Predictive value of early and late residual 18F-fluorodeoxyglucose and 18F-fluorothymidine uptake using different SUV measurements in patients with non-small-cell lung cancer treated with erlotinib

Abstract

Early and late residual FDG uptake, measured using different quantitative SUV parameters, are predictive factors for short-term outcome in patients with advanced NSCLC treated with erlotinib. Additionally, low residual FDG and FLT uptake early and late in the course of erlotinib treatment is associated with improved PFS.

TLG-S criteria are superior to both EORTC and PERCIST for predicting outcomes in patients with metastatic lung adenocarcinoma treated with erlotinib

“…Several studies have shown that FDG-PET is a useful imaging modality for predicting response to erlotinib in patients with non-small cell lung cancer (NSCLC) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. However, most of these studies used only the primary tumor as the target lesion for sequential imaging [3][4][5][6][7][8][9][10][11][12], and treatment response was largely assessed using the European Organization for Research and Treatment of Cancer (EORTC) criteria [3][4][5][6][7][8][9]20]. Other studies have evaluated treatment response using the Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) [21], based on the measurement of a specific focus on the hottest single lesion, including the metastatic tumor [15,16].…”

Comparison of the diagnostic performance of 18F-fluorothymidine versus 18F-fluorodeoxyglucose positron emission tomography on pulmonary lesions: A meta analysis

“…Despite high sensitivity for staging lung cancer with 18 F-FDG PET compared to conventional imaging modalities, false-positive findings can occur, particularly in inflammatory lesions (4,5,10). Non-specific uptake by these non-malignant tissues resulted in a positive predictive value of 18 F-FDG PET in the pulmonary lesions as low as 44.6% (27). 18 F-FLT is an analog of thymidine and its uptake has been found PET, positron emission tomography; FLT, fluorothymidine; FDG, fluorodeoxyglucose; PLR, positive-likelihood ratio; NLR, negative-likelihood ratio; DOR, diagnostic odds ratio.…”

“…A pulmonary lesion is an extremely common and clinically challenging disorder in China, as well as in a number of other countries (27,28), and lung cancer is the first leading cause of tumor-related mortality. The differentiation of lung cancer from benign pulmonary lesions is a well-known diagnostic problem in daily clinical practice.…”

“…However, the significant correlation between FLT uptake and tumor cell proliferation indicates the importance of 18 F-FLT PET or PET/CT for the assessment of therapy response and outcome (12). To a certain extent, this was one of the reasons for the increasing studies regarding the assessment of the responses to erlotinib therapy for NSCLC using 18 F-FLT versus 18 F-FDG PET and/or PET/CT (25)(26)(27)(28)(29)(30). Several published meta analyses only reported pooled data from statistically heterogeneous studies and possibly provided the misleading information.…”

Optimisation and harmonisation: two sides of the same coin?

“…In addition to diagnosis and staging, FDG PET/CT is used to measure treatment response. Here residual FDG uptake or changes in uptake during or after treatment are used as predictive factors [4][5][6]. To this end, criteria to measure FDG uptake changes and/or metabolic response have been proposed [7,8].…”