Molecular Imaging Insight - June 2008 - (Page 16)

BY MARY C . TIERNEY Clinical Study Digest PET/CT IN ONCOLOGY & CARDIOLOGY METASTATIC BREAST CANCER Bone Metastases in Patients with Metastatic Breast Cancer: Morphologic and Metabolic Monitoring of Response to Systemic Therapy with Integrated PET/CT Radiology: Volume 247: Number 1-April 2008 This retrospective analysis of 102 women (mean age: 55) found that a decrease in attenuation and an increase in standardized uptake value (SUV) of FDG via PET/CT of bone metastases after systemic therapy are associated with a markedly increased risk of disease progression in patients with metastatic breast cancer (MBC). Thus, the study found that a “decrease in SUV of the lesion after systemic therapy was an independent predictor of response duration in patients with MBC who had bone metastasis.” A decrease in SUV of 8.5 percent or more was a significant predictor of a long response duration. In patients deemed responders, the target lesion showed decreased uptake when compared with the same lesion depicted on baseline images. In non-responders, a follow-up exam showed FDG uptake in the target lesion was “substantially increased” or similar to what was seen previously.  HEAD & NECk CANCER Clinical Utility of 18F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer J Nucl Med 2008; 49:532-540 In patients with locoregional advanced head and neck squamous cell carcinoma (HNSCC) who are treated with concurrent chemoradiotherapy, posttreatment 18FFDG PET/CT is effective in excluding residual viable cancer in neck lymph nodes (Negative Predictive Value of 98%), according to a study published in April. The study of 65 patients with a total of 84 heminecks showed that PET/CT is able to reduce false positive findings by more than 50 percent compared with CT alone. PET/CT imaging also assesses the primary tumor site with high accuracy (specificity 95%; NPV 97%) and identifies unexpected early metastatic disease. The authors concluded that planned neck dissection can be safely withheld in patients without residual lymphadenopathy on CT and negative PET. In patients showing residual lymphadenopathy and a normal PET, the NPV is high at more than 90 percent.  GASTRIC CANCER Early Metabolic Response Evaluation by Fluorine-18 Fluorodeoxyglycose Positron Emission Tomography Allows In Vivo Testing of Chemosensitivity in Gastric Cancer: Long-term Results of a Prospective Study  CORONARy ARTERy DISEASE Interrelation of Coronary Calcification, Myocardial Ischemia, and Outcomes in Patients with Intermediate Likelihood of Coronary Artery Disease: A Combined Positron Emission Tomography/Computed Tomography Study Circulation, 2008;117:1693-1700 In the quest to identify patients at risk of ischemic heart disease, a recent study of 621 intermediate-risk patients at Brigham & Women’s Hospital in Boston suggests that PET/CT is more effective than PET myocardial perfusion imaging (MPI). Using PET/ CT to evaluate the anatomic burden of disease by coronary artery calcium (CAC) scores adds “incremental prognostic information over the delineation of myocardial ischemia [via PET] alone in patients with an intermediate pretest likelihood of CAD.” The study also found that even though increasing coronary artery calcium (CAC) content is a general predictor of a higher likelihood of ischemia, its absence does not completely Cardiac PET image eliminate the possibility of flow-limiting courtesy of Technical coronary artery disease. University of Munich.  MolecularImaging.net Clin Cancer Res 2008;14(7), April 1, 2008 In gastric cancer patients, the quantification of tumor 18FFDG uptake “allows prediction of both histopathologic response and treatment success prior to or early in the course of neo-adjuvant treatment,” according to a new German study. Tumor response was predicted with sufficient accuracy by an a priori-defined metabolic response cutoff value of 35 percent. The study found that PET/CT identified patients who were not responding to therapy (specificity 82%; NPV 84%). It also predicted unfavorable outcomes with FDG non-avid tumors as well as a median survival of 36.7 months. The authors recommend: “To improve the response rates and the prognosis of PET nonresponding patients, alternative treatment concepts such as immediate resection after 2 weeks of chemotherapy or adjustment of chemotherapy with or without adjuvant treatment or potentially more intense perioperative chemotherapeutic regimens—possibly including biologically targeted drugs—in initially FDG nonavid tumors should be considered.” 1 Molecular Imaging Insight | June 2008 http://radiology.rsnajnls.org/cgi/content/abstract/247/1/189 http://www.ncbi.nlm.nih.gov/pubmed/18344440 http://clincancerres.aacrjournals.org/cgi/content/abstract/14/7/2012 http://www.ncbi.nlm.nih.gov/pubmed/18362235 http://MolecularImaging.net

Table of Contents Feed for the Digital Edition of Molecular Imaging Insight - June 2008

Molecular Imaging Insight - June 2008 Contents NOPR: A Landmark Study Cover Story: Evidence-based Medicine Points to Wider Role for Molecular Imaging in Patient Care NOPR Delivers Evidence for Expanded PET Use in Oncology Imaging The Balancing Act Nuclear Cardiology’s Next Step Molecular Imaging Training Gaining Traction SPECT/CT’s Role in Post-Transplant Infection Imaging Clinical Study Digest : Heart Disease & Metastatic Breast, Gastric and Head & Neck Cancer

Molecular Imaging Insight - June 2008

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