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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