Intratumoral Metabolic Heterogeneity for Prediction of Disease Progression After Concurrent Chemoradiotherapy in Patients with Inoperable Stage III Non-Small-Cell Lung Cancer

Kang, Sae-Ryung; Song, Ho‐Chun; Byun, Byung Hyun; Oh, Jong-Ryool; Kim, Hyeon-Sik; Hong, Sun-Pyo; Kwon, Seong; Chong, Ari; Kim, Jahae; Cho, Sang-Geon; Park, Hee Jeong; Kim, Young‐Chul; Ahn, Sung‐Ja; Min, Jung‐Joon; Bom, Hee‐Seung

doi:10.1007/s13139-013-0231-7

Cited by 51 publications

(55 citation statements)

References 23 publications

(32 reference statements)

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“…Recently, studies have suggested that the examination of spatial heterogeneity with computed tomography (CT) and the use of SUVs within solid tumors (particularly NSCLC) may provide prognostic information (8)(9)(10)(11)(12). Although these studies have generated compelling early evidence that heterogeneous tumors may lead to inferior outcomes, they have lacked adjustment for known prognostic factors and the use of proper validation techniques.…”

Section: Nuclear Medicine: Stage III Non-small Cell Lung Cancermentioning

confidence: 99%

“…Pretreatment risk or prognosis in patients with NSCLC (9)(10)(11). It is hypothesized that tumor heterogeneity in fluorodeoxyglucose PET tracer uptake may reflect underlying tumor biology such as hypoxia, angiogenesis, and necrosis (21).…”

Section: Nuclear Medicine: Stage III Non-small Cell Lung Cancermentioning

confidence: 99%

“…Therefore, these methods could be used to identify tumors that are predisposed to aggressive behavior. In NSCLC specifically, preliminary data exist that suggest a relationship between quantitative imaging features and patient outcome (9,11). However, these studies do not sufficiently adjust for conventional prognostic factors when assessing the significance of new quantitative imaging features.…”

Section: Nuclear Medicine: Stage III Non-small Cell Lung Cancermentioning

confidence: 99%

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Stage III Non–Small Cell Lung Cancer: Prognostic Value of FDG PET Quantitative Imaging Features Combined with Clinical Prognostic Factors

Fried¹,

Mawlawi

Zhang³

et al. 2016

Radiology

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Purpose:To determine whether quantitative imaging features from pretreatment positron emission tomography (PET) can enhance patient overall survival risk stratification beyond what can be achieved with conventional prognostic factors in patients with stage III non-small cell lung cancer (NSCLC). Materials and Methods:The institutional review board approved this retrospective chart review study and waived the requirement to obtain informed consent. The authors retrospectively identified 195 patients with stage III NSCLC treated definitively with radiation therapy between January 2008 and January 2013. All patients underwent pretreatment PET/computed tomography before treatment. Conventional PET metrics, along with histogram, shape and volume, and co-occurrence matrix features, were extracted. Linear predictors of overall survival were developed from leaveone-out cross-validation. Predictive Kaplan-Meier curves were used to compare the linear predictors with both quantitative imaging features and conventional prognostic factors to those generated with conventional prognostic factors alone. The Harrell concordance index was used to quantify the discriminatory power of the linear predictors for survival differences of at least 0, 6, 12, 18, and 24 months. Models were generated with features present in more than 50% of the cross-validation folds. Results:Linear predictors of overall survival generated with both quantitative imaging features and conventional prognostic factors demonstrated improved risk stratification compared with those generated with conventional prognostic factors alone in terms of log-rank statistic (P = .18 vs P = .0001, respectively) and concordance index (0.62 vs 0.58, respectively). The use of quantitative imaging features selected during cross-validation improved the model using conventional prognostic factors alone (P = .007). Disease solidity and primary tumor energy from the co-occurrence matrix were found to be selected in all folds of cross-validation. Conclusion:Pretreatment PET features were associated with overall survival when adjusting for conventional prognostic factors in patients with stage III NSCLC.q RSNA, 2015

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Section: Nuclear Medicine: Stage III Non-small Cell Lung Cancermentioning

confidence: 99%

Section: Nuclear Medicine: Stage III Non-small Cell Lung Cancermentioning

confidence: 99%

Section: Nuclear Medicine: Stage III Non-small Cell Lung Cancermentioning

confidence: 99%

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Stage III Non–Small Cell Lung Cancer: Prognostic Value of FDG PET Quantitative Imaging Features Combined with Clinical Prognostic Factors

Fried¹,

Mawlawi

Zhang³

et al. 2016

Radiology

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“…Tumor heterogeneity measured by 18F-FDG PET/CT has been emphasized in various malignancies. Heterogeneity has been associated with treatment response in esophageal cancer and rectal cancer [8,9] and prediction of disease progression in lung cancer and nasopharyngeal carcinoma [10,11]. Other studies have suggested that tumor heterogeneity is associated with histopathological features in lung cancer, head and neck cancer, and oligodendrogliomas [12,13,14].…”

Section: Introductionmentioning

confidence: 99%

Tumor Heterogeneity Assessed by 18F-FDG PET/CT Is Not Significantly Associated with Nodal Metastasis in Breast Cancer Patients

et al. 2015

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Introduction: The purpose of this study was to evaluate the association of tumor heterogeneity as assessed by positron emission tomography/computed tomography (PET/CT) with pathological factors of breast cancer, and the prediction of nodal metastasis through tumor heterogeneity. Methods: From January 2013 to December 2013, 102 patients with invasive ductal carcinoma of the breast were enrolled into this study. [¹⁸F]Fluorodeoxyglucose PET/CT was performed before surgery. The metabolic tumor volume (MTV) of each lesion was calculated and a series of standardized uptake value (SUV) thresholds (e.g. 40%, 50%, 60%, 70%, and 80% of SUVmax) was obtained. A threshold-volume (dV/dT) curve was acquired by plotting thresholds to MTV values automatically calculated with these thresholds. Tumor heterogeneity was calculated from the slope of the threshold-volume curve and defined as heterogeneity factor (HF). Results: HF differed significantly according to T stage (p < 0.0001), N stage (p = 0.0131) and American Joint Committee on Cancer (AJCC) stage (p = 0.0006). Among the pathological parameters, dermal lymphatic involvement (p = 0.0039) showed the significant correlations with HF. Lymphovascular invasion (p = 0.0005) was the only independent factor for predicting nodal metastasis. Conclusions: Tumor heterogeneity measured by 18F-FDG PET/CT is significantly associated with dermal lymphatic involvement. However, PET might not be able to predict nodal metastasis in breast cancer.

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“…Simple product of volume and metabolic activity may not be the most accurate solution, and recently, a new metric was proposed that incorporates the commonly utilized metrics of SUV, metabolic tumor volume, and total lesion glycolysis into a single parameter [14]. Various textural features and parameters representing tumor heterogeneity have shown much potential for predicting disease progression [15,16]. How to best represent the volumetric and SUL data, and possibly such features as intratumoral metabolic heterogeneity, is a challenge that needs to be further investigated.…”

Section: Performing Percistmentioning

confidence: 99%

PERCIST in Perspective

Wahl

2017

Nucl Med Mol Imaging

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Positron Emission tomography Response Criteria In Solid Tumors (PERCIST) version 1.0 was introduced in 2009 for objective assessment of tumor metabolic response using 18 F-FDG PET/CT. Practical PERCIST: A Simplified Guide to PET Response Criteria in Solid Tumors 1.0 was published in 2016 to review and clarify some of the issues with the PERCIST. In this article, we reflect on the benefits and challenges of implementing PERCIST, and speculate on topics that could be discussed in PERCIST 1.1 in the future.

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Intratumoral Metabolic Heterogeneity for Prediction of Disease Progression After Concurrent Chemoradiotherapy in Patients with Inoperable Stage III Non-Small-Cell Lung Cancer

Abstract: Intratumoral metabolic heterogeneity of primary lung tumor in (18)F-FDG PET/CT can predict disease progression after CCRT in inoperable stage III NSCLC.

Cited by 51 publications

References 23 publications

Stage III Non–Small Cell Lung Cancer: Prognostic Value of FDG PET Quantitative Imaging Features Combined with Clinical Prognostic Factors

Stage III Non–Small Cell Lung Cancer: Prognostic Value of FDG PET Quantitative Imaging Features Combined with Clinical Prognostic Factors

Tumor Heterogeneity Assessed by 18F-FDG PET/CT Is Not Significantly Associated with Nodal Metastasis in Breast Cancer Patients

PERCIST in Perspective

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