Positron emission tomography with 2-[18F]-fluoro-2-deoxy-D-glucose in oncology

Abstract

Positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) is considered to be a very useful adjunct to anatomic imaging techniques and is now primarily used for oncological indications. These indications include diagnosis, staging, and therapy monitoring. In this review, we discuss the articles in which FDG-PET is clinically used for monitoring therapy in lung and colorectal tumours, head and neck cancer, sarcoma, and hepatocellular carcinoma. It is found that the amount of FDG uptake strongly correlates with response to therapy: a decrease in FDG uptake after therapy indicates a positive response to therapy. However, this conclusion is based on small numbers of patients, whereas the exact response mechanism is still unknown. Moreover, in these case series, the interval between tumour therapy and FDG-PET, as well as the method of quantification, SUV or tumour-to-non-tumour ratios, differ per study. Finally, dynamic imaging is a recommended technique by some authors, but it is not a standard technique in clinical practice to evaluate tumour therapy. Therefore, further study is required which has to deal with these major issues before it is possible to draw definite conclusions.

Cancer Metabolism as a Mechanism of Treatment Resistance and Potential Therapeutic Target in Hepatocellular Carcinoma

“…The uptake mechanism and biochemical pathway of 18F-FDG metabolism has been extensively studied in vitro and in vivo ; transport through cell membrane via glucose transporter isoform 1 (GLUT1) and intracellular phosphorylation by hexokinase (HK) have been identified as key steps for subsequent accumulation in HCC. 8 9 10 11 12 13 Many studies have shown upregulation of GLUT1 in HCC, but not in non-tumor liver tissue. 14 15 Amann, et al 15 demonstrated a positive correlation between GLUT1 expression and Ki-67 labeling index in patients with HCC, suggesting that its expression is associated with advanced tumor stage and poor differentiation.…”

Targeting glucose metabolism in cancer: a new class of agents for loco-regional and systemic therapy of liver cancer and beyond?

“…Subsequently, 2-DG at a therapeutic dose causes ATP depletion as well as oxidative stress and eventually facilitates cell death [21,22]. Moreover, these features of 2-DG in combination with the increased glucose uptake in cancer cells provide the rationale for the detection of tumors by positron emission tomography (PET) using 18 F-labeled 2-deoxy-D-glucose (FDG) [23,24]. …”

Metabolic Portraits of Breast Cancer by HR MAS MR Spectroscopy of Intact Tissue Samples

“…To compensate for the inefficient ATP production, most tumors have an increased rate of glucose uptake. This property makes PET a highly sensitive and specific clinical tool to identify primary and metastatic lesions [35,36]. This technique uses the glucose analogue tracer 18 Fluorodeoxyglucose (FdG) to image and quantify glucose uptake, which has been found to be correlated with poor prognosis and to be highly dependent on the glycolytic rate [17,35,36].…”