Ralph A Bundschuh1, Julia Dinges2, Larissa Neumann2, Martin Seyfried2, Norbert Zsótér3, Laszló Papp3, Robert Rosenberg4, Karen Becker5, Sabrina T Astner6, Martin Henninger7, Ken Herrmann8, Sibylle I Ziegler2, Markus Schwaiger2, Markus Essler9. 1. Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Wuerzburg, Germany Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn, Bonn, Germany bundschuh_r@klinik.uni-wuerzburg.de. 2. Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany. 3. Mediso Medical Imaging Systems Ltd., Budapest, Hungary. 4. Chirurgische Klinik, Kantonsspital Baden, Baden, Switzerland. 5. Institut für Pathologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany. 6. Klinik und Poliklinik für Radioonkolgie und Strahlentherapie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany; and. 7. Institut für Röntgendiagnostik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany. 8. Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Wuerzburg, Germany. 9. Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn, Bonn, Germany.
Abstract
UNLABELLED: (18)F-FDG PET/CT is effective in the assessment of therapy response. Changes in glucose uptake or tumor size are used as a measure. Tumor heterogeneity was found to be a promising predictive and prognostic factor. We investigated textural parameters for their predictive and prognostic capability in patients with rectal cancer using histopathology as the gold standard. In addition, a comparison to clinical outcome was performed. METHODS: Twenty-seven patients with rectal cancer underwent (18)F-FDG PET/CT before, 2 wk after the start, and 4 wk after the completion of neoadjuvant chemoradiotherapy. In all PET/CT scans, conventional parameters (tumor volume, diameter, maximum and mean standardized uptake values, and total lesion glycolysis [TLG]) and textural parameters (coefficient of variation [COV], skewness, and kurtosis) were determined to assess tumor heterogeneity. Values on pretherapeutic PET/CT as well as changes early in the course of therapy and after therapy were compared with histopathologic response. In addition, the prognostic value was assessed by correlation with time to progression and survival time. RESULTS: The COV showed a statistically significant capability to assess histopathologic response early in therapy (sensitivity, 68%; specificity, 88%) and after therapy (79% and 88%, respectively). Thereby, the COV had a higher area under the curve in receiver-operating-characteristic analysis than did any analyzed conventional parameter for early and late response assessment. The COV showed a statistically significant capability to evaluate disease progression and to predict survival, although the latter was not statistically significant. CONCLUSION: Tumor heterogeneity assessed by the COV, being superior to the investigated conventional parameters, is an important predictive factor in patients with rectal cancer. Furthermore, it can provide prognostic information. Therefore, its application is an important step for personalized treatment of rectal cancer.
UNLABELLED: (18)F-FDG PET/CT is effective in the assessment of therapy response. Changes in glucose uptake or tumor size are used as a measure. Tumor heterogeneity was found to be a promising predictive and prognostic factor. We investigated textural parameters for their predictive and prognostic capability in patients with rectal cancer using histopathology as the gold standard. In addition, a comparison to clinical outcome was performed. METHODS: Twenty-seven patients with rectal cancer underwent (18)F-FDG PET/CT before, 2 wk after the start, and 4 wk after the completion of neoadjuvant chemoradiotherapy. In all PET/CT scans, conventional parameters (tumor volume, diameter, maximum and mean standardized uptake values, and total lesion glycolysis [TLG]) and textural parameters (coefficient of variation [COV], skewness, and kurtosis) were determined to assess tumor heterogeneity. Values on pretherapeutic PET/CT as well as changes early in the course of therapy and after therapy were compared with histopathologic response. In addition, the prognostic value was assessed by correlation with time to progression and survival time. RESULTS: The COV showed a statistically significant capability to assess histopathologic response early in therapy (sensitivity, 68%; specificity, 88%) and after therapy (79% and 88%, respectively). Thereby, the COV had a higher area under the curve in receiver-operating-characteristic analysis than did any analyzed conventional parameter for early and late response assessment. The COV showed a statistically significant capability to evaluate disease progression and to predict survival, although the latter was not statistically significant. CONCLUSION:Tumor heterogeneity assessed by the COV, being superior to the investigated conventional parameters, is an important predictive factor in patients with rectal cancer. Furthermore, it can provide prognostic information. Therefore, its application is an important step for personalized treatment of rectal cancer.
Authors: Matthew J Nyflot; Fei Yang; Darrin Byrd; Stephen R Bowen; George A Sandison; Paul E Kinahan Journal: J Med Imaging (Bellingham) Date: 2015-08-05
Authors: Charles Lemarignier; Antoine Martineau; Luis Teixeira; Laetitia Vercellino; Marc Espié; Pascal Merlet; David Groheux Journal: Eur J Nucl Med Mol Imaging Date: 2017-02-10 Impact factor: 9.236
Authors: Rudolf A Werner; Matthias Kroiss; Masatoyo Nakajo; Dirk O Mügge; Stefanie Hahner; Martin Fassnacht; Andreas Schirbel; Christina Bluemel; Takahiro Higuchi; Laszló Papp; Norbert Zsótér; Andreas K Buck; Ralph A Bundschuh; Constantin Lapa Journal: Endocrine Date: 2016-05-02 Impact factor: 3.633