation (ASCT) PET for response assessment in addition to contrast-enhanced CT. The impact of post-ASCT PET on response assessment and predicting prognosis was retrospectively evaluated. Of the 41 patients, 11 (26.8%) patients showed discordant response between two image modalities (Cohen's κ = 0.465). The additional PET study actually guides changing the post-ASCT response in six (54.5%) of these 11 patients. Moreover, positive post-ASCT PET was associated with worse prognosis in event-free survival and overall survival than negative post-ASCT PET (P = 0.003 and P = 0.044, respectively). Excluding four patients in whom further confirmation was not available due to early mortality, in 22 lesions showing discrepancy between two image modalities, 12 lesions were true positive (N = 4) or true negative (N = 8) for PET and ten lesions were false positive (N = 7) or false negative (N = 3). The accuracy for the discrepant lesions was 54.5% (12 of 22), the overall accuracy for the detected lesions was 76.7% (33 of 43), and the overall accuracy for patients was 89.2% (33 of 37). Post-ASCT PET was useful in response assessment after ASCT, and the positive post-ASCT PET result was associated with worse prognosis than the negative post-ASCT PET in patients with T-NHLs.

Usefulness of FDG-PET in the evaluation of tumor response to proton beam therapy for locally advanced pancreatic ductal adenocarcinoma.

271 Background: Evaluation of tumor response to radiation therapy in pancreatic ductal adenocarcinoma (PDA) using conventional radiological tests is difficult due to generally small size and inflammatory or fibrotic changes of radiated tissue. Although increasing evidence has shown that 18-F-fluorodeoxyglucose-positoron emission tomography (FDG-PET) can assess functional changes in various tumors, available data in PDA with radiation therapy is scarce. In this study, we investigated the role of FDG-PET in long-term monitoring tumor response to proton beam therapy (PBT) for PDA. Methods: Thirty-four locally advanced PDA patients with pre- and post-PBT FDG-PET data were included in this study. Local tumor responses by computed tomography (CT) and FDG-PET were defined as below: response group in CT (complete response: CR, partial response: PR, stable disease: SD, progressive disease: PD) was defined according to Response Evaluation Criteria in Solid Tumors, but only evaluation of primary tumor; and in FDG-PET, CR was defined as disappearance of FDG uptake, PR as decrease, SD as unchange, and PD as increase, compared to pre-PBT data. We evaluated tumor response at three different time points: 0-3, 3-6, and 6-12 months after PBT. Also serum CA19-9 values were evaluated. Results: Radiation doses were 50.4-70.2 GyE and 28 (82%) patients received concomitant chemotherapy. During the follow-up period (median 19 months), a total of 90 FDG-PET tests were performed. At the first time point, SD was noted in 90% (9/10) of patients by CT, whereas CR or PR in all by FDG-PET. At the second point, 39% (7/18) of patients demonstrated PR by CT, whereas 91% CR or PR by FDG-PET. Two patients with PD by FDG-PET were diagnosed as SD by CT, while one patient with PD by CT was diagnosed as PR by FDG-PET. At the third point, four patients with PD by FDG-PET were diagnosed as PR or SD by CT. Serum CA19-9 values supported FDG-PET findings. In four of 14 patients with serial FDG-PET, the maximum effects were noted at the second point. Conclusions: Serial FDG-PET can detect changes in local tumor response to PBT for PDA earlier and more sensitively than CT. Of note, there is the risk for false positive in early post-PBT FDG-PET.