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Therapy Monitoring by Assessment of Tumor Metabolism
Time course of FDG uptake
during chemotherapy
• High grade non-Hodgkin lymphoma during
CHOP therapy
• Model for a tumor that responds well to
chemotherapy
• FDG-PET in 11 patients on days 0, 7, and 42
of therapy
• Calculation of FDG-uptake (SUV) and
metabolic rates (Patlak approach)
Therapy Monitoring by Assessment of Tumor Metabolism
Time course of therapy induced
changes during CHOP therapy
coronal
14
Day
Day
Day7042
12
10
axial
8
6
4
2
0
day 0
Non-Hodgkin lymphoma
day 7
day 42
Römer et al.
Blood 91:4464-71 (1998)
Quantitative assessment of glucose
metabolism during CHOP therapy
20
SUV [avg]
SUV [avg-gl]
influx constant K
18
16
N = 11
14
12
10
8
6
4
2
0
baseline day 7
day 42
Römer et al. Blood 1998
baseline day 7
day 42 baseline day 7
day 42
Treatment monitoring with FDGPET in esophageal cancer
Applications
• Assessment of tumor viability
after completion of therapy
• Prediction of treatment
response early in the course of
therapy
FDG-PET in esophageal cancer
Reduction of FDG-uptake after chemoradiotherapy and
histopathologic response
reduction of FDG uptake (%)
p = 0.002
0
-20
n = 13
-40
-60
n = 11
-80
< 10% viable
tumor cells
> 10% viable
tumor cells
Brücher, Weber et al. Ann Surg 2001
Prediction of response to chemotherapy
in patients with esophageal cancer by
FDG-PET
40%
reduction of FDG-uptake
N = 15
20%
p < 0.001
0
N = 27
-20%
-40%
-60%
-80%
-100%
non-responding
tumors
responding
tumors
Prediction of response to chemotherapy
in patients with esophageal cancer
survival without progression or
recurrence
100%
p = 0.01
80%
> 35% reduction of FDG uptake
(N = 15)
60%
40%
 35% reduction of FDG uptake
(N = 27)
20%
0%
0
10
20
30
40
50
60
months after initiation of chemotherapy
Weber, Ott et al. J Clin Oncol 2001
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