513 Objectives FDG-PET/CT is widely used for initial staging or therapeutic assessment of HNSCC. Its prognostic value has been shown by tumor SUVmax measured at initial staging but without real established cut-off. SUL (lean body mass corrected SUV) peak corresponding to the highest possible mean value of a 1 cm3 spherical VOI positioned within the tumor has been recently defined as the optimal parameter for therapeutic evaluation by PERCIST recommendations but its predictive value of survival has never been studied. The aim of this study was to compare the prognostic interest of SULpeak and SUVmax on pretreatment FDG-PET/CT in patients with HNSCC. Methods Patients referred to our department to perform FDG-PET/CT at staging of HNSCC were prospectively included in the study. SULpeak and SUVmax were determined on tumor using a semi-automatic quantification tool (Syngo.via software, Siemens®). Different discrete values between 3 and 15 were evaluated with log-rank test to determine the best prognostic cut-off point. Kaplan-Meier methods were used to estimate event free survival (EFS) and overall survival (OS). Results 80 consecutive patients (70M/10F) (mean +/- sd age; 62.7 +/- 9.1 yo) were included. Mean +/- sd SULpeak and SUVmax were respectively 7.7 +/- 4.7 (median 6.5; range 1.3-22.8) and 9.5 +/- 5.6 (median 8.1; range 1.6-25.5). Mean follow-up +/- sd was 20.9 +/- 13.9 months. For EFS analysis, the lowest p-value was found for a threshold of 7 (p Conclusions Our results suggest no additional prognostic value of tumor SULpeak in comparison with SUVmax on pretreatment FDG-PET/CT in patients with HNSCC.
Abstract O -(2-[ 18 F]fluoroethyl)- l -tyrosine positron-emission tomography/computed tomography ( 18 F-FET PET/CT) is well known in brain tumor management. Our study aimed to identify the prognostic value of 18 F-FET PET/CT in high-grade gliomas (HGG) according the current 2016 World Health Organization (WHO) classification. Patients with histologically proven WHO 2016 HGG were prospectively included. A dynamic 18 F-FET PET/CT was performed allowing to obtain 2 static PET frames (static frame 1: 20–40 minutes and static frame 2: 2–22 minutes). We analyzed static parameters (standard uptake value [SUV]max, SUVmean, SUVpeak, TBRmax, TBRmean, tumoral lesion glycolysis, and metabolic tumoral volume) for various isocontours (from 10% to 90%). PET parameters, clinical features, and molecular biomarkers were compared with progression-free survival (PFS) and overall survival (OS) in univariate and multivariate analysis. Twenty-nine patients were included (grade III n = 3, grade IV n = 26). Mean PFS and OS were, respectively, 8.8 and 13.9 months. According to univariate analysis, SUVmean, SUVpeak, TBRmax, and TBRmean were significantly correlated with OS. In static 1 analysis, TBRmax seemed to be the best OS prognostic parameter ( P = .004). In static 2 analysis, TBRmean was the best parameter ( P = .01). In static 1 analysis, only SUVpeak was significant ( P = .05) for PFS. Good performance status (PS < 2; P < .0001) and extent of resection ( P = .019) identified the subgroup of patients with the best OS. Only TBRmax ( P = .026) and extent of resection ( P = .025) remained significant parameters in multivariate analysis. Our data suggested that high TBRmax seemed to be the most significant OS independent prognostic factor in patients with newly diagnosed HGG.
Abstract Paclitaxel-ramucirumab chemotherapy is indicated in second line of metastatic gastroesophageal junction cancer (mGEJC) after progression under platinum–5-FU chemotherapy. Nevertheless, the reported common response after treatment is only partial within series. To date, only 1 case report of negative posttreatment FDG PET/CT was published without baseline examination from RAINBOW trial. We illustrated the interest of FDG PET/CT to evaluate treatment especially paclitaxel-ramucirumab with 2 examples of complete metabolic responses in 2 patients having different HER2 biomarker profiles of mGEJC. As illustrated, FDG PET/CT emerges as a useful approach for therapeutic assessment of targeted drugs in mGEJC.
1520 Objectives The use of SPECT/CT has been shown to increase the diagnostic performance of bone scintigraphy for staging of malignancies. A systematic whole body (WB) SPECT/CT may allow further improvement. However, this would be balanced by higher dosimetry and longer acquisition time. The aim of this study was to assess the incremental diagnostic utility of a systematic WB SPECT/CT acquisition for bone scintigraphy in initial staging of cancer patients. Methods Consecutive patients referred for bone scintigraphy for initial staging of malignancy from February to June 2014 were analyzed. All patients underwent a two-bed WB SPECT/CT acquisition of the trunk (from the cervical spine to the proximal femora) on a Symbia/Intevo T6 gamma-camera. Images were interpreted by two nuclear medicine physicians in a 3-step procedure. Firstly, only WB planar images were used; secondly, one additional single bed SPECT/CT chosen based on planar images was used; finally, WB planar and SPECT/CT images were available for interpretation. Lesions were classified as benign, equivocal or suspicious for metastasis. A per-lesion, per-anatomical region and per-patient analysis was performed. Results 102 patients were analyzed (prostate n = 67, breast n = 17, lung n = 6, bladder n = 6, kidney n = 4, other n = 2). In a per-lesion analysis, the number of equivocal and suspicious lesions was 91 and 241 using WB planar images, 17 and 259 using a single-bed SPECT/CT acquisition and 11 and 269 using WB SPECT/CT images, respectively. In a per-anatomical region analysis, the number of equivocal and suspicious regions was 67 and 57 using WB planar images, 10 and 63 using one single-bed SPECT/CT and 7 and 71 using WB SPECT/CT, respectively. In a per-patient analysis, the diagnostic conclusion was “no evidence of disease”, “equivocal” or “evidence of disease” in 35, 53 and 14 patients using WB planar images, 77, 6 and 19 patients using an additional single-bed SPECT/CT and 76, 7 and 19 using WB SPECT/CT images, respectively. Only one patient had a different diagnostic conclusion based on systematic WB SPECT/CT (equivocal scan) as compared with the single-bed SPECT/CT (no evidence of disease). Guided biopsy of the equivocal lesion did not show malignancy. Conclusions As previously demonstrated, adding a single-bed SPECT/CT to whole body planar bone scintigraphy reduced the proportion of indeterminate results for initial staging of malignancy.
Although a systematic WB SPECT/CT acquisition slightly increased the number of suspicious anatomical regions as compared with one single bed SPECT/CT acquisition, there was no benefit in terms of patient’s management, the only discrepancy resulting in an unnecessary biopsy. Further taking into account dosimetric considerations and acquisition time, it does not appear to have an incremental diagnostic utility to perform a systematic WB SPECT/CT acquisition for bone scintigraphy in initial staging of cancer patients.
