Whole Body <sup>18</sup>FDG-PET and the Response of Esophageal Cancer to Induction Therapy: Results of a Prospective Trial

Downey, Robert J.; Akhurst, Tim; Ilson, David H.; Ginsberg, Robert J.; Bains, Manjit S.; Gönen, Mithat; Koong, Heng Nung; Gollub, Marc J.; Minsky, Bruce D.; Zakowski, Maureen F.; Turnbull, A. D.; Larson, Steven M.; Rusch, Valerie W.

doi:10.1200/jco.2003.04.013

Cited by 311 publications

(173 citation statements)

References 22 publications

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“…In our study, we found no significant difference between responders and nonresponders with respect to CT-PET findings at completion of neoadjuvant therapy and before planned surgery. These findings are at variance with reports from previous studies, in which investigators have shown that pathologic responders can be differentiated from nonresponders based on the absolute and percentage decrease in FDG uptake between baseline and completion of neoadjuvant therapy (with ''optimal'' thresholds ranging between 35% and 60%) [14][15][16][18][19][20] or on the degree of residual metabolic activity within the primary tumor after completion of treatment. 12,13,17 It is important to note that in all of these previous reports, criteria for determining therapeutic response based on FDG-PET findings were calculated retrospectively based on re- ceiver operating characteristics (ROC) acquired from the study itself, and have varied from investigator to investigator.…”

Section: Discussioncontrasting

confidence: 55%

“…[12][13][14][15][16][17][18][19][20][21][22] Conversely, studies have shown that persistent FDG uptake at the site of the primary tumor after neoadjuvant therapy correlates both with a lack of pathological response to chemoradiotherapy and with a worse clinical outcome, implying that nonsurgical management is indicated for these patients. [12][13][14][15][16]19,20 However, there have only been a limited number of such studies and uncertainty remains over the clinical utility of computed tomography PET (CT-PET), particularly with respect to the optimal timing of performing CT-PET, its specificity for differentiating between residual tumor and therapy-induced inflammation, and the detection of distant metastases after neoadjuvant therapy. 23,24 The aim of this study was to report our clinical experience with CT-PET for detecting distant metastases and in evaluating the therapeutic response of the primary tumor to neoadjuvant therapy in patients with locally advanced potentially resectable esophageal carcinoma.…”

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confidence: 99%

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Detection of interval distant metastases

Bruzzi

Swisher

Truong

et al. 2006

Cancer

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BACKGROUND.The objective of the study was to determine the utility of integrated computed tomography / positron emission tomography (CT‐PET) imaging for detecting interval distant metastases and assessing therapeutic response in patients with locally advanced, potentially resectable esophageal carcinoma after neoadjuvant therapy.METHODS.A retrospective study was performed of 88 patients with potentially resectable esophageal carcinoma who received neoadjuvant therapy before planned surgical resection. CT‐PET before and after completion of neoadjuvant was used for evaluating therapeutic response; response criteria were based on qualitative and semiquantitative analyses.RESULTS.Neoadjuvant therapy comprised chemoradiotherapy in 85 patients, with prior induction chemotherapy in 39 patients. Fifty‐five patients proceeded to esophagectomy. Repeat CT‐PET was performed after induction chemotherapy (n = 23) and after completing chemoradiotherapy (n = 85). CT‐PET identified the interval appearance of metastatic disease in 7 (8%) patients. For assessment of locoregional therapeutic response, CT‐PET was unable to predict pathological response to neoadjuvant therapy in the primary tumor or locoregional lymph nodes. CT‐PET had sensitivity, specificity, and positive and negative predictive values of 57%, 46%, 39%, and 64%, respectively, for detection of residual macroscopic malignancy within the primary tumor; and sensitivity, specificity, and positive and negative predictive values of 0%, 90%, 0%, and 69% for detection of residual malignancy within resected lymph nodes.CONCLUSIONS.CT‐PET performed after neoadjuvant therapy in patients with potentially resectable esophageal carcinoma is important for detecting interval metastases that preclude surgical resection, but is of limited utility for assessing locoregional therapeutic response. Cancer 2007. © 2006 American Cancer Society

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Section: Discussioncontrasting

confidence: 55%

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confidence: 99%

Detection of interval distant metastases

Bruzzi

Swisher

Truong

et al. 2006

Cancer

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“…[29][30][31][32] Similar to findings for other cancers, decreases in FDG uptake between 50% and 60% from baseline indicated clinically significant treatment responses. 33,34 Early in treatment, responses also have been identified in patients who have locally advanced disease. 35 Recently, in esophageal cancer, treatment protocols designed to select responders have been initiated.…”

Section: Gastrointestinal Cancersmentioning

confidence: 99%

PET Imaging for Treatment Response in Cancer

Eary

2008

PET Clinics

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KeywordsPET; FDG; Cancer imaging; Response imaging PET tumor surveys have become widely used in clinical practice. [F-18] fluorodeoxyglucose (FDG) is the most commonly used radiotracer for clinical indication of tumor staging and restaging after treatment. FDG PET consistently has exhibited better diagnostic performance than conventional imaging in adults and pediatric populations. [1][2][3][4] More recently, a growing body of literature is reporting the use of FDG and other PET imaging agents in treatment response assessment. [5][6][7] In many cases, FDG PET has proved to be a reliable means of noninvasively observing response in various treatments.Additionally, reliable determination of past treatment changes, including recurrent tumors and differentiation of benign and malignant lesions, will reduce morbidity and the cost of care in anatomic imaging. The Response Evaluation Criteria in Solid Tumors (RECIST) are a useful means to report quantitative changes in tumor size on CT scans in many different tumors in response to treatment. 8,9,10 Many tumor types, however, do not change size appreciably in response to treatment. Early changes that may indicate treatment regimen effectiveness also may not result in tumor change in size. FDG PET is a relatively sensitive indicator of treatment response in many tumors, indicating changes in metabolism that often precede or take the place of tumor size change. Fig. 1 shows some examples of FDG PET tumor response.Recently, several cooperative groups have addressed the use of FDG PET as a biomarker for cancer treatment response. An early report by the European Organization for Research and Treatment of Cancer (EORTC) set criteria for treatment response according to changes in tumor FDG uptake compared to baseline. 2 These criteria include:Complete response (CR)- [F-18] fluorodeoxyglucose uptake is comparable to baseline activity in all lesions Partial response (PR)-all target lesions have greater than 25% decrease in standardized uptake variable (SUV) Stable disease (SD)-target lesions have less than 25% increase or decrease in SUV Progressive disease (PD)-at least one target lesion has greater than 25% increase in SUV, or new lesions appear (regardless of SUV changes in target lesions)These criteria are in wide use today for clinical FDG PET imaging. A set of criteria for clinically significant changes in tumor FDG uptake, however, is based on consistent parameters for the FDG PET acquisition between studies in the same patient, and between patient imaging groups at different institutions. Development and evaluation of new cancer therapies could be enhanced by a set of validated biomarkers for treatment response. FDG PET meets these criteria in clinical studies, if imaging studies are conducted with patients on clinical therapeutic trials in a reliable and consistent manner. 3 To address the consistency in FDG PET data for use as NIH Public Access A review of cancer treatment response begins with consideration of the pathological basis of the tumor process. Tumors are c...

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“…A series of EC patients scanned with FDG-PET before and after induction chemotherapy showed a doubling in two-year disease-free survival when the SUVmax declined by greater than 60% [16]. Because cellular uptake of FLT is a more specific marker for proliferation than FDG, it has theoretical advantages over FDG-PET.…”

Section: Introductionmentioning

confidence: 99%

Long-term Results of a Pilot Study Comparing FLT-PET and FDG-PET in the Evaluation of Response to Treatment in Advanced Head and Neck and Esophageal Malignancies

RS¹,

Vj²,

Rl³

et al. 2017

J Nucl Med Radiat Ther

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Objective: We prospectively compared FDG-PET and FLT-PET in assessing patient responses to induction cetuximab and/or chemoradiotherapy (CRT) for advanced head and neck squamous cell carcinoma (HNSCC) and esophageal cancer (EC). Methods:Sixteen patients were enrolled, 9 with HNSCC and 7 with EC. FDG-PET and FLT-PET scans were performed at baseline and two weeks into chemoradiotherapy (CRT) for patients with EC. Patients with HNSCC received two weeks of induction chemotherapy along with post-induction PET scans prior to starting CRT in addition to the baseline and intra-chemoradiotherapy PET scans. Changes in SUVmax and total lesion glycolysis/ proliferation (TLG/TLP) were compared with baseline.Results: Median follow-up for living patients was 6.0 years. Median overall survival (OS) was 3.3 years and progression-free survival (PFS) was 2.5 years. Patients with HNSCC had higher baseline SUVmax, TLG and TLP than those with EC. Changes in SUVmax, TLG and TLP after induction chemotherapy or during CRT did not correlate with PFS or OS. Those with >40% decline in SUVmax on FDG-PET six weeks after completing CRT had better PFS (p<0.0001) and OS (p=0.0003) than those with less of a response. In addition, >70% decrease in posttreatment TLG correlated with better PFS (p=0.03) and OS (p=0.04). Conclusions:Functional imaging performed early during chemoradiotherapy for advanced HNSCC and EC is feasible. Changes on post-induction and intra-CRT FLT and FDG PET did not correlate with PFS or OS. However, better PFS and OS were seen in patients with >40% decline in SUVmax and >70% decrease in TLG on FDG-PET performed six weeks after completing CRT. Further research is needed to determine the prognostic impact of PET performed during chemotherapy and radiotherapy.

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Whole Body ¹⁸FDG-PET and the Response of Esophageal Cancer to Induction Therapy: Results of a Prospective Trial

Cited by 311 publications

References 22 publications

Detection of interval distant metastases

Detection of interval distant metastases

PET Imaging for Treatment Response in Cancer

Long-term Results of a Pilot Study Comparing FLT-PET and FDG-PET in the Evaluation of Response to Treatment in Advanced Head and Neck and Esophageal Malignancies

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Whole Body 18FDG-PET and the Response of Esophageal Cancer to Induction Therapy: Results of a Prospective Trial

Cited by 311 publications

References 22 publications

Detection of interval distant metastases

Detection of interval distant metastases

PET Imaging for Treatment Response in Cancer

Long-term Results of a Pilot Study Comparing FLT-PET and FDG-PET in the Evaluation of Response to Treatment in Advanced Head and Neck and Esophageal Malignancies

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Product

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Whole Body ¹⁸FDG-PET and the Response of Esophageal Cancer to Induction Therapy: Results of a Prospective Trial