Abstract
During the past 10 years, positron emission tomography with the glucose analog fluorodeoxyglucose (FDG PET) has evolved from a research tool to a clinical test that is used for diagnosis and staging of a variety of malignant tumors. More recently FDG PET has been evaluated for monitoring tumor response to therapy. Most of these studies have used FDG PET after completion of therapy in order to differentiate between viable tumor and therapy-induced fibrosis. However, there are also encouraging data that FDG PET may be used to predict tumor response during therapy. This chapter summarizes the results of recent studies on treatment monitoring by FDG PET and discusses potential clinical applications. Different approaches for quantitative analysis of FDG PET studies are also reviewed, since monitoring tumor response by FDG PET frequently relies on quantifying tumor metabolic activity over time. To put the results achieved by FDG PET in a more general context, the current clinical practice of assessing tumor response and its scientific background are briefly discussed.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer 1981;47:207–214.
Moertel CG, Hanley JA. The effect of measuring error on the results of therapeutic trials in advanced cancer. Cancer 1976;38:388–394.
Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92:205–216.
Salzer-Kuntschik M, Delling G, Beron G, Sigmund R. Morphological grades of regression in osteosarcoma after polychemotherapy—-study COSS 80. J Cancer Res Clin Oncol 1983;106(Suppl):21–24.
Junker K, Langner K, Klinke F, Bosse U, Thomas M. Grading of tumor regression in non-small cell lung cancer: Morphology and prognosis. Chest 2001;120:1584–1591.
Mandard A, Dalibard F, Mandard J, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 1994;73:2680–2686.
Becker K, Mueller JD, Schulmacher C, et al. Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy. Cancer 2003;98:1521–1530.
Bielack SS, Kempf-Bielack B, Delling G, et al. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: An analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 2002;20:776–790.
Wieder HA, Brucher BL, Zimmermann F, et al. Time course of tumor metabolic activity during chemoradiotherapy of esophageal squamous cell carcinoma and response to treatment. J Clin Oncol 2004;22:900–908.
Thie JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med 2004;45:1431–1434.
Geworski L, Knoop BO, de Cabrejas ML, Knapp WH, Munz DL. Recovery correction for quantitation in emission tomography: A feasibility study. Eur J Nucl Med 2000;27:161–169.
Stahl A, Ott K, Schwaiger M, Weber WA. Comparison of different SUV-based methods for monitoring cytotoxic therapy with FDG PET. Eur J Nucl Med Mol Imaging 2004;31:1471–1478.
Torizuka T, Clavo AC, Wahl RL. Effect of hyperglycemia on in vitro tumor uptake of tritiated FDG, thymidine, L-methionine and L-leucine. J Nucl Med 1997;38:382–386.
Keyes JW Jr. SUV: Standard uptake or silly useless value? J Nucl Med 1995;36:1836–1839.
Boellaard R, Krak NC, Hoekstra OS, Lammertsma AA. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: A simulation study. J Nucl Med 2004;45:1519–1527.
Paquet N, Albert A, Foidart J, Hustinx R. Within-patient variability of (18)F-FDG: Standardized uptake values in normal tissues. J Nucl Med 2004;45:784–788.
Young H, Baum R, Cremerius U, et al. Measurement of clinical and sublinical tumour response using F-18-fluorodeoxyglucose and positron emission tomography: Review and 1999 EORTC recommendations. Eur J Cancer 1999;35:1773–1782.
Minn H, Zasadny KR, Quint LE, Wahl RL. Lung cancer: Reproducibility of quantitative measurements for evaluating 2-[F-18]-fluoro-2-deoxy-D-glucose uptake at PET. Radiology 1995;196:167–173.
Weber WA, Ziegler SI, Thodtmann R, Hanauske AR, Schwaiger M. Reproducibility of metabolic measurements in malignant tumors using FDG PET. J Nucl Med 1999;40:1771–1777.
Weber WA, Petersen V, Schmidt B, et al. Positron emission tomography in non-small-cell lung cancer: Prediction of response to chemotherapy by quantitative assessment of glucose use. J Clin Oncol 2003;21:2651–2657.
Yamane T, Daimaru O, Ito S, Yoshiya K, Nagata T, Uchida H. Decreased 18F-FDG uptake 1 day after initiation of chemotherapy for malignant lymphomas. J Nucl Med 2004;45:1838–1842.
Kostakoglu L, Coleman M, Leonard JP, Kuji I, Zoe H, Goldsmith SJ. PET predicts prognosis after 1 cycle of chemotherapy in aggressive lymphoma and Hodgkin’s disease. J Nucl Med 2002;43:1018–1027.
Weber W, Dick S, Reidl G, et al. Correlation between postoperative 123I-alpha-methyl-L-tyrosine uptake and survival in patients with gliomas. J Nucl Med 2001;42:1144–1150.
Ott K, Fink U, Becker K, et al. Prediction of response to preoperative chemotherapy in gastric carcinoma by metabolic imaging: Results of a prospective trial. J Clin Oncol 2003;21:4604–4610.
Brun E, Kjellen E, Tennvall J, et al. FDG PET studies during treatment: Prediction of therapy outcome in head and neck squamous cell carcinoma. Head Neck 2002;24:127–135.
Haberkorn U, Morr I, Oberdorfer F, et al. Fluorodeoxyglucose uptake in vitro: Aspects of method and effects of treatment with gemcitabine. J Nucl Med 1994;35:1842–1850.
Higashi K, Clavo AC, Wahl RL. In vitro assessment of 2-fluoro-2-deoxy-D-glucose, L-methionine and thymidine as agents to monitor the early response of a human adenocarcinoma cell line to radiotherapy [see comments]. J Nucl Med 1993;34:773–779.
Rozental JM, Levine RL, Nickles RJ, Dobkin JA. Glucose uptake by gliomas after treatment. A positron emission tomographic study [see comments]. Arch Neurol 1989;46:1302–1307.
Maruyama I, Sadato N, Waki A, et al. Hyperacute changes in glucose metabolism of brain tumors after stereotactic radiosurgery: A PET study. J Nucl Med 1999;40:1085–1090.
Mortimer JE, Dehdashti F, Siegel BA, Trinkaus K, Katzenellenbogen JA, Welch MJ. Metabolic flare: Indicator of hormone responsiveness in advanced breast cancer. J Clin Oncol 2001;19:2797–2803.
Hicks RJ, Mac Manus MP, Matthews JP, et al. Early FDG PET imaging after radical radiotherapy for non-small-cell lung cancer: Inflammatory changes in normal tissues correlate with tumor response and do not confound therapeutic response evaluation. Int J Radiat Oncol Biol Phys 2004;60:412–418.
Jerusalem G, Beguin Y, Fassotte MF, et al. Whole-body positron emission tomography using 18F-fluorodeoxyglucose for posttreatment evaluation in Hodgkin’s disease and non-Hodgkin’s lymphoma has higher diagnostic and prognostic value than classical computed tomography scan imaging. Blood 1999;94:429–433.
Zinzani PL, Fanti S, Battista G, et al. Predictive role of positron emission tomography (PET) in the outcome of lymphoma patients. Br J Cancer 2004;91:850–854.
de Wit M, Bohuslavizki KH, Buchert R, Bumann D, Clausen M, Hossfeld DK. 18FDG PET following treatment as valid predictor for disease-free survival in Hodgkin’s lymphoma. Ann Oncol 2001;12:29–37.
Weihrauch MR, Re D, Scheidhauer K, et al. Thoracic positron emission tomography using 18Ffluorodeoxyglucose for the evaluation of residual mediastinal Hodgkin disease. Blood 2001;98:2930–2934.
Mikhaeel NG, Timothy AR, O’Doherty MJ, Hain S, Maisey MN. 18-FDG PET as a prognostic indicator in the treatment of aggressive non-Hodgkin’s lymphoma-comparison with CT. Leuk Lymphoma 2000;39:543–553.
Spaepen K, Stroobants S, Dupont P, et al. Prognostic value of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose ([18F]FDG) after first-line chemotherapy in non-Hodgkin’s lymphoma: Is [18F]FDG PET a valid alternative to conventional diagnostic methods? J Clin Oncol 2001;19:414–419.
Spaepen K, Stroobants S, Dupont P, et al. Prognostic value of pretransplantation positron emission tomography using fluorine 18-fluorodeoxyglucose in patients with aggressive lymphoma treated with high-dose chemotherapy and stem cell transplantation. Blood 2003;102:53–59.
Schot B, van Imhoff G, Pruim J, Sluiter W, Vaalburg W, Vellenga E. Predictive value of early 18F-fluoro-deoxyglucose positron emission tomography in chemosensitive relapsed lymphoma. Br J Haematol 2003;123:282–287.
Brucher BL, Weber W, Bauer M, et al. Neoadjuvant therapy of esophageal squamous cell carcinoma: Response evaluation by positron emission tomography. Ann Surg 2001;233:300–309.
Flamen P, Van Cutsem E, Lerut A, et al. Positron emission tomography for assessment of the response to induction chemotherapy in locally advanced esophageal cancer. Ann Oncol 2002;13:361–368.
Downey RJ, Akhurst T, Ilson D, et al. Whole body 18FDG PET and the response of esophageal cancer to induction therapy: Results of a prospective trial. J Clin Oncol 2003;21:428–432.
Swisher SG, Maish M, Erasmus JJ, et al. Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer. Ann Thorac Surg 2004;78:1152–1160; discussion 1152–1160.
Swisher SG, Erasmus J, Maish M, et al. 2-Fluoro-2-deoxy-D-glucose positron emission tomography imaging is predictive of pathologic response and survival after preoperative chemoradiation in patients with esophageal carcinoma. Cancer 2004;101:1776–1785.
Mac Manus MP, Hicks RJ, Matthews JP, et al. Positron emission tomography is superior to computed tomography scanning for response-assessment after radical radiotherapy or chemoradiotherapy in patients with non-small-cell lung cancer. J Clin Oncol 2003;21:1285–1292.
Hellwig D, Graeter TP, Ukena D, Georg T, Kirsch CM, Schafers HJ. Value of F-18-fluorodeoxyglucose positron emission tomography after induction therapy of locally advanced bronchogenic carcinoma. J Thorac Cardiovasc Surg 2004;128:892–899.
Akhurst T, Downey RJ, Ginsberg MS, et al. An initial experience with FDG PET in the imaging of residual disease after induction therapy for lung cancer. Ann Thorac Surg 2002;73:259–264; discussion 264–266.
Ryu JS, Choi NC, Fischman AJ, Lynch TJ, Mathisen DJ. FDG PET in staging and restaging non-small cell lung cancer after neoadjuvant chemoradiotherapy: Correlation with histopathology. Lung Cancer 2002;35:179–187.
Cerfolio RJ, Bryant AS, Winokur TS, Ohja B, Bartolucci AA. Repeat FDG PET after neoadjuvant therapy is a predictor of pathologic response in patients with non-small cell lung cancer. Ann Thorac Surg 2004;78:1903–1909; discussion 1909.
Port JL, Kent MS, Korst RJ, Keresztes R, Levin MA, Altorki NK. Positron emission tomography scanning poorly predicts response to preoperative chemotherapy in non-small cell lung cancer. Ann Thorac Surg 2004;77:254–259; discussion 259.
Grigsby PW, Siegel BA, Dehdashti F, Rader J, Zoberi I. Posttherapy [18F] fluorodeoxyglucose positron emission tomography in carcinoma of the cervix: Response and outcome. J Clin Oncol 2004;22:2167–2171.
Schuetze SM, Rubin BP, Vernon C, et al. Use of positron emission tomography in localized extremity soft tissue sarcoma treated with neoadjuvant chemotherapy. Cancer 2005;103:339–348.
Schulte M, Brecht-Krauss D, Werner M, et al. Evaluation of neoadjuvant therapy response of osteogenic sarcoma using FDG PET. J Nucl Med 1999;40:1637–1643.
Hawkins DS, Rajendran JG, Conrad EU 3rd, Bruckner JD, Eary JF. Evaluation of chemotherapy response in pediatric bone sarcomas by [F-18]-fluorodeoxy-D-glucose positron emission tomography. Cancer 2002;94:3277–3284.
Kunkel M, Forster GJ, Reichert TE, et al. Radiation response non-invasively imaged by [18F]FDG PET predicts local tumor control and survival in advanced oral squamous cell carcinoma. Oral Oncol 2003;39:170–177.
Kumar R, Xiu Y, Potenta S, et al. 18F-FDG PET for evaluation of the treatment response in patients with gastrointestinal tract lymphomas. J Nucl Med 2004;45:1796–1803.
Wahl RL, Zasadny K, Helvie M, Hutchins GD, Weber B, Cody R. Metabolic monitoring of breast cancer chemohormonotherapy using positron emission tomography: Initial evaluation. J Clin Oncol 1993;11:2101–2111.
Jansson T, Westlin JE, Ahlstrom H, Lilja A, Langstrom B, Bergh J. Positron emission tomography studies in patients with locally advanced and/or metastatic breast cancer: A method for early therapy evaluation? J Clin Oncol 1995;13:1470–1477.
Findlay M, Young H, Cunningham D, et al. Noninvasive monitoring of tumor metabolism using fluorodeoxyglucose and positron emission tomography in colorectal cancer liver metastases: Correlation with tumor response to fluorouracil. J Clin Oncol 1996;14:700–708.
Schiller JH, Harrington D, Belani CP, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 2002;346:92–98.
Haringhuizen A, van Tinteren H, Vaessen HF, Baas P, van Zandwijk N. Gefitinib as a last treatment option for non-small-cell lung cancer: Durable disease control in a subset of patients. Ann Oncol 2004;15:786–792.
Fukuoka M, Yano S, Giaccone G, et al. Multi-institutional randomized phase II trial of gefitinib for previously treated patients with advanced non-small-cell lung cancer. J Clin Oncol 2003;21:2237–2246.
Honkoop AH, van Diest PJ, de Jong JS, et al. Prognostic role of clinical, pathological and biological characteristics in patients with locally advanced breast cancer. Br J Cancer 1998;77:621–626.
Smith IC, Welch AE, Hutcheon AW, et al. Positron emission tomography using [(18)F]-fluorodeoxy-D-glucose to predict the pathologic response of breast cancer to primary chemotherapy. J Clin Oncol 2000;18:1676–1688.
Schelling M, Avril N, Nahrig J, et al. Positron emission tomography using [(18)F]fluorodeoxyglucose for monitoring primary chemotherapy in breast cancer. J Clin Oncol 2000;18:1689–1695.
Mankoff DA, Dunnwald LK, Gralow JR, et al. Changes in blood flow and metabolism in locally advanced breast cancer treated with neoadjuvant chemotherapy. J Nucl Med 2003;44:1806–1814.
Kelsen DP, Minsky B, Smith M, et al. Preoperative therapy for esophageal cancer: A randomized comparison of chemotherapy versus radiation therapy. J Clin Oncol 1990;8:1352–1361.
Medical_Research_Council. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: A randomised controlled trial. Lancet 2002;359:1727–1733.
Kelsen D. Preoperative chemoradiotherapy for esophageal cancer. J Clin Oncol 2001;19:283–285.
Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 2001;19:305–313.
Ajani JA, Mansfield PF, Lynch PM, et al. Enhanced staging and all chemotherapy preoperatively in patients with potentially resectable gastric carcinoma. J Clin Oncol 1999;17:2403–2411.
Weber WA, Ott K, Becker K, et al. Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol 2001;19:3058–3065.
Lordick F, Weber WA, Stein HJ, et al. Individualized neoadjuvant treatment strategy in adenocarcinoma of the esophago-gastric junction (AEG): Interim report on the MUNICON trial. J Clin Oncol 2004;22:328S.
Sawyers C. Targeted cancer therapy. Nature 2004;432:294–297.
Whiteman EL, Cho H, Birnbaum MJ. Role of Akt/protein kinase B in metabolism. Trends Endocrinol Metab 2002;13:444–451.
Blume-Jensen P, Hunter T. Oncogenic kinase signalling. Nature 2001;411:355–365.
Van den Abbeele AD, Badawi RD. Use of positron emission tomography in oncology and its potential role to assess response to imatinib mesylate therapy in gastrointestinal stromal tumors (GISTs). Eur J Cancer 2002;38(Suppl 5):S60–S65.
Antoch G, Kanja J, Bauer S, et al. Comparison of PET, CT, and dual-modality PET/CT imaging for monitoring of imatinib (STI571) therapy in patients with gastrointestinal stromal tumors. J Nucl Med 2004;45:357–365.
Gayed I, Vu T, Iyer R, et al. The role of 18F-FDG PET in staging and early prediction of response to therapy of recurrent gastrointestinal stromal tumors. J Nucl Med 2004;45:17–21.
Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 2002;347:472–480.
Stroobants S, Goeminne J, Seegers M, et al. 18FDG-Positron emission tomography for the early prediction of response in advanced soft tissue sarcoma treated with imatinib mesylate (Glivec). Eur J Cancer 2003;39:2012–2020.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Humana Press Inc., Totowa, NJ
About this chapter
Cite this chapter
Weber, W.A. (2007). [18F]Fluorodeoxyglucose Positron Emission Tomography Assessment of Response. In: Shields, A.F., Price, P. (eds) In Vivo Imaging of Cancer Therapy. Cancer Drug Discovery and Development. Humana Press. https://doi.org/10.1007/978-1-59745-341-7_7
Download citation
DOI: https://doi.org/10.1007/978-1-59745-341-7_7
Publisher Name: Humana Press
Print ISBN: 978-1-58829-633-7
Online ISBN: 978-1-59745-341-7
eBook Packages: MedicineMedicine (R0)