Browsing by Subject "Fluorodeoxyglucose F18"

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    18F-FDG-PET/CT Imaging for Gastrointestinal Malignancies.
    (Radiologic clinics of North America, 2021-09) Howard, Brandon A; Wong, Terence Z
    Gastrointestinal malignancies encompass a variety of primary tumor sites, each with different staging criteria and treatment approaches. In this review we discuss technical aspects of 18F-FDG-PET/CT scanning to optimize information from both the PET and computed tomography components. Specific applications for 18F-FDG-PET/CT are summarized for initial staging and follow-up of the major disease sites, including esophagus, stomach, hepatobiliary system, pancreas, colon, rectum, and anus.
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    Early 18F-FDG-PET Response During Radiation Therapy for HPV-Related Oropharyngeal Cancer May Predict Disease Recurrence.
    (International journal of radiation oncology, biology, physics, 2020-11) Mowery, Yvonne M; Vergalasova, Irina; Rushing, Christel N; Choudhury, Kingshuk Roy; Niedzwiecki, Donna; Wu, Qiuwen; Yoo, David S; Das, Shiva; Wong, Terence Z; Brizel, David M

    Purpose

    Early indication of treatment outcome may guide therapeutic de-escalation strategies in patients with human papillomavirus (HPV)-related oropharyngeal cancer (OPC). This study investigated the relationships between tumor volume and 18F-fluorodeoxyglucose positron emission tomography (PET) parameters before and during definitive radiation therapy with treatment outcomes.

    Methods and materials

    Patients undergoing definitive (chemo)radiation for HPV-related/p16-positive OPC were prospectively enrolled on an institutional review board-approved study. 18F-fluorodeoxyglucose PET/computed tomography scans were performed at simulation and after 2 weeks at a dose of ∼20 Gy. Tumor volume and standardized uptake value (SUV) characteristics were measured. SUV was normalized to blood pool uptake. Tumor volume and PET parameters associated with recurrence were identified through recursive partitioning (RPART). Recurrence-free survival (RFS) and overall survival (OS) curves between RPART-identified cohorts were estimated using the Kaplan-Meier method, and Cox models were used to estimate the hazard ratios (HRs).

    Results

    From 2012 to 2016, 62 patients with HPV-related OPC were enrolled. Median follow-up was 4.4 years. RPART identified patients with intratreatment SUVmax (normalized to blood pool SUVmean) <6.7 or SUVmax (normalized to blood pool SUVmean) ≥6.7 with intratreatment SUV40% ≥2.75 as less likely to recur. For identified subgroups, results of Cox models showed unadjusted HRs for RFS and OS (more likely to recur vs less likely) of 7.33 (90% confidence interval [CI], 2.97-18.12) and 6.09 (90% CI, 2.22-16.71), respectively, and adjusted HRs of 6.57 (90% CI, 2.53-17.05) and 5.61 (90% CI, 1.90-16.54) for RFS and OS, respectively.

    Conclusions

    PET parameters after 2 weeks of definitive radiation therapy for HPV-related OPC are associated with RFS and OS, thus potentially informing an adaptive treatment approach.
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    Imaging biomarker roadmap for cancer studies.
    (Nature reviews. Clinical oncology, 2017-03) O'Connor, James PB; Aboagye, Eric O; Adams, Judith E; Aerts, Hugo JWL; Barrington, Sally F; Beer, Ambros J; Boellaard, Ronald; Bohndiek, Sarah E; Brady, Michael; Brown, Gina; Buckley, David L; Chenevert, Thomas L; Clarke, Laurence P; Collette, Sandra; Cook, Gary J; deSouza, Nandita M; Dickson, John C; Dive, Caroline; Evelhoch, Jeffrey L; Faivre-Finn, Corinne; Gallagher, Ferdia A; Gilbert, Fiona J; Gillies, Robert J; Goh, Vicky; Griffiths, John R; Groves, Ashley M; Halligan, Steve; Harris, Adrian L; Hawkes, David J; Hoekstra, Otto S; Huang, Erich P; Hutton, Brian F; Jackson, Edward F; Jayson, Gordon C; Jones, Andrew; Koh, Dow-Mu; Lacombe, Denis; Lambin, Philippe; Lassau, Nathalie; Leach, Martin O; Lee, Ting-Yim; Leen, Edward L; Lewis, Jason S; Liu, Yan; Lythgoe, Mark F; Manoharan, Prakash; Maxwell, Ross J; Miles, Kenneth A; Morgan, Bruno; Morris, Steve; Ng, Tony; Padhani, Anwar R; Parker, Geoff JM; Partridge, Mike; Pathak, Arvind P; Peet, Andrew C; Punwani, Shonit; Reynolds, Andrew R; Robinson, Simon P; Shankar, Lalitha K; Sharma, Ricky A; Soloviev, Dmitry; Stroobants, Sigrid; Sullivan, Daniel C; Taylor, Stuart A; Tofts, Paul S; Tozer, Gillian M; van Herk, Marcel; Walker-Samuel, Simon; Wason, James; Williams, Kaye J; Workman, Paul; Yankeelov, Thomas E; Brindle, Kevin M; McShane, Lisa M; Jackson, Alan; Waterton, John C
    Imaging biomarkers (IBs) are integral to the routine management of patients with cancer. IBs used daily in oncology include clinical TNM stage, objective response and left ventricular ejection fraction. Other CT, MRI, PET and ultrasonography biomarkers are used extensively in cancer research and drug development. New IBs need to be established either as useful tools for testing research hypotheses in clinical trials and research studies, or as clinical decision-making tools for use in healthcare, by crossing 'translational gaps' through validation and qualification. Important differences exist between IBs and biospecimen-derived biomarkers and, therefore, the development of IBs requires a tailored 'roadmap'. Recognizing this need, Cancer Research UK (CRUK) and the European Organisation for Research and Treatment of Cancer (EORTC) assembled experts to review, debate and summarize the challenges of IB validation and qualification. This consensus group has produced 14 key recommendations for accelerating the clinical translation of IBs, which highlight the role of parallel (rather than sequential) tracks of technical (assay) validation, biological/clinical validation and assessment of cost-effectiveness; the need for IB standardization and accreditation systems; the need to continually revisit IB precision; an alternative framework for biological/clinical validation of IBs; and the essential requirements for multicentre studies to qualify IBs for clinical use.
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    Increased tryptophan, but not increased glucose metabolism, predict resistance of pembrolizumab in stage III/IV melanoma.
    (Oncoimmunology, 2023-01) Oldan, Jorge D; Giglio, Benjamin C; Smith, Eric; Zhao, Weiling; Bouchard, Deeanna M; Ivanovic, Marija; Lee, Yueh Z; Collichio, Frances A; Meyers, Michael O; Wallack, Diana E; Abernethy-Leinwand, Amber; Long, Patricia K; Trembath, Dimitri G; Googe, Paul B; Kowalski, Madeline H; Ivanova, Anastasia; Ezzell, Jennifer A; Nikolaishvili-Feinberg, Nana; Thomas, Nancy E; Wong, Terence Z; Ollila, David W; Li, Zibo; Moschos, Stergios J
    Clinical trials of combined IDO/PD1 blockade in metastatic melanoma (MM) failed to show additional clinical benefit compared to PD1-alone inhibition. We reasoned that a tryptophan-metabolizing pathway other than the kynurenine one is essential. We immunohistochemically stained tissues along the nevus-to-MM progression pathway for tryptophan-metabolizing enzymes (TMEs; TPH1, TPH2, TDO2, IDO1) and the tryptophan transporter, LAT1. We assessed tryptophan and glucose metabolism by performing baseline C11-labeled α-methyl tryptophan (C11-AMT) and fluorodeoxyglucose (FDG) PET imaging of tumor lesions in a prospective clinical trial of pembrolizumab in MM (clinicaltrials.gov, NCT03089606). We found higher protein expression of all TMEs and LAT1 in melanoma cells than tumor-infiltrating lymphocytes (TILs) within MM tumors (n = 68). Melanoma cell-specific TPH1 and LAT1 expressions were significantly anti-correlated with TIL presence in MM. High melanoma cell-specific LAT1 and low IDO1 expression were associated with worse overall survival (OS) in MM. Exploratory optimal cutpoint survival analysis of pretreatment 'high' vs. 'low' C11-AMT SUVmax of the hottest tumor lesion per patient revealed that the 'low' C11-AMT SUVmax was associated with longer progression-free survival in our clinical trial (n = 26). We saw no such trends with pretreatment FDG PET SUVmax. Treatment of melanoma cell lines with telotristat, a TPH1 inhibitor, increased IDO expression and kynurenine production in addition to suppression of serotonin production. High melanoma tryptophan metabolism is a poor predictor of pembrolizumab response and an adverse prognostic factor. Serotoninergic but not kynurenine pathway activation may be significant. Melanoma cells outcompete adjacent TILs, eventually depriving the latter of an essential amino acid.
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    Pilot Study of [18F] Fluorodeoxyglucose Positron Emission Tomography (FDG-PET)/Magnetic Resonance Imaging (MRI) for Staging of Muscle-invasive Bladder Cancer (MIBC).
    (Clinical genitourinary cancer, 2020-10) Eulitt, Patrick J; Altun, Ersan; Sheikh, Arif; Wong, Terence Z; Woods, Michael E; Rose, Tracy L; Wallen, Eric M; Pruthi, Raj S; Smith, Angela B; Nielsen, Matthew E; Whang, Young E; Kim, William Y; Godley, Paul A; Basch, Ethan M; David, Grace U; Ramirez, Juanita; Deal, Allison M; Rathmell, W Kimryn; Chen, Ronald C; Bjurlin, Marc A; Lin, Weili; Lee, Joseph K; Milowsky, Matthew I

    Introduction

    Computed tomography (CT) has limited diagnostic accuracy for staging of muscle-invasive bladder cancer (MIBC). [18F] Fluorodeoxyglucose positron emission tomography (FDG-PET)/magnetic resonance imaging (MRI) is a novel imaging modality incorporating functional imaging with improved soft tissue characterization. This pilot study evaluated the use of preoperative FDG-PET/MRI for staging of MIBC.

    Patients and methods

    Twenty-one patients with MIBC with planned radical cystectomy were enrolled. Two teams of radiologists reviewed FDG-PET/MRI scans to determine: (1) presence of primary bladder tumor; and (2) lymph node involvement and distant metastases. FDG-PET/MRI was compared with cystectomy pathology and computed tomography (CT).

    Results

    Eighteen patients were included in the final analysis, most (72.2%) of whom received neoadjuvant chemotherapy. Final pathology revealed 10 (56%) patients with muscle invasion and only 3 (17%) patients with lymph node involvement. Clustered analysis of FDG-PET/MRI radiology team reads revealed a sensitivity of 0.80 and a specificity of 0.56 for detection of the primary tumor with a sensitivity of 0 and a specificity of 1.00 for detection of lymph node involvement when compared with cystectomy pathology. CT imaging demonstrated similar rates in evaluation of the primary tumor (sensitivity, 0.91; specificity, 0.43) and lymph node involvement (sensitivity, 0; specificity, 0.93) when compared with pathology.

    Conclusions

    This pilot single-institution experience of FDG-PET/MRI for preoperative staging of MIBC performed similar to CT for the detection of the primary tumor; however, the determination of lymph node status was limited by few patients with true pathologic lymph node involvement. Further studies are needed to evaluate the potential role for FDG-PET/MRI in the staging of MIBC.
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    Reply to "Prognostic Value of Fluorodeoxyglucose-Positron Emission Tomography".
    (J Thorac Oncol, 2015-10) Kwon, Woocheol; Howard, Brandon A; Herndon, James E; Patz, Edward F
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    Task Group 174 Report: Utilization of [18 F]Fluorodeoxyglucose Positron Emission Tomography ([18 F]FDG-PET) in Radiation Therapy.
    (Medical physics, 2019-10) Das, Shiva K; McGurk, Ross; Miften, Moyed; Mutic, Sasa; Bowsher, James; Bayouth, John; Erdi, Yusuf; Mawlawi, Osama; Boellaard, Ronald; Bowen, Stephen R; Xing, Lei; Bradley, Jeffrey; Schoder, Heiko; Yin, Fang-Fang; Sullivan, Daniel C; Kinahan, Paul
    The use of positron emission tomography (PET) in radiation therapy (RT) is rapidly increasing in the areas of staging, segmentation, treatment planning, and response assessment. The most common radiotracer is 18 F-fluorodeoxyglucose ([18 F]FDG), a glucose analog with demonstrated efficacy in cancer diagnosis and staging. However, diagnosis and RT planning are different endeavors with unique requirements, and very little literature is available for guiding physicists and clinicians in the utilization of [18 F]FDG-PET in RT. The two goals of this report are to educate and provide recommendations. The report provides background and education on current PET imaging systems, PET tracers, intensity quantification, and current utilization in RT (staging, segmentation, image registration, treatment planning, and therapy response assessment). Recommendations are provided on acceptance testing, annual and monthly quality assurance, scanning protocols to ensure consistency between interpatient scans and intrapatient longitudinal scans, reporting of patient and scan parameters in literature, requirements for incorporation of [18 F]FDG-PET in treatment planning systems, and image registration. The recommendations provided here are minimum requirements and are not meant to cover all aspects of the use of [18 F]FDG-PET for RT.
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    The QIBA Profile for FDG PET/CT as an Imaging Biomarker Measuring Response to Cancer Therapy.
    (Radiology, 2020-03) Kinahan, Paul E; Perlman, Eric S; Sunderland, John J; Subramaniam, Rathan; Subramaniam, Rathan; Wollenweber, Scott D; Turkington, Timothy G; Lodge, Martin A; Boellaard, Ronald; Obuchowski, Nancy A; Wahl, Richard L
    The Quantitative Imaging Biomarkers Alliance (QIBA) Profile for fluorodeoxyglucose (FDG) PET/CT imaging was created by QIBA to both characterize and reduce the variability of standardized uptake values (SUVs). The Profile provides two complementary claims on the precision of SUV measurements. First, tumor glycolytic activity as reflected by the maximum SUV (SUVmax) is measurable from FDG PET/CT with a within-subject coefficient of variation of 10%-12%. Second, a measured increase in SUVmax of 39% or more, or a decrease of 28% or more, indicates that a true change has occurred with 95% confidence. Two applicable use cases are clinical trials and following individual patients in clinical practice. Other components of the Profile address the protocols and conformance standards considered necessary to achieve the performance claim. The Profile is intended for use by a broad audience; applications can range from discovery science through clinical trials to clinical practice. The goal of this report is to provide a rationale and overview of the FDG PET/CT Profile claims as well as its context, and to outline future needs and potential developments.