Anne Winther-Larsen1, Joan Fledelius2, Boe Sandahl Sorensen3, Peter Meldgaard4. 1. Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark. Electronic address: anlarsen@rm.dk. 2. Department of Nuclear Medicine, Herning Regional Hospital, Herning, Denmark. 3. Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark. 4. Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
Abstract
OBJECTIVES: Accurate estimation of the prognosis of advanced non-small cell lung cancer (NSCLC) patients is essential before initiation of palliative treatment; especially in the second and third-line setting. This study was conducted in order to evaluate tumor burden measured on an 2'-deoxy-2'-[18F] fluoro-D-glucose (F-18-FDG) positron emission tomography/computed tomography (PET/CT) scan as a marker of outcome in advanced epidermal growth factor receptor (EGFR) wild-type patients treated with second or third-line erlotinib. MATERIAL AND METHODS: Fifty-one patients were included from a prospectively collected cohort. An F-18-FDG-PET/CT scan was conducted prior to erlotinib treatment and tumor burden was measured in terms of metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Median values of MTV and TLG were used for dichotomization of patients. Survival outcome was compared between groups. RESULTS: MTV and TLG could be measured in 49 patients. High values of MTV and TLG were significantly correlated with shorter PFS (p<0.001 and p=0.027, respectively) and OS (p<0.001 and p=0.002, respectively). In multivariate analyses, including both clinical and imaging data, high MTV and TLG remained strong independent markers of both shorter PFS (MTV, hazard ratio (HR)=5.44 (95% confidence interval (CI) 2.46-12.02); TLG, HR=2.17 (95% CI 1.11-4.26)) and OS (MTV, HR=4.80 (95% CI 2.08-11.06); TLG, HR=2.76 (95% CI 1.33-5.71)). CONCLUSION: High MTV and TLG are independently correlated with shorter PFS and OS in advanced EGFR wild-type NSCLC patients treated with second or third-line erlotinib. Metabolic tumor burden is a highly promising clinical tool that may allow better patient selection for palliative treatment in the future.
OBJECTIVES: Accurate estimation of the prognosis of advanced non-small cell lung cancer (NSCLC) patients is essential before initiation of palliative treatment; especially in the second and third-line setting. This study was conducted in order to evaluate tumor burden measured on an 2'-deoxy-2'-[18F] fluoro-D-glucose (F-18-FDG) positron emission tomography/computed tomography (PET/CT) scan as a marker of outcome in advanced epidermal growth factor receptor (EGFR) wild-type patients treated with second or third-line erlotinib. MATERIAL AND METHODS: Fifty-one patients were included from a prospectively collected cohort. An F-18-FDG-PET/CT scan was conducted prior to erlotinib treatment and tumor burden was measured in terms of metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Median values of MTV and TLG were used for dichotomization of patients. Survival outcome was compared between groups. RESULTS:MTV and TLG could be measured in 49 patients. High values of MTV and TLG were significantly correlated with shorter PFS (p<0.001 and p=0.027, respectively) and OS (p<0.001 and p=0.002, respectively). In multivariate analyses, including both clinical and imaging data, high MTV and TLG remained strong independent markers of both shorter PFS (MTV, hazard ratio (HR)=5.44 (95% confidence interval (CI) 2.46-12.02); TLG, HR=2.17 (95% CI 1.11-4.26)) and OS (MTV, HR=4.80 (95% CI 2.08-11.06); TLG, HR=2.76 (95% CI 1.33-5.71)). CONCLUSION: High MTV and TLG are independently correlated with shorter PFS and OS in advanced EGFR wild-type NSCLCpatients treated with second or third-line erlotinib. Metabolic tumor burden is a highly promising clinical tool that may allow better patient selection for palliative treatment in the future.
Authors: Yonglin Pu; James X Zhang; Haiyan Liu; Daniel Appelbaum; Jianfeng Meng; Bill C Penney Journal: Eur J Nucl Med Mol Imaging Date: 2018-06-07 Impact factor: 9.236
Authors: Paula Lapa; Bárbara Oliveiros; Margarida Marques; Jorge Isidoro; Filipe Caseiro Alves; J M Nascimento Costa; Gracinda Costa; João Pedroso de Lima Journal: Eur J Nucl Med Mol Imaging Date: 2017-08-07 Impact factor: 9.236
Authors: Joan Fledelius; Anne Winther-Larsen; Azza A Khalil; Karin Hjorthaug; Jørgen Frøkiær; Peter Meldgaard Journal: Am J Nucl Med Mol Imaging Date: 2018-02-05
Authors: Kimiteru Ito; Heiko Schöder; Rebecca Teng; John L Humm; Ai Ni; Jedd D Wolchok; Wolfgang A Weber Journal: Eur J Nucl Med Mol Imaging Date: 2018-11-28 Impact factor: 9.236
Authors: Anne Winther-Larsen; Joan Fledelius; Christina Demuth; Catharina M Bylov; Peter Meldgaard; Boe S Sorensen Journal: Transl Oncol Date: 2016-10-29 Impact factor: 4.243
Authors: Anne Winther-Larsen; Christina Demuth; Joan Fledelius; Anne Tranberg Madsen; Karin Hjorthaug; Peter Meldgaard; Boe Sandahl Sorensen Journal: Br J Cancer Date: 2017-07-06 Impact factor: 7.640