Research ArticlePersonalizing Cancer Therapy with FDG PET: From RECIST to PERCIST

Radiopharmaceuticals in Preclinical and Clinical Development for Monitoring of Therapy with PET

Mark P.S. Dunphy and Jason S. Lewis
Journal of Nuclear Medicine May 2009, 50 (Suppl 1) 106S-121S; DOI: https://doi.org/10.2967/jnumed.108.057281

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    (A) 18F-FLT. (B) 18F-FMAU.

  • FIGURE 2. 
    FIGURE 2. 

    Newly diagnosed glioblastoma. (A) MRI (contrast-enhanced T1-weighted image) shows large area of contrast enhancement in right frontal lobe. (B and C) Both 18F-FDG PET (B) and 18F-FLT PET (C) show increased uptake in same area. (Reprinted with permission of (189).)

  • FIGURE 3. 
    FIGURE 3. 

    (A) 64Cu-ATSM. (B) 18F-FMISO.

  • FIGURE 4. 
    FIGURE 4. 

    Progression-free survival (left) and cause-specific survival (right) determined from 60Cu-ATSM uptake by Kaplan–Meier method. ○ = event in patients with T/M of ≤3.5; ▿ = event in patients with T/M of >3.5. (Reprinted with permission of (83).)

  • FIGURE 5. 
    FIGURE 5. 

    (A) Transaxial CT (top left) and 18F-FDG PET (top right) images of pelvis show intense 18F-FDG uptake within known cervical tumor at site of cervical mass seen on CT. Transaxial 30- to 60-min summed images of 60Cu-ATSM PET (bottom left) and 64Cu-ATSM PET (bottom right) of pelvis at same level demonstrate mildly increased uptake within known primary cervical tumor. There are similar patterns of 60Cu-ATSM and 64Cu-ATSM uptake within tumor. (B) Transaxial coregistered 18F-FDG PET/CT (top left) and 18F-FDG PET (top right) images of pelvis show intense 18F-FDG uptake within known cervical tumor at site of cervical mass seen on CT. Transaxial 30- to 60-min summed images of 60Cu-ATSM PET (bottom left) and 64Cu-ATSM PET (bottom right) of pelvis at same level demonstrate markedly increased uptake within known primary cervical tumor. There are similar patterns of 60Cu-ATSM and 64Cu-ATSM uptake within tumor. (Reprinted with permission of (86).)

  • FIGURE 6. 
    FIGURE 6. 

    (A and B) Bifrontal glioblastoma multiforme imaged after biopsy in 55-y-old woman. (A) MRI (gadolinium-enhanced T1-weighted image [T1Gd]) shows large, contrast-enhancing, irregular ring-shaped tumor with necrotic center. Non–contrast-enhanced volume was 20 cm3, T1Gd volume was 80 cm3, and T2-weighted volume was 167 cm3. (B) 18F-FMISO image through same plane. HV was 129 cm3, and T/Bmax ratio was 3.0. (C and D) Left temporal glioblastoma multiforme imaged after gross total resection in 53-y-old man. (C) MRI (T1Gd) shows only blood products and no residual contrast-positive disease. Non–contrast-enhanced volume was 1 cm3, T1Gd volume was 7 cm3, and T2-weighted volume was 37 cm3. (D) 18F-FMISO image through same plane. HV was 5.3 cm3, and T/Bmax ratio was 1.6. (Reprinted with permission of (97).)

  • FIGURE 7. 
    FIGURE 7. 

    Imaging of 49-y-old woman who had been previously treated for glioblastoma multiforme with tumor resection and conventional radiotherapy at dose of 60 Gy. (A) T1-weighted MR image obtained with contrast medium 13 mo after initial surgery showed contrast-enhanced lesion in left frontal lobe. (B) 11C-MET PET image showed obvious accumulation of tracer corresponding to abnormality on MR image. Mean lesion-to-normal tissue ratio was 1.70. Recurrent tumor was pathologically confirmed by second surgery. (Reprinted with permission of (106).)

  • FIGURE 8. 
    FIGURE 8. 

    (A) 18F-FES. (B) 18F-FDHT.

  • FIGURE 9. 
    FIGURE 9. 

    Baseline tumor 18F-FES (left) and percentage change in tumor 18F-FDG (right) uptake after estradiol challenge in patients who responded and patients who did not respond to endocrine therapy. (Reprinted with permission of (140).)

  • FIGURE 10. 
    FIGURE 10. 

    18F-FDHT (A) and 18F-FDG (B) scans displayed in maximum-intensity-projection format. This figure demonstrates the contrasting metabolism of the 2 tracers in a patient with metastatic prostate cancer. (Reprinted with permission of (158).)

Tables

  • TABLE 1

    Selected Clinical Studies Using Molecular Probes Other Than 18F-FDG for Monitoring of Therapy with PET

    AgentTumor type or stageAuthorsYearNo. of patientsCriteria for response on PETOutcome measuresHazard ratioP
    18F-FLTRecurrent malignant gliomaChen et al. (57)200719SUV decrease of 25%Overall survival and TTP5.00.02
    18F-FLTRectal cancerWieder et al. (55)200710% decrease in SUV*Histopathologic response (<10% residual tumor)NRNS
    18F-FLTLymphomaHerrmann et al. (58)200714Posttherapy SUV*Complete vs. partial responseNR0.009
    18F-FLTLymphomaKasper et al. (47)200748SUV < 1.5Overall survivalNR0.016
    60Cu-ATSMNon–small cell lung cancer, IA–IVDehdashti et al. (84)200314T/M < 3.0Response to therapyNR0.002
    60Cu-ATSMCervical cancer, Ib1–IVaDehdashti et al. (83)200838T/M < 3.5Progression-free survivalNR0.01
    60Cu-ATSMRectal cancer, T2–T4Dietz et al. (85)200817T/M < 2.6Progression-free survivalNR0.05
    18F-FMISOHead and neck cancerRajendran et al. (96)200673T/Bmax ratio > 1.6†Overall survival1.680.002
    18F-FMISOGlioblastoma multiformeSpence et al. (97)200822T/Bmax ratio > 2.06†Overall survival1.460.0002
    18F-FMISOHead and neck cancer, III–IVRischin et al. (99)‡200645Qualitative scoringLocoregional failure (with different treatment regimens)
    11C-MET§Malignant glioma, II–IVGalldiks et al. (104)200615Decrease in % uptakeTTPNR0.01
    18F-FESBreast cancerDehdashti et al. (140)200841Pretherapy SUV ≥ 2Overall survivalNRNS
    18F-FESBreast cancerDehdashti et al. (144)199911% decrease in SUV*Clinical responseNR0.008
    18F-FESBreast cancerMcGuire et al. (141)199116NRClinical responseNRNR
    18F-FESBreast cancerMortimer et al. (143)200140Pretherapy SUV*and % decrease in SUV*Clinical responseNR for both criteria0.0007 for pretherapy SUV and 0.0003 for % decrease in SUV
    18F-FESBreast cancerMortimer et al. (145)199643Pretherapy SUV ≥ 1.0Clinical responseNRNS
    18F-FESBreast cancerLinden et al. (142)200647SUV ≥ 1.5Tumor response (modified RECIST)NR0.01

    • ↵* No prospective SUV threshold was used; retrospective statistical correlations were derived.

    • ↵† T/B ratio of ≥1.2 indicated severe hypoxia.

    • ↵‡ See Rischin et al. (99) for hazard ratio and P value data; multiple treatment regimens were used.

    • ↵§ See also Table 2 in article by Singhal et al. (103).

    • NR = not reported; NS = not statistically significant.

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