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18F-FDG PET/CT for monitoring anti-PD-1 therapy in patients with non-small cell lung cancer using SUV harmonization of results obtained with various types of PET/CT scanners used at different centers

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Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

The prognostic value of treatment response in patients with non-small cell lung cancer (NSCLC) treated with immune-checkpoint inhibitors (ICIs) shown by 18F-fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) results obtained with multiple types of PET scanners using standardized uptake value (SUV) harmonization was evaluated.

Methods

Fifty-eight patients treated with ICIs who underwent 18F-FDG PET/CT examinations with nine types of PET scanners at six hospitals were enrolled. SUV harmonization of multiple PET scanner results was performed using the dedicated software packages “RAVAT” and “RC Tool for Harmonization”. Tumor response was assessed by change in sum of harmonized SUVmax, according to the European Organization for Research and Treatment of Cancer (EORTC5) or the SUV of up to five lesions normalized to lean body mass, according to the PET Response Criteria in Solid Tumors (PERCIST5) and immunotherapy-modified PERCIST (imPERCIST5) criteria. The correlation between tumor response according to those three definitions and overall survival (OS) was evaluated and compared to known prognostic factors.

Results

One-year OS in responders and non-responders for harmonized EROTC5 was 86 and 32%, for harmonized PERCIST5 was 86 and 32%, and for harmonized imPERCIST5 was 80 and 30%, respectively (each p = 0.001). Univariate analysis showed that all response criteria remained as prognostic factors. However, there was an overlap for the categories stable metabolic disease (SMD) and progression metabolic disease (PMD) in survival curves using the PET treatment response criteria.

Conclusion

In patients with NSCLC treated with ICIs, tumor response based on the harmonized response criteria was associated with OS. PET response criteria using harmonized metabolic parameters may be difficult to routinely employ in daily practice due to overlapping SMD and PMD, although may have a supporting role for determining prognosis.

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Acknowledgements

The authors wish to express gratefulness to Dr. Hidehito Horinouchi, Dr. Haruhisa Saito and Prof. Kozo Kuribayashi for their kind support of our work.

Funding

This work was supported by a working group grant from the Japanese Society of Nuclear Medicine (No. 2019-1).

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Kimiteru Ito

  2. Division of Nuclear Medicine and PET Center, Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Kazuhiro Kitajima

  3. PET Imaging Center, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan

    Akira Toriihara

  4. Division of Radiology, Department of Pathophysiological and Therapeutic Sciences, Tottori University, 86 Nishi-cho, Yonago, Tottori, 683-8503, Japan

    Mana Ishibashi

  5. Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Tadaki Nakahara

  6. Graduate School of Radiological Technology, Gunma Prefectural College of Health Science, 323-1 Kamioki machi, Maebashi, Gunma, 371-0052, Japan

    Hiromitsu Daisaki

  7. Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yuichiro Ohe

  8. Department of Respiratory Medicine, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan

    Ryoichi Honda

  9. Department of Respiratory Medicine and Hematology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Takashi Kijima

  10. Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Seiki Hasegawa

  11. Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan

    Masatoyo Nakajo

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  1. Kimiteru Ito
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  9. Takashi Kijima
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Correspondence to Kimiteru Ito.

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Ito, K., Kitajima, K., Toriihara, A. et al. 18F-FDG PET/CT for monitoring anti-PD-1 therapy in patients with non-small cell lung cancer using SUV harmonization of results obtained with various types of PET/CT scanners used at different centers. Ann Nucl Med 35, 1253–1263 (2021). https://doi.org/10.1007/s12149-021-01667-8

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  • DOI: https://doi.org/10.1007/s12149-021-01667-8

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